1Department of Neurosurgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania; and.
2Division of Neurosurgery, Department of Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
J Neurosurg Pediatr. 2024 Mar 1;33(5):405-410. doi: 10.3171/2023.11.PEDS23278. Print 2024 May 1.
Among patients with a history of prior lipomyelomeningocele repair, an association between increased lumbosacral angle (LSA) and cord retethering has been described. The authors sought to build a predictive algorithm to determine which complex tethered cord patients will develop the symptoms of spinal cord retethering after initial surgical repair with a focus on spinopelvic parameters.
An electronic medical record database was reviewed to identify patients with complex tethered cord (e.g., lipomyelomeningocele, lipomyeloschisis, myelocystocele) who underwent detethering before 12 months of age between January 1, 2008, and June 30, 2022. Descriptive statistics were used to characterize the patient population. The Caret package in R was used to develop a machine learning model that predicted symptom development by using spinopelvic parameters.
A total of 72 patients were identified (28/72 [38.9%] were male). The most commonly observed dysraphism was lipomyelomeningocele (41/72 [56.9%]). The mean ± SD age at index MRI was 2.1 ± 2.2 months, at which time 87.5% of patients (63/72) were asymptomatic. The mean ± SD lumbar lordosis at the time of index MRI was 23.8° ± 11.1°, LSA was 36.5° ± 12.3°, sacral inclination was 30.4° ± 11.3°, and sacral slope was 23.0° ± 10.5°. Overall, 39.6% (25/63) of previously asymptomatic patients developed new symptoms during the mean ± SD follow-up period of 44.9 ± 47.2 months. In the recursive partitioning model, patients whose LSA increased at a rate ≥ 5.84°/year remained asymptomatic, whereas those with slower rates of LSA change experienced neurological decline (sensitivity 77.5%, specificity 84.9%, positive predictive value 88.9%, and negative predictive value 70.9%).
This is the first study to build a machine learning algorithm to predict symptom development of spinal cord retethering after initial surgical repair. The authors found that, after initial surgery, patients who demonstrate a slower rate of LSA change per year may be at risk of developing neurological symptoms.
在有既往脂肪脊膜膨出修复史的患者中，已描述了腰骶角（LSA）增加与脊髓再栓系之间的关联。作者试图构建一个预测算法，以确定哪些复杂的脊髓栓系患者在最初的手术修复后会出现脊髓再栓系的症状，重点关注脊柱骨盆参数。
回顾电子病历数据库，以确定 2008 年 1 月 1 日至 2022 年 6 月 30 日期间在 12 个月龄之前接受过松解术的复杂脊髓栓系（例如脂肪脊膜膨出、脂肪脊髓裂、脊髓脊膜膨出）患者。使用描述性统计来描述患者人群。使用 R 中的 Caret 包开发了一个机器学习模型，该模型通过脊柱骨盆参数预测症状的发展。
共确定了 72 例患者（28/72 [38.9%]为男性）。最常见的畸形是脂肪脊膜膨出（41/72 [56.9%]）。指数 MRI 时的平均年龄±标准差为 2.1±2.2 个月，87.5%（63/72）的患者无症状。指数 MRI 时的平均±标准差腰椎前凸为 23.8°±11.1°，LSA 为 36.5°±12.3°，骶骨倾斜度为 30.4°±11.3°，骶骨斜率为 23.0°±10.5°。总体而言，63 例先前无症状患者中有 39.6%（25/63）在平均±标准差随访 44.9±47.2 个月期间出现新症状。在递归分区模型中，LSA 增加率≥5.84°/年的患者保持无症状，而 LSA 变化率较慢的患者则出现神经功能下降（敏感性 77.5%，特异性 84.9%，阳性预测值 88.9%，阴性预测值 70.9%）。
这是第一项构建机器学习算法以预测初始手术修复后脊髓再栓系症状发展的研究。作者发现，初次手术后，LSA 每年变化率较慢的患者可能有出现神经症状的风险。
