Li Lei, Wang Chao, Zhang Hao, Lin Antao, Qu Changpeng, Sun Yihao, Tao Hao, Ma Xuexiao
The Affiliated Hospital of Qingdao University, Qingdao, People's Republic of China.
J Pain Res. 2024 Dec 17;17:4301-4313. doi: 10.2147/JPR.S475650. eCollection 2024.
This study examines the occurrence of Modic changes (MC) within the first year following percutaneous endoscopic transforaminal lumbar discectomy (PETD) and investigates associated risk factors.
This study adopted a retrospective cohort design. Between January 2019 and June 2023, 538 patients diagnosed with single-level lumbar disc herniation and treated with PETD were included. The patients were divided into a training set and a validation set based on their surgery dates. Preoperative radiographic parameters and perioperative indicators were evaluated. Univariate analysis examined risk factors for postoperative MC. Gender-specific subgroups were analyzed. Binary logistic regression developed a predictive model for postoperative MC, assessed using ROC, calibration, and decision curves.
The incidence of MC at one year after PETD was 24.8%. Logistic regression identified 8 significant risk factors for MC after PELD: longer symptom duration, proximity of herniated segment to sacrum, severe disc degeneration, reduced disc height, greater vertebral endplate concavity angle, segmental instability, and lumbar-sacral fusion. Menopause and herniation type were identified as female-specific risk factors. In males, total cholesterol levels were additionally found to be a risk factor for postoperative MC. The male and female subgroup models exhibited satisfactory performance across ROC analysis, calibration plots, and decision curve analysis. Specifically, for male patients, the area under the curve (AUC) was 0.831 for the training set and 0.820 for the validation set; for female patients, the AUC was 0.911 for the training set and 0.868 for the validation set. A nomogram was developed to visualize the model.
This study explored the relevant risk factors of MC after PETD and visualized the prediction model by nomogram, which is beneficial to optimize the surgical scheme of PETD to improve the clinical efficacy.
本研究探讨经皮内镜下椎间孔腰椎间盘切除术（PETD）后第一年内Modic改变（MC）的发生情况，并调查相关危险因素。
本研究采用回顾性队列设计。纳入2019年1月至2023年6月间538例诊断为单节段腰椎间盘突出症并接受PETD治疗的患者。根据手术日期将患者分为训练集和验证集。评估术前影像学参数和围手术期指标。单因素分析检测术后MC的危险因素。对按性别划分的亚组进行分析。二元逻辑回归建立术后MC的预测模型，并通过ROC、校准和决策曲线进行评估。
PETD术后一年MC的发生率为24.8%。逻辑回归确定了PELD术后MC的8个显著危险因素：症状持续时间较长、突出节段靠近骶骨、严重椎间盘退变、椎间盘高度降低、椎体终板凹角增大、节段性不稳定和腰骶融合。绝经和突出类型被确定为女性特有的危险因素。在男性中，还发现总胆固醇水平是术后MC的危险因素。男性和女性亚组模型在ROC分析、校准图和决策曲线分析中均表现出令人满意的性能。具体而言，对于男性患者，训练集的曲线下面积（AUC）为0.831，验证集为0.820；对于女性患者，训练集的AUC为0.911，验证集为0.868。绘制了列线图以直观显示该模型。
本研究探讨了PETD术后MC的相关危险因素，并通过列线图直观显示预测模型，这有助于优化PETD手术方案以提高临床疗效。
