A clinical nomogram for predicting the residual low back pain after percutaneous endoscopic surgery for lumbar disc herniation

作者全名："Zhong, Dian; Ke, Zhen-yong; Chen, Qiu; Liu, Yang; Lin, Lu; Wang, Yang"

作者地址："[Zhong, Dian; Ke, Zhen-yong; Liu, Yang; Lin, Lu; Wang, Yang] Chongqing Med Univ, Dept Orthoped Surg, Affiliated Hosp 2, Chongqing, Peoples R China; [Chen, Qiu] Chongqing Med Univ, Sch Publ Hlth & Management, Chongqing, Peoples R China"

通信作者："Wang, Y (通讯作者)，Chongqing Med Univ, Dept Orthoped Surg, Affiliated Hosp 2, Chongqing, Peoples R China."

来源：INTERNATIONAL ORTHOPAEDICS

ESI学科分类：CLINICAL MEDICINE

WOS号：WOS:000901959400002

JCR分区：Q2

影响因子：2

年份：2023

卷号：47

期号：3

开始页：819

结束页：830

文献类型：Article

关键词：Low back pain; Percutaneous endoscopic lumbar discectomy; Minimally invasive spine surgery; Risk factors; Nomogram

摘要："Purpose Current findings suggest that minimally percutaneous endoscopic lumbar discectomy (PELD) is a practical therapeutic approach for lumbar disc herniation (LDH). However, some patients still end up with residual low back pain, even after surgery. Our study aims to construct and validate a nomogram to predict residual low back pain after PELD.Methods The medical records of 355 LDH patients admitted to the author's hospital were retrospectively analyzed between January 2019 and December 2021. The patients were randomly divided into two groups with a ratio of 7:3, namely a modelling group and a validation group. The univariable logistics and multivariable regression methods were used to screen the independent risk factors. A nomogram was then drawn using independent risk factors selected from the univariable and multivariable regression analyses. The concordance index (C-index), the receiver operating characteristic (ROC) curve, the calibration curve, and the decision curve analysis were used to evaluate the nomogram's performance. Finally, the accuracy of the nomogram was verified by a validation cohort.Results 36.6% (130/355) of patients showed low back pain after percutaneous endoscopic lumbar discectomy, while 63.4% (225/355) showed no symptoms. Multivariable logistical regression analysis showed that Modic change (p < 0.05, OR = 1.813), fatty infiltration of the paravertebral muscle (p < 0.05, OR = 2.935), and edema of lumbodorsal fascia (p = 0.049, OR =1.611) were significant risk factors for post-operative residual back pain. Moreover, the C-index of the predictive nomogram was 0.743 (0.681-0.805), the area under the receiver operating characteristic curve (AUC) value was 0.739, and the DCA results exhibit a net benefit between 0.16 and 0.66. The above internal validation methods demonstrate the nomogram's good predictive capability.Conclusion Each variable in the model had a quantitatively corresponding risk score, which can be used in predicting residual low back pain after PELD."

基金机构："Teaching reform project of The association of Higher Education of Chongqing [CQGJ19B13]; Teaching reform project of Chongqing Municipal Education Commission [203387]; Program for Youth Innovation in Future Medicine, Chongqing Medical University [W0021]; Teaching reform project of Chongqing Medical University [JY190305]"

基金资助正文："This work was supported by the Teaching reform project of The association of Higher Education of Chongqing (CQGJ19B13); Teaching reform project of Chongqing Municipal Education Commission (203387); Program for Youth Innovation in Future Medicine, Chongqing Medical University (W0021); and Teaching reform project of Chongqing Medical University (JY190305)"