FUSE-ML: development and external validation of a clinical prediction model for mid-term outcomes after lumbar spinal fusion for degenerative disease.

Autor: Staartjes VE; Machine Intelligence in Clinical Neuroscience (MICN) Laboratory, Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland. victoregon.staartjes@usz.ch.; Amsterdam UMC, Neurosurgery, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands. victoregon.staartjes@usz.ch.; Department of Neurosurgery, Bergman Clinics Amsterdam, Amsterdam, The Netherlands. victoregon.staartjes@usz.ch., Stumpo V; Machine Intelligence in Clinical Neuroscience (MICN) Laboratory, Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland., Ricciardi L; Department of NESMOS, Azienda Ospedaliera Universitaria Sant'Andrea, Sapienza University, Rome, Italy., Maldaner N; Machine Intelligence in Clinical Neuroscience (MICN) Laboratory, Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland., Eversdijk HAJ; Department of Neurosurgery, Bergman Clinics Amsterdam, Amsterdam, The Netherlands., Vieli M; Machine Intelligence in Clinical Neuroscience (MICN) Laboratory, Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland., Ciobanu-Caraus O; Machine Intelligence in Clinical Neuroscience (MICN) Laboratory, Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland., Raco A; Department of NESMOS, Azienda Ospedaliera Universitaria Sant'Andrea, Sapienza University, Rome, Italy., Miscusi M; Department of NESMOS, Azienda Ospedaliera Universitaria Sant'Andrea, Sapienza University, Rome, Italy., Perna A; Department of Aging, Neurological, Orthopedic and Head-Neck Sciences, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy.; Department of Geriatrics and Orthopedics, Sacred Heart Catholic University, Rome, Italy., Proietti L; Department of Aging, Neurological, Orthopedic and Head-Neck Sciences, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy.; Department of Geriatrics and Orthopedics, Sacred Heart Catholic University, Rome, Italy., Lofrese G; Neurosurgery Division, Department of Neurosciences, 'M.Bufalini' Hospital, Cesena, Italy., Dughiero M; Neurosurgery Division, Department of Neurosciences, 'M.Bufalini' Hospital, Cesena, Italy., Cultrera F; Neurosurgery Division, Department of Neurosciences, 'M.Bufalini' Hospital, Cesena, Italy., Nicassio N; Neurosurgery Division, Department of Neurosciences, 'M.Bufalini' Hospital, Cesena, Italy., An SB; Department of Neurosurgery, Spine and Spinal Cord Institute, Severance Hospital, College of Medicine, Yonsei University, Seoul, Korea., Ha Y; Department of Neurosurgery, Spine and Spinal Cord Institute, Severance Hospital, College of Medicine, Yonsei University, Seoul, Korea., Amelot A; Department of Neurosurgery, La Pitié Salpétrière Hospital, Paris, France.; Neurosurgical Spine Department, University Hospital of Tours, Tours, France., Alcobendas I; Department of Neurosurgery, Hospital Universitario La Paz, Madrid, Spain., Viñuela-Prieto JM; Department of Neurosurgery, Hospital Universitario La Paz, Madrid, Spain., Gandía-González ML; Department of Neurosurgery, Hospital Universitario La Paz, Madrid, Spain., Girod PP; Department of Neurosurgery, Medical University of Innsbruck, Innsbruck, Austria., Lener S; Department of Neurosurgery, Medical University of Innsbruck, Innsbruck, Austria., Kögl N; Department of Neurosurgery, Medical University of Innsbruck, Innsbruck, Austria., Abramovic A; Department of Neurosurgery, Medical University of Innsbruck, Innsbruck, Austria., Safa NA; University Spine Center, Balgrist University Hospital, University of Zurich, Zurich, Switzerland., Laux CJ; University Spine Center, Balgrist University Hospital, University of Zurich, Zurich, Switzerland., Farshad M; University Spine Center, Balgrist University Hospital, University of Zurich, Zurich, Switzerland., O'Riordan D; Department of Teaching, Research and Development, Spine Center Division, Schulthess Klinik, Zurich, Switzerland., Loibl M; Department of Spine Surgery, Schulthess Klinik, Zurich, Switzerland., Mannion AF; Department of Teaching, Research and Development, Spine Center Division, Schulthess Klinik, Zurich, Switzerland., Scerrati A; Department of Neurosurgery, Policlinico Universitario di Ferrara, Ferrara, Italy., Molliqaj G; Department of Neurosurgery, HUG Geneva University Hospital, Geneva, Switzerland., Tessitore E; Department of Neurosurgery, HUG Geneva University Hospital, Geneva, Switzerland., Schröder ML; Department of Neurosurgery, Bergman Clinics Amsterdam, Amsterdam, The Netherlands., Vandertop WP; Amsterdam UMC, Neurosurgery, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands., Stienen MN; Department of Neurosurgery, Cantonal Hospital St. Gallen, St. Gallen, Switzerland., Regli L; Machine Intelligence in Clinical Neuroscience (MICN) Laboratory, Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland., Serra C; Machine Intelligence in Clinical Neuroscience (MICN) Laboratory, Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland.
Jazyk: angličtina
Zdroj: European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society [Eur Spine J] 2022 Oct; Vol. 31 (10), pp. 2629-2638. Date of Electronic Publication: 2022 Feb 21.
DOI: 10.1007/s00586-022-07135-9
Abstrakt: Background: Indications and outcomes in lumbar spinal fusion for degenerative disease are notoriously heterogenous. Selected subsets of patients show remarkable benefit. However, their objective identification is often difficult. Decision-making may be improved with reliable prediction of long-term outcomes for each individual patient, improving patient selection and avoiding ineffective procedures.
Methods: Clinical prediction models for long-term functional impairment [Oswestry Disability Index (ODI) or Core Outcome Measures Index (COMI)], back pain, and leg pain after lumbar fusion for degenerative disease were developed. Achievement of the minimum clinically important difference at 12 months postoperatively was defined as a reduction from baseline of at least 15 points for ODI, 2.2 points for COMI, or 2 points for pain severity.
Results: Models were developed and integrated into a web-app ( https://neurosurgery.shinyapps.io/fuseml/ ) based on a multinational cohort [N = 817; 42.7% male; mean (SD) age: 61.19 (12.36) years]. At external validation [N = 298; 35.6% male; mean (SD) age: 59.73 (12.64) years], areas under the curves for functional impairment [0.67, 95% confidence interval (CI): 0.59-0.74], back pain (0.72, 95%CI: 0.64-0.79), and leg pain (0.64, 95%CI: 0.54-0.73) demonstrated moderate ability to identify patients who are likely to benefit from surgery. Models demonstrated fair calibration of the predicted probabilities.
Conclusions: Outcomes after lumbar spinal fusion for degenerative disease remain difficult to predict. Although assistive clinical prediction models can help in quantifying potential benefits of surgery and the externally validated FUSE-ML tool may aid in individualized risk-benefit estimation, truly impacting clinical practice in the era of "personalized medicine" necessitates more robust tools in this patient population.
(© 2022. The Author(s).)
Databáze: MEDLINE
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