Development of a Multivariate Prediction Model for Successful Oswestry Disability Index Changes in L5/S1 Anterior Lumbar Interbody Fusion for Degenerative Disc Disease
| Autor: | Gideon R. Budiono, Matthew H. Pelletier, Ralph J. Mobbs, Telvinderjit Singh, William C. H. Parr, Miles H. McCaffrey, Wen Jie Choy |
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| Rok vydání: | 2020 |
| Předmět: |
Adult
Male medicine.medical_specialty Multivariate statistics Sacrum Intervertebral Disc Degeneration Logistic regression Degenerative disc disease Cohort Studies 03 medical and health sciences 0302 clinical medicine Predictive Value of Tests Back pain Medicine Humans Disabled Persons Aged Retrospective Studies Lumbar Vertebrae business.industry Retrospective cohort study Odds ratio Middle Aged medicine.disease Confidence interval Surgery Oswestry Disability Index Spinal Fusion Treatment Outcome 030220 oncology & carcinogenesis Multivariate Analysis Female Neurology (clinical) medicine.symptom business 030217 neurology & neurosurgery |
| Zdroj: | World neurosurgery. 148 |
| ISSN: | 1878-8769 |
| Popis: | Objective Lower back pain associated with degenerative disc disease (DDD) is a leading cause of disability worldwide. Anterior lumbar interbody fusion (ALIF) has been shown to be effective for treating refractory DDD, but it remains unclear which patients may benefit most from the procedure. This study aims to develop a predictive model for clinical success in L5/S1 ALIF for DDD. Methods A retrospective cohort study of 68 patients with refractory DDD who underwent L5/S1 ALIF was performed. Clinical success was defined as an improvement in Oswestry Disability Index (ODI) of 20 points postoperatively. Exploratory analyses were performed on 16 preoperative clinical and radiographic parameters, followed by a multivariate logistic regression. Evaluation of the predictive model was performed. Results After exploratory analyses, 4 parameters were suitable for inclusion in the multivariate model. Workers' compensation status (odds ratio [OR], 0.02; 95% confidence interval [CI], 0.001–0.262; P = 0.004) and preoperative ODI (OR, 1.13; 95% CI, 1.05–1.23; P = 0.002) were statistically significant parameters. Furthermore, posterior disc height and disc depth contributed significantly to the model variance (OR, 0.69, 95% CI, 0.44–1.09 and OR, 0.97, 95% CI, 0.81–1.15, respectively). The model had a sensitivity of 81.5%, specificity of 83.3%, C-statistic of 0.921, and a calibration plot similar to the 45° reference line. Conclusions This analysis confirms workers' compensation and low preoperative ODI as risk factors for successful L5/S1 ALIF performed for DDD. It also identifies novel prognostic factors, namely posterior disc height and disc depth. This model can aid in patient counseling and selection in the management of L5/S1 DDD. |
| Databáze: | OpenAIRE |
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