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Zileli M, Oertel J, Sharif S, Zygourakis C. Lumbar disc herniation: Prevention and treatment of recurrence: WFNS spine committee recommendations. World Neurosurg X 2024; 22:100275. [PMID: 38385057 PMCID: PMC10878111 DOI: 10.1016/j.wnsx.2024.100275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 02/01/2024] [Indexed: 02/23/2024] Open
Abstract
Objective This review aims to formulate the most current evidence-based recommendations on the epidemiology, prevention, and treatment of recurrent lumbar disc herniation (LDH). Methods We performed a systematic literature search in PubMed, Medline, and Google Scholar databases from 2012 to 2022 using the keywords "lumbar disc recurrence." Screening criteria resulted in 57 papers, which were summarized and presented at two international consensus meetings of the World Federation of Neurosurgical Societies (WFNS) Spine Committee. The 57 papers covered the following topics: (1) Definition and incidence of recurrence after lumbar disc surgery; (2) Prediction of recurrence before primary surgery; (3) Prevention of recurrence by surgical measures; (4) Prevention of recurrence by postoperative measures; (5) Treatment options for recurrent disc herniation; (6) The outcomes of recurrent disc herniation surgery. We utilized the Delphi method and voted on eight final consensus statements. Results and conclusion Recurrence after disc herniation surgery may be considered a surgical complication, its incidence is approximately 5% and is different from overall re-operation incidence. There are multiple risk factors predicting LDH recurrence, including smoking, younger age, male gender, obesity, diabetes, disc degeneration, and presence of lumbosacral transitional vertebrae. The level of lumbar discectomy surgery and the amount of disc material removed do not correlate with recurrence rate. Minimally invasive discectomies may have higher recurrence rates, especially during the surgeon's learning period. However, the experience of the surgeon is not related to recurrence. High-quality studies are needed to determine if activity restriction, weight loss, smoking cessation, and muscle-strengthening exercises after primary surgery can help prevent recurrence of LDH.The best treatment option for recurrent disc herniation is still being discussed. While complications of minimally invasive techniques may be lower than open discectomy, outcomes are similar. Fusion should only be considered when spinal instability and/or spinal deformity are present. Clinical outcomes and patient satisfaction after recurrent disc herniation surgery are inferior to those after initial discectomy.
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Affiliation(s)
- Mehmet Zileli
- Department of Neurosurgery, Sanko University Faculty of Medicine, Gaziantep, Turkey
| | - Joachim Oertel
- Department of Neurosurgery, Saarland University Medical Centre, Homburg, Germany
| | - Salman Sharif
- Department of Neurosurgery, Liaqat Medical School, Karachi, Pakistan
| | - Corinna Zygourakis
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA
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Pan YH, Wan D, Wang Q, Shen WJ, Yang JR, Wang ZY, Cai ZL, Jiang S, Cao M. Association of spinal-pelvic parameters with recurrence of lumbar disc herniation after endoscopic surgery: a retrospective case-control study. 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 2024; 33:444-452. [PMID: 38236278 DOI: 10.1007/s00586-023-08073-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 10/27/2023] [Accepted: 11/29/2023] [Indexed: 01/19/2024]
Abstract
PURPOSE This study aimed to investigate the relationship between spinal-pelvic parameters and recurrence of lumbar disc herniation (rLDH) after percutaneous endoscopic lumbar discectomy (PELD) through a retrospective case-control study. METHODS Patients who underwent PELD for single-segment LDH at our hospital were included in this study. The relationship between sagittal balance parameters of the spine and recurrence was analysed through correlation analysis, and ROC curves were plotted. The baseline characteristics, sagittal balance parameters of the spine and radiological parameters of the case and control groups were compared, and the relationship between sagittal balance parameters of the spine and recurrence of rLDH after PELD was determined through univariate and multivariate logistic regression analysis. RESULTS Correlation analysis showed that PI and ∆PI-LL were negatively correlated with grouping (r = -0.090 and -0.120, respectively, P = 0.001 and 0.038). ROC curve analysis showed that the area under the curve (ROC-AUC) for predicting rLDH based on PI was 0.65 (CI95% = 0.598, 0.720), with a cut-off of 50.26°. The ROC-AUC for predicting rLDH based on ∆PI-LL was 0.56 (CI95% = 0.503, 0.634), with a cut-off of 28.21°. Multivariate logistic regression analysis showed that smoking status (OR = 2.667, P = 0.008), PI ≤ 50.26 (OR = 2.161, P = 0.009), ∆PI-LL ≤ 28.21 (OR = 3.185, P = 0.001) and presence of Modic changes (OR = 4.218, P = 0.001) were independent risk factors, while high DH (OR = 0.788, P = 0.001) was a protective factor. CONCLUSION PI < 50.26 and ∆PI-LL < 28.21 were risk factors for recurrence of lumbar disc herniation after spinal endoscopic surgery and had some predictive value for post-operative recurrence.
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Affiliation(s)
- Yu-Hao Pan
- Spinal Surgery Department, Sichuan Orthopaedic Hospital, Chengdu, Sichuan, China
| | - Dun Wan
- Spinal Surgery Department, Sichuan Orthopaedic Hospital, Chengdu, Sichuan, China.
| | - Qi Wang
- Chengdu Sport University, Chengdu, Sichuan, China
| | - Wen-Jun Shen
- Chengdu Sport University, Chengdu, Sichuan, China
| | - Jin-Rui Yang
- Chengdu Sport University, Chengdu, Sichuan, China
| | | | - Zong-Lin Cai
- Spinal Surgery Department, Sichuan Orthopaedic Hospital, Chengdu, Sichuan, China
| | - Shui Jiang
- Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Min Cao
- Spinal Surgery Department, Sichuan Orthopaedic Hospital, Chengdu, Sichuan, China
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Kim D, Kim SJ, Lee YJ, Yang CS, Han CH, Ha IH. Are Primary Outcomes Really Primary? An Exploratory Cross-Sectional Nationwide Web-Based Survey Study for Outcomes Reflecting Real Symptoms and Needs of Patients with Lumbar Disc Herniation. Healthcare (Basel) 2023; 11:2598. [PMID: 37761795 PMCID: PMC10531434 DOI: 10.3390/healthcare11182598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 09/11/2023] [Accepted: 09/18/2023] [Indexed: 09/29/2023] Open
Abstract
As primary outcomes differ among clinical lumbar disc herniation (LDH) studies, this study aimed to explore outcomes reflecting real-world patient experiences through an exploratory questionnaire survey. Those diagnosed with LDH having radiating leg pain in South Korea in November of 2022 (N = 500) were administered a questionnaire including basic characteristics, disease onset, symptoms and severity, priority symptoms for improvement, and important treatment factors. Outcome measures included the identification of priority symptoms and disabilities. Most common symptoms were numbness in the leg (N = 435, 87.0%) and back pain (N = 406, 81.2%); most common disabilities were discomfort in sitting (N = 323, 64.6%) and lifting (N = 318, 63.6%). The highest priority symptom was back pain (N = 242, 48.4%). A satisfactory degree of symptom improvement was a decrease of at least 3 points on the numeric rating scale. The majority of respondents preferred improvement in disability over pain (N = 270, 55.8%), a stable effect over a rapid effect (N = 391, 78.2%), and safety over treatment efficacy (N = 282, 56.4%). Safety (N = 129, 25.8%) and cost (N = 111, 22.2%) were the most important treatment factors. Improvements in back pain, leg pain, sitting, and sleeping were prioritized, and safety, stable treatment effect, and functional recovery were desired. Clinical trials for LDH should be designed to reflect this real-world patient need. Further study to examine the patients' symptoms and needs in details is needed.
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Affiliation(s)
- Doori Kim
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, 540 Gangnam-daero, Gangnam-gu, Seoul 06110, Republic of Korea; (D.K.); (S.-J.K.); (Y.J.L.)
| | - Soo-Jin Kim
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, 540 Gangnam-daero, Gangnam-gu, Seoul 06110, Republic of Korea; (D.K.); (S.-J.K.); (Y.J.L.)
| | - Yoon Jae Lee
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, 540 Gangnam-daero, Gangnam-gu, Seoul 06110, Republic of Korea; (D.K.); (S.-J.K.); (Y.J.L.)
| | - Chang Sop Yang
- Clinical Medicine Division, Korea Institute of Oriental Medicine, 1672 Yuseong-daero, Yuseong-gu, Daejeon 34054, Republic of Korea;
| | - Chang-Hyun Han
- Korean Convergence Medical Science, School of Korea Institute of Oriental Medicine, University of Science & Technology (UST), 1672 Yuseong-daero, Yuseong-gu, Daejeon 34054, Republic of Korea
- KM Science Research Division, Korea Institute of Oriental Medicine, 1672 Yuseong-daero, Yuseong-gu, Daejeon 34054, Republic of Korea
| | - In-Hyuk Ha
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, 540 Gangnam-daero, Gangnam-gu, Seoul 06110, Republic of Korea; (D.K.); (S.-J.K.); (Y.J.L.)
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Baranowska-Kijewska J, Baranowski P, Baranowska A, Jarzyński T, Rybarczyk M. Reoperation rate after fusion and non-fusion surgery for degenerative lumbar spine disease. Arch Med Sci 2023; 19:1154-1161. [PMID: 37560744 PMCID: PMC10408031 DOI: 10.5114/aoms/165859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 05/02/2023] [Indexed: 08/11/2023] Open
Abstract
INTRODUCTION The number of reoperations increases with the growing number of operations performed. METHODS The clinical material included a group of 2194 patients treated surgically due to degenerative disease of the lumbar spine; we selected a total of 332 patients who were reoperated, and the indications for reoperation were analysed. RESULTS The percentage of patients operated due to adjacent segment disease in the group of patients with stabilization was on average 8.9%. CONCLUSIONS Indications for stabilizing or preservation of the mobility of the operated segment should provide for the nature of the lesions, and anatomical and surgical conditions.
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Affiliation(s)
| | - Paweł Baranowski
- Department of Neuro-orthopaedics, Mazovian Rehabilitation Centre STOCER, Konstancin-Jeziorna, Poland
- Faculty of Medicine, Lazarski University, Warsaw, Poland
| | - Alicja Baranowska
- Department of Neuro-orthopaedics, Mazovian Rehabilitation Centre STOCER, Konstancin-Jeziorna, Poland
- Faculty of Medicine, Lazarski University, Warsaw, Poland
| | - Tobiasz Jarzyński
- Department of Neuro-orthopaedics, Mazovian Rehabilitation Centre STOCER, Konstancin-Jeziorna, Poland
- Department of Descriptive and Clinical Anatomy, the Medical University of Warsaw, Warsaw, Poland
| | - Marek Rybarczyk
- Department of Neuro-orthopaedics, Mazovian Rehabilitation Centre STOCER, Konstancin-Jeziorna, Poland
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Zhu F, Jia D, Zhang Y, Ning Y, Leng X, Feng C, Li C, Zhou Y, Huang B. Moderate to Severe Multifidus Fatty Atrophy is the Risk Factor for Recurrence After Microdiscectomy of Lumbar Disc Herniation. Neurospine 2023; 20:637-650. [PMID: 37401083 PMCID: PMC10323347 DOI: 10.14245/ns.2346054.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 04/30/2023] [Accepted: 05/11/2023] [Indexed: 07/05/2023] Open
Abstract
OBJECTIVE We attempted to investigate the potential risk factors of recurrent lumbar disc herniation (rLDH) after tubular microdiscectomy. METHODS We retrospectively analyzed the data of patients who underwent tubular microdiscectomy. The clinical and radiological factors were compared between the patients with and without rLDH. RESULTS This study included 350 patients with lumbar disc herniation (LDH) who underwent tubular microdiscectomy. The overall recurrence rate was 5.7% (20 of 350). The visual analogue scale (VAS) score and Oswestry Disability Index (ODI) at the final follow-up significantly improved compared with those preoperatively. There was no significant difference in the preoperative VAS score and ODI between the rLDH and non-rLDH groups, while the leg pain VAS score and ODI of the rLDH group were significantly higher than those of the non-rLDH group at final follow-up. This suggested that rLDH patients had a worse prognosis than non-rLDH patients even after reoperation. There were no significant differences in sex, age, body mass index, diabetes, current smoking and drinking, disc height index, sagittal range of motion, facet orientation, facet tropism, Pfirrmann grade, Modic changes, interdisc kyphosis, and large LDH between the 2 groups. Univariate logistic regression analysis revealed that rLDH was associated with hypertension, multilevel microdiscectomy, and moderate-severe multifidus fatty atrophy (MFA). A multivariate logistic regression analysis indicated that MFA was the sole and strongest risk factor for rLDH after tubular microdiscectomy. CONCLUSION Moderate-severe MFA was a risk factor for rLDH after tubular microdiscectomy, which can serve as an important reference for surgeons in formulating surgical strategies and the assessment of prognosis.
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Affiliation(s)
- Fengzhao Zhu
- Department of Orthopedics, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Dongqing Jia
- Department of Blood Transfusion, University-Town Hospital of Chongqing Medical University, Chongqing, China
| | - Yaqing Zhang
- Department of Orthopedics, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Ya Ning
- Department of Orthopedics, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Xue Leng
- Department of Orthopedics, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Chencheng Feng
- Department of Orthopedics, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Changqing Li
- Department of Orthopedics, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Yue Zhou
- Department of Orthopedics, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Bo Huang
- Department of Orthopedics, Xinqiao Hospital, Army Medical University, Chongqing, China
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Yang J, Liu R, Miao Y, Nian L, Meng X. Risk Factors for Recurrence After Percutaneous Endoscopic Lumbar Discectomy: A Meta-Analysis. World Neurosurg 2023; 172:88-93. [PMID: 36764451 DOI: 10.1016/j.wneu.2023.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 02/02/2023] [Indexed: 02/11/2023]
Abstract
OBJECTIVE Postoperative recurrence of percutaneous endoscopic lumbar disc increases the physical damage and financial burden on patients and negatively affects physicians' treatment decisions. We conducted this meta-analysis to explore the risk factors for postoperative recurrence of percutaneous endoscopic lumbar disc for lumbar disc herniation. METHODS We conducted article search in the PubMed, EMBASE and Cochrane Library databases. PRISMA guidelines were followed in this review. The data are statistically analyzed by the Roundup Manager (version 3.6.1). The results of the meta-analysis are presented in the form of forest-like plots. RESULTS We included 13 articles and identified 7524 cases. Patients with older age (odds ratio [OR] = 1.28, 95% confidence interval [CI]: 1.18-1.40), higher body mass index (OR = 1.16, 95% CI: 1.05-1.28), smoker (OR = 1.73, 95% CI: 0.95-3.15), degenerative grades ≥3 (OR = 6.07, 95% CI: 2.81-13.11), and postoperative sagittal motion ≥10° (OR = 2.42, 95% CI: 1.63-3.58) have a higher recurrence rate. CONCLUSIONS A thorough preoperative evaluation is essential to prevent postoperative recurrence of percutaneous endoscopic lumbar discectomy. The study addresses several factors of preoperative evaluation, which is hopeful to provide a reference for neurosurgeons.
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Affiliation(s)
- Jiameng Yang
- Department of Orthopedics, Affiliated Hospital of Inner Mongolia Medical University, Inner Mongolia, China
| | - Rui Liu
- Department of Orthopedics, Affiliated Hospital of Inner Mongolia Medical University, Inner Mongolia, China.
| | - Yu Miao
- Department of Ultrasound, The Third Hospital of BaoGang Group, Baotou City, Inner Mongolia, China
| | - Liwei Nian
- Department of Orthopedics, Affiliated Hospital of Inner Mongolia Medical University, Inner Mongolia, China
| | - Xiaotao Meng
- Department of Ultrasound, The Third Hospital of BaoGang Group, Baotou City, Inner Mongolia, China
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Hussain I, Hofstetter CP, Wang MY. Innovations in Spinal Endoscopy. World Neurosurg 2022; 160:138-148. [PMID: 35364672 DOI: 10.1016/j.wneu.2021.11.099] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 11/22/2021] [Indexed: 10/18/2022]
Abstract
Innovations in spinal endoscopy technology and technique have broadened their applications during the past 10 years. Smaller outer-diameter working-channel endoscopes have permitted safe usage in the cervical spine for full endoscopic decompressions. Endoscopic fusions have now been widely reported, leveraging compatible instrumentation for disc preparation and expandable interbody grafts. This ultra-minimally invasive technique has also enabled the performance of fusion procedures in awake patients under monitored anesthesia care, affording speedier recovery and treatment options for those unable to undergo general anesthesia. Revision surgery after open or minimally invasive posterior discectomy or instrumentation can now be performed with endoscopic techniques, which often leverage the transforaminal approach to avoid scar tissue and adhesions. These procedures, among other endoscopic surgeries, are now being increasingly performed in ambulatory surgery centers, as safe outcomes, economic benefits to the healthcare system, and patients' desire to recover at home are becoming more apparent. Finally, the standardization of endoscopic terminology, which has long been a confounder to proper communication and education in this field, has recently been addressed by leading experts in a consensus document, which will serve as the foundation for future collaborative advancements.
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Affiliation(s)
- Ibrahim Hussain
- Department of Neurological Surgery, University of Miami, Miami, Florida, USA.
| | | | - Michael Y Wang
- Department of Neurological Surgery, University of Miami, Miami, Florida, USA
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Stephens ME, O'Neal CM, Westrup AM, Muhammad FY, McKenzie DM, Fagg AH, Smith ZA. Utility of machine learning algorithms in degenerative cervical and lumbar spine disease: a systematic review. Neurosurg Rev 2021; 45:965-978. [PMID: 34490539 DOI: 10.1007/s10143-021-01624-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 06/28/2021] [Accepted: 08/09/2021] [Indexed: 10/20/2022]
Abstract
Machine learning is a rapidly evolving field that offers physicians an innovative and comprehensive mechanism to examine various aspects of patient data. Cervical and lumbar degenerative spine disorders are commonly age-related disease processes that can utilize machine learning to improve patient outcomes with careful patient selection and intervention. The aim of this study is to examine the current applications of machine learning in cervical and lumbar degenerative spine disease. A systematic review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A search of PubMed, Embase, Medline, and Cochrane was conducted through May 31st, 2020, using the following terms: "artificial intelligence" OR "machine learning" AND "neurosurgery" AND "spine." Studies were included if original research on machine learning was utilized in patient care for degenerative spine disease, including radiographic machine learning applications. Studies focusing on robotic applications in neurosurgery, navigation, or stereotactic radiosurgery were excluded. The literature search identified 296 papers, with 35 articles meeting inclusion criteria. There were nine studies involving cervical degenerative spine disease and 26 studies on lumbar degenerative spine disease. The majority of studies for both cervical and lumbar spines utilized machine learning for the prediction of postoperative outcomes, with 5 (55.6%) and 15 (61.5%) studies, respectively. Machine learning applications focusing on degenerative lumbar spine greatly outnumber the current volume of cervical spine studies. The current research in lumbar spine also demonstrates more advanced clinical applications of radiographic, diagnostic, and predictive machine learning models.
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Affiliation(s)
- Mark E Stephens
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, 1000 N Lincoln Blvd, Suite 4000, Oklahoma City, OK, 73104, USA
| | - Christen M O'Neal
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, 1000 N Lincoln Blvd, Suite 4000, Oklahoma City, OK, 73104, USA
| | - Alison M Westrup
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, 1000 N Lincoln Blvd, Suite 4000, Oklahoma City, OK, 73104, USA
| | - Fauziyya Y Muhammad
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, 1000 N Lincoln Blvd, Suite 4000, Oklahoma City, OK, 73104, USA
| | - Daniel M McKenzie
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, 1000 N Lincoln Blvd, Suite 4000, Oklahoma City, OK, 73104, USA
| | - Andrew H Fagg
- School of Computer Science, University of Oklahoma, Norman, OK, USA
| | - Zachary A Smith
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, 1000 N Lincoln Blvd, Suite 4000, Oklahoma City, OK, 73104, USA.
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Artificial intelligence predicts disk re-herniation following lumbar microdiscectomy: development of the "RAD" risk profile. 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 2021; 30:2167-2175. [PMID: 34100112 DOI: 10.1007/s00586-021-06866-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 04/19/2021] [Accepted: 05/02/2021] [Indexed: 02/08/2023]
Abstract
PURPOSE Surgical treatment of herniated lumbar intervertebral disks is a common procedure worldwide. However, recurrent herniated nucleus pulposus (re-HNP) may develop, complicating outcomes and patient management. The purpose of this study was to utilize machine-learning (ML) analytics to predict lumbar re-HNP, whereby a personalized risk prediction can be developed as a clinical tool. METHODS A retrospective, single center study was conducted of 2630 consecutive patients that underwent lumbar microdiscectomy (mean follow-up: 22-months). Various preoperative patient pain/disability/functional profiles, imaging parameters, and anthropomorphic/demographic metrics were noted. An Extreme Gradient Boost (XGBoost) classifier was implemented to develop a predictive model identifying patients at risk for re-HNP. The model was exported to a web application software for clinical utility. RESULTS There were 1608 males and 1022 females, 114 of whom experienced re-HNP. Primary herniations were central (65.8%), paracentral (17.6%), and far lateral (17.1%). The XGBoost algorithm identified multiple re-HNP predictors and was incorporated into an open-access web application software, identifying patients at low or high risk for re-HNP. Preoperative VAS leg, disability, alignment parameters, elevated body mass index, symptom duration, and age were the strongest predictors. CONCLUSIONS Our predictive modeling via an ML approach of our large-scale cohort is the first study, to our knowledge, that has identified significant risk factors for the development of re-HNP after initial lumbar decompression. We developed the re-herniation after decompression (RAD) profile index that has been translated into an online screening tool to identify low-high risk patients for re-HNP. Additional validation is needed for potential global implementation.
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