腰椎间盘手术后的结果预测:结果轨迹、预后因素和风险模型的纵向研究。

IF 2.9 2区 医学 Q2 CLINICAL NEUROLOGY
Jeffrey J Hébert, Erin E Bigney, Sarah Nowell, Shuaijin Wang, Niels Wedderkopp, Christopher Small, Edward P Abraham, Najmedden Attabib, Nathan Evaniew, Jérôme Paquet, Raphaele Charest-Morin, Supriya Singh, Michael H Weber, Adrienne Kelly, Stephen Kingwell, Eric Crawford, Andrew Nataraj, Travis Marion, Bernard LaRue, Henry Ahn, Hamilton Hall, Charles G Fisher, Y Raja Rampersaud, Nicolas Dea, Christopher S Bailey, Neil A Manson
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引用次数: 0

摘要

研究目的本研究旨在:1)描述腰椎间盘突出症术后 2 年的腿部疼痛轨迹和总体临床结果;2)确定预测不良临床结果轨迹的术前预后因素;3)开发多变量预后模型并进行内部验证,以协助临床决策:这项回顾性队列研究纳入了加拿大脊柱结果与研究网络(Canadian Spine Outcomes and Research Network)的注册患者,这些患者被诊断为腰椎间盘病变和根性病变,并在 18 个脊柱中心之一接受了腰椎间盘切除术。潜在的结果预测因素包括术前人口统计学、健康相关因素和临床预后因素。临床结果包括:1)腿部疼痛强度(数字疼痛评分量表)的两年单变量潜在轨迹;2)总体结果,包括显示腿部和背部疼痛强度(数字疼痛评分量表)以及疼痛相关残疾(Oswestry残疾指数)的术后综合过程的多变量轨迹。每个结果模型都根据术后临床状态的最小变化确定了一个结果较差的患者亚群。多变量风险模型的性能和内部有效性是通过基于500次重置的自举缩小法的辨别和校准统计进行评估的:作者纳入了 1142 名患者(47.6% 为女性)的数据。轨迹模型根据患者的术后疼痛或残疾情况确定了 3 个亚组:腿痛模型中 88.6% 的患者和总体结果模型中 71.9% 的患者获得了良好到优秀的结果。这些模型将 11.4% 的患者(腿痛疗效)和 28.2% 的患者(总体疗效)归类为临床疗效差,即术后疼痛或残疾改善极小。有 11 个人口、健康和临床因素可预测患者的腿痛和总体疗效不佳。腿部疼痛的多变量风险模型表现不佳,而总体预后模型在预测不良手术预后方面具有可接受的区分度、校准性和内部有效性:结论:腰椎间盘切除术后,腰椎病患者术后疼痛和残疾的轨迹各不相同。个别术前因素与术后结果相关,可结合多变量风险模型预测患者的总体结果。这些结果可为临床实践提供参考,但在临床应用前还需要外部验证。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Outcome prediction following lumbar disc surgery: a longitudinal study of outcome trajectories, prognostic factors, and risk models.

Objective: This study aimed to 1) describe the 2-year postoperative trajectories of leg pain and overall clinical outcome after surgery for radiculopathy, 2) identify the preoperative prognostic factors that predict trajectories representing poor clinical outcomes, and 3) develop and internally validate multivariable prognostic models to assist with clinical decision-making.

Methods: This retrospective cohort study included patients enrolled in the Canadian Spine Outcomes and Research Network who were diagnosed with lumbar disc pathology and radiculopathy and had undergone lumbar discectomy at one of 18 spine centers. Potential outcome predictors included preoperative demographic, health-related, and clinical prognostic factors. Clinical outcomes were 1) 2-year univariable latent trajectories of leg pain intensity (numeric pain rating scale) and 2) overall outcomes comprising multivariable trajectories showing the combined postoperative courses of leg and back pain intensity (numeric pain rating scale) together with pain-related disability (Oswestry Disability Index). Each outcome model identified a subgroup of patients classified as experiencing a poor outcome based on minimal change in their clinical status after surgery. Multivariable risk model performance and internal validity were evaluated with discrimination and calibration statistics based on bootstrap shrinkage with 500 resamplings.

Results: The authors included data from 1142 patients (47.6% female). The trajectory models identified 3 subgroups based on the patients' postoperative courses of pain or disability: 88.6% of patients in the leg pain model and 71.9% in the overall outcome model experienced a good-to-excellent outcome. The models classified 11.4% (leg pain outcome) and 28.2% (overall outcome) of patients as experiencing a poor clinical outcome, which was defined as minimal improvement in pain or disability after surgery. Eleven individual demographic, health, and clinical factors predicted patients' poor leg pain and overall outcomes. The performance of the multivariable risk model for leg pain was inadequate, while the overall outcome model had acceptable discrimination, calibration, and internal validity for predicting a poor surgical outcome.

Conclusions: Patients with lumbar radiculopathy experience heterogeneous postoperative trajectories of pain and disability after lumbar discectomy. Individual preoperative factors are associated with postoperative outcomes and can be combined within a multivariable risk model to predict overall patient outcome. These results may inform clinical practice but require external validation before confident clinical implementation.

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来源期刊
Journal of neurosurgery. Spine
Journal of neurosurgery. Spine 医学-临床神经学
CiteScore
5.10
自引率
10.70%
发文量
396
审稿时长
6 months
期刊介绍: Primarily publish original works in neurosurgery but also include studies in clinical neurophysiology, organic neurology, ophthalmology, radiology, pathology, and molecular biology.
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