Three-Dimensional Radiomics and Machine Learning for Predicting Postoperative Outcomes in Laminoplasty for Cervical Spondylotic Myelopathy: A Clinical-Radiomics Model

Objective

This study aims to explore a method based on three-dimensional cervical spinal cord reconstruction, radiomics feature extraction, and machine learning to build a postoperative prognosis prediction model for patients with cervical spondylotic myelopathy (CSM). It also evaluates the predictive performance of different cervical spinal cord segmentation strategies and machine learning algorithms.

Methods

A retrospective analysis is conducted on 126 CSM patients who underwent posterior single-door laminoplasty from January 2017 to December 2022. Three different cervical spinal cord segmentation strategies (narrowest segment, surgical segment, and entire cervical cord C1–C7) are applied to preoperative magnetic resonance imaging images for radiomics feature extraction. Good clinical prognosis is defined as a postoperative Japanese Orthopaedic Association (JOA) recovery rate ≥50%. By comparing the performance of 8 machine learning algorithms, the optimal cervical spinal cord segmentation strategy and classifier are selected. Subsequently, clinical features (smoking history, diabetes, preoperative JOA score, and cervical sagittal vertical axis (cSVA) are combined with radiomics features to construct a clinical-radiomics prediction model.

Results

Among the three cervical spinal cord segmentation strategies, the support vector machine model based on the narrowest segment performed best (area under the curve [AUC] = 0.885). Among clinical features, smoking history, diabetes, preoperative JOA score, and cSVA are important indicators for prognosis prediction. When clinical features are combined with radiomics features, the fusion model achieved excellent performance on the test set (accuracy = 0.895, AUC = 0.967), significantly outperforming either the clinical model or the radiomics model alone.

Conclusions

This study validates the feasibility and superiority of three-dimensional radiomics combined with machine learning in predicting postoperative prognosis for CSM. The combination of radiomics features based on the narrowest segment and clinical features can yield a highly accurate prognosis prediction model, providing new insights for clinical assessment and individualized treatment decisions. Future studies need to further validate the stability and generalizability of this model in multicenter, large-sample cohorts.