Influencing Factors of Adjacent Segment Degeneration after Lumbar Fusion Surgery for Lumbar Degenerative Diseases and Establishment of Nomogram Model
Objective To explore the influencing factors of adjacent segment degeneration(ASD)in patients with lumbar degenerative disc disease(LDDD)after lumbar fusion surgery and establish a Nomogram model.Methods From May 2020 to May 2022,319 LDDD patients who underwent lumbar fusion surgery in our hospital were selected as the observation subjects.They were randomly grouped into modeling group(223 cases)and validation group(96 cases)in a 7∶3 ratio using a random number table method.The modeling group was separated into ASD subgroup and non-ASD subgroup.Multivariate Logistic regression was applied to analyze the factors leading to ASD in LDDD patients after lumbar fusion surgery.Nomogram model was constructed,and the predictive performance of the model was evaluated by ROC curves and calibration curves,and the area under the curve(AUC)was calculated.Results Among 223 LDDD patients who underwent lumbar fusion surgery,57 cases developed ASD,with an incidence rate of 25.56％.Multivariate Logistic regression analysis showed that age ≥60 years[OR=4.146.95％CI(1.163,14.782),P=0.028],body mass index(BMI)≥24 kg/m2[OR=4.581,95％CI(1.409,14.891),P=0.011],multiple fusion segments[OR=7.825,95％CI(2.036,30.083),P=0.003]and poor fusion degree[OR=4.077,95％CI(1.265,13.143),P=0.019]were risk factors for postoperative ASD in patients,and preoperative pelvic incidence[OR=0.831,95％CI(0.772,0.894),P＜0.001]was a protective factor for postoperative ASD in patients(P＜0.05).The AUC of the model in modeling group was 0.965[95％CI(0.932,0.997)],and the calibration curve showed the good consistency(P=0.678);The AUC of the validation group was 0.971[95％CI(0.949,0.994)],and the calibration curve also showed the good consistency(P=0.697).Conclusion Older age,high BMI,multiple fusion segments and poor fusion degree are risk factors for ASD in LDDD patients after lumbar fusion surgery,the preoperative pelvic incidence is a protective factor,and the constructed Nomogram model has good discrimination and consistency,which can intuitively predict the risk of ASD in LDDD patients after lumbar fusion surgery.
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