Construction of a nomogram model for predicting recurrence after percutaneous transforaminal endoscopic discectomy in patients with lumbar disc herniation
Objective To analyze the factors influencing recurrence after percutaneous transforaminal endoscopic discectomy(PTED)in patients with lumbar disc herniation(LDH),to construct a nomogram model and to verify the predictive value of model.Methods Totally 268 LDH patients underwent PTED in Nanyang Central Hospital from January to December 2022,and were divided into recurrence group(n=40)and non-recurrence group(n=228)according to one-year follow-up results.The clinical data as body mass index,duration of LDH,Pfirrmann grade,fibrous destruction and nucleus removal were compared between two groups.Multivariate logistic regression analysis was used to evaluate the influencing factors of recurrence of LDH after PTED.A nomogram model was constructed based on the influencing factors to predict recurrence of LDH after PTED,and its predictive efficiency was assessed by ROC curve.Bootstrap method was used for internal verification.The calibration and net benefit of the nomogram model were assessed by calibration and decision curves.Results The age was older in recurrence group[(62.55±8.38)years]than that in non-recurrence group[(53.99±5.01)years](t=6.266,P＜0.001).The body mass index,and proportions of duration of LDH≥6 months,Pfirrmann grade Ⅲ-Ⅳ,presence of fibrous destruction and nucleus incomplete removal were higher in recurrence group[(25.65±2.13)kg/m2,70.00％,60.00％,52.50％,50.00％]than those in non-recurrence group[(23.44±1.25)kg/m2,41.67％,32.02％,25.44％,24.12％](t=6.364,x2=11.001,x2=11.538,x2=11.988,x2=11.307,all P values＜0.05).Age(OR=1.275,95％CI:1.158-1.402,P＜0.001),body mass index(OR=2.209,95％CI:1.540-3.170,P＜0.001),duration of LDH(OR=4.954,95％CI:1.624-15.110,P=0.005),Pfirrmann grade(OR=4.064,95％CI:1.338-12.339,P=0.013),fibrous destruction(OR=3.851,95％CI:1.346-11.016,P=0.012),and nucleus removal(OR=3.090,95％CI:1.126-8.478,P=0.028)were the influencing factors of LDH recurrence after PTED.The AUC of nomogram model for predicting LDH recurrence after PTED was 0.939(95％CI:0.903-0.965,P＜0.001),with a sensitivity of 90.00％and a specificity of 82.46％.The C-index of nomogram model was 0.839(95％CI:0.796-0.882,P＜0.001),and the calibration curve was basically close to the ideal curve,with a good consistency.The decision curve was far away from the horizontal and vertical coordinates,predicting a recurrence risk threshold of＞0.16 after PTED in LDH patients,with a good net clinical benefit.Conclusions The old age,large body mass index,duration of LDH ≥6 months,Pfirrmann grade Ⅲ-Ⅳ,fibrous destruction,and nucleus incomplete removal indicate a high risk of recurrence after PTED in LDH patients.To construct a nomogram model achieves a high predictive value for LDH recurrence after PTED.
lumbar disc herniationpercutaneous transforaminal endoscopic discectomyrecurrencenomogram model
NETL
NSTL
万方数据
