The Prediction of Recurrence Lumbar Disc Herniation At L5-S1 Level Through Machine Learning Models Based on Endoscopic Discectomy Via the Interlaminar Approach
NCT ID: NCT06833099
Last Updated: 2025-02-18
Study Results
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Basic Information
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COMPLETED
309 participants
OBSERVATIONAL
2020-01-01
2024-11-01
Brief Summary
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Who Participated? The study reviewed the medical records of 309 patients who had undergone the PEID surgery. Out of these, 33 patients experienced a recurrence of their herniation, while 276 patients did not.
What Did the Researchers Do?
Data Collection:
They gathered information from each patient before the surgery, including clinical details (like body weight and any health conditions such as diabetes) and imaging studies (like X-rays, CT scans, or MRIs) that show the condition of the spine.
Identifying Key Risk Factors:
Using a statistical method called LASSO regression, the researchers identified eight important factors that could influence whether the herniation might come back. These included factors such as body mass index (BMI), a measure related to disc height (posterior disc height index), signs of spinal canal narrowing, how long the patient had symptoms before surgery, and other health conditions.
Developing Prediction Models:
They then used several machine learning techniques (advanced computer methods that learn from data) to build prediction models. Two of the best-performing models were based on methods called Random Forest and Extreme Gradient Boosting (XGB).
What Were the Main Findings?
Key Predictors: Higher BMI and changes in the disc (as measured by the posterior disc height index) were found to be the strongest predictors of a herniation coming back after surgery. Other factors, like spinal canal narrowing and longer duration of symptoms before surgery, also played significant roles.
Practical Implication: These models can help doctors identify which patients are at higher risk for recurrence. With this information, they can adjust treatment plans and follow-up care to better manage and potentially reduce the risk of the herniation coming back.
Why Is This Important? For patients and their families, this study offers hope for more personalized and effective treatment plans, reducing the chances of needing additional surgeries in the future. For healthcare providers, the findings provide useful tools to improve decision-making before surgery, ensuring better long-term outcomes for patients with L5-S1 lumbar disc herniation.
In summary, this research uses modern computer methods to predict the risk of recurrent disc herniation after a common minimally invasive back surgery, aiming to enhance patient care and improve surgical outcomes.
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Detailed Description
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This study aimed to enhance care for patients undergoing a minimally invasive spine surgery known as percutaneous endoscopic interlaminar discectomy (PEID), which is used to treat herniated discs at the L5-S1 level. Recurrent disc herniation-where the disc problem returns after surgery-can lead to additional pain and the need for further treatment. To address this issue, the research team conducted an in-depth review of patient data gathered at a single hospital.
How the Study Was Conducted Researchers collected comprehensive information from 309 patients who had undergone PEID. This information included clinical details (such as age, body mass index, and existing conditions like diabetes) and imaging data (from X-rays, CT scans, and MRIs) that provided insights into the structure and condition of the spine. Rather than relying on a single factor, the study examined a wide range of variables to understand which ones might predict a recurrence of the herniated disc.
Advanced Data Analysis and Prediction Methods To sift through the large amount of collected data, the team used a statistical technique called LASSO regression. This method helped identify the most influential factors from many possible measurements. Eight key factors emerged, including body mass index (BMI) and specific measurements related to the spinal disc's structure.
Building on this foundation, the study employed several machine learning techniques-advanced computer methods that detect patterns in data-to create models capable of predicting the risk of recurrence. Among the various models tested, two (Random Forest and Extreme Gradient Boosting) stood out for their strong performance. These models not only highlighted the significance of factors like BMI and certain spinal measurements but also provided a promising tool for clinicians to assess risk before surgery.
Why This Matters For healthcare providers, having a reliable predictive model means they can better tailor surgical techniques and postoperative care to individual patients. By understanding a patient's risk profile, surgeons can take additional precautions or consider alternative approaches to reduce the chance of recurrence. For patients and their families, this translates into more personalized treatment plans and potentially fewer complications or repeat surgeries in the future.
In Summary This study represents an important step toward personalized medicine in spinal care. By integrating detailed clinical and imaging data with state-of-the-art machine learning techniques, the researchers developed a model that can forecast the likelihood of a recurrent herniated disc after PEID surgery. The insights gained not only improve the understanding of key risk factors but also pave the way for more targeted and effective treatment strategies, ultimately aiming to enhance long-term patient outcomes.
Conditions
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Study Design
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CASE_CONTROL
RETROSPECTIVE
Study Groups
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Recurrent rLDH
: Patients who experienced recurrent lumbar disc herniation following L5-S1 PEID.
VAS Point and Imaging Examination
This intervention uses a machine learning model to predict the risk of recurrent lumbar disc herniation (rLDH) in patients who have had percutaneous endoscopic interlaminar discectomy (PEID) at the L5-S1 level. The model combines clinical data (e.g., BMI, disease duration, diabetes) and imaging metrics (e.g., posterior disc height index, spinal canal stenosis) to create a personalized risk score, unlike traditional methods that rely on clinical judgment or imaging alone.
Key Features:
Data-Driven Approach: Developed using data from 309 patients for real-world relevance.
Advanced Variable Selection: Identifies eight key predictors using LASSO regression.
Multiple Machine Learning Techniques: Uses algorithms like support vector machine, random forest, and extreme gradient boosting.
Optimized for Clinical Decision-Making: Assists surgeons in personalizing treatment plans to reduce recurrence risk.
Non-Recurrent rLDH
Patients who did not experience recurrent lumbar disc herniation following L5-S1 PEID.
VAS Point and Imaging Examination
This intervention uses a machine learning model to predict the risk of recurrent lumbar disc herniation (rLDH) in patients who have had percutaneous endoscopic interlaminar discectomy (PEID) at the L5-S1 level. The model combines clinical data (e.g., BMI, disease duration, diabetes) and imaging metrics (e.g., posterior disc height index, spinal canal stenosis) to create a personalized risk score, unlike traditional methods that rely on clinical judgment or imaging alone.
Key Features:
Data-Driven Approach: Developed using data from 309 patients for real-world relevance.
Advanced Variable Selection: Identifies eight key predictors using LASSO regression.
Multiple Machine Learning Techniques: Uses algorithms like support vector machine, random forest, and extreme gradient boosting.
Optimized for Clinical Decision-Making: Assists surgeons in personalizing treatment plans to reduce recurrence risk.
Interventions
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VAS Point and Imaging Examination
This intervention uses a machine learning model to predict the risk of recurrent lumbar disc herniation (rLDH) in patients who have had percutaneous endoscopic interlaminar discectomy (PEID) at the L5-S1 level. The model combines clinical data (e.g., BMI, disease duration, diabetes) and imaging metrics (e.g., posterior disc height index, spinal canal stenosis) to create a personalized risk score, unlike traditional methods that rely on clinical judgment or imaging alone.
Key Features:
Data-Driven Approach: Developed using data from 309 patients for real-world relevance.
Advanced Variable Selection: Identifies eight key predictors using LASSO regression.
Multiple Machine Learning Techniques: Uses algorithms like support vector machine, random forest, and extreme gradient boosting.
Optimized for Clinical Decision-Making: Assists surgeons in personalizing treatment plans to reduce recurrence risk.
Eligibility Criteria
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Inclusion Criteria
(D) No other abnormalities detected in imaging. (E) Minimum follow-up period of 6 months.
Exclusion Criteria
ALL
No
Sponsors
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Nantong First People's Hospital
OTHER
Jinyu Chen
OTHER
Responsible Party
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Jinyu Chen
resident physician
Locations
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Nantong First People's Hospital
Nantong, Jiangsu, China
Countries
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References
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Shi H, Zhu L, Jiang ZL, Wu XT. Radiological risk factors for recurrent lumbar disc herniation after percutaneous transforaminal endoscopic discectomy: a retrospective matched case-control study. Eur Spine J. 2021 Apr;30(4):886-892. doi: 10.1007/s00586-020-06674-3. Epub 2021 Jan 1.
Yu C, Zhan X, Liu C, Liao S, Xu J, Liang T, Zhang Z, Chen J. Risk Factors for Recurrent L5-S1 Disc Herniation After Percutaneous Endoscopic Transforaminal Discectomy: A Retrospective Study. Med Sci Monit. 2020 Mar 25;26:e919888. doi: 10.12659/MSM.919888.
Choi G, Lee SH, Raiturker PP, Lee S, Chae YS. Percutaneous endoscopic interlaminar discectomy for intracanalicular disc herniations at L5-S1 using a rigid working channel endoscope. Neurosurgery. 2006 Feb;58(1 Suppl):ONS59-68; discussion ONS59-68. doi: 10.1227/01.neu.0000192713.95921.4a.
Siemionow K, An H, Masuda K, Andersson G, Cs-Szabo G. The effects of age, sex, ethnicity, and spinal level on the rate of intervertebral disc degeneration: a review of 1712 intervertebral discs. Spine (Phila Pa 1976). 2011 Aug 1;36(17):1333-9. doi: 10.1097/BRS.0b013e3181f2a177.
Li Y, Wang B, Li H, Chang X, Wu Y, Hu Z, Liu C, Gao X, Zhang Y, Liu H, Li Y, Li C. Adjuvant surgical decision-making system for lumbar intervertebral disc herniation after percutaneous endoscopic lumber discectomy: a retrospective nonlinear multiple logistic regression prediction model based on a large sample. Spine J. 2021 Dec;21(12):2035-2048. doi: 10.1016/j.spinee.2021.07.012. Epub 2021 Jul 20.
Jia M, Sheng Y, Chen G, Zhang W, Lin J, Lu S, Li F, Ying J, Teng H. Development and validation of a nomogram predicting the risk of recurrent lumbar disk herniation within 6 months after percutaneous endoscopic lumbar discectomy. J Orthop Surg Res. 2021 Apr 21;16(1):274. doi: 10.1186/s13018-021-02425-2.
Han M, Liu L, Hu M, Liu G, Li P. Medical expert and machine learning analysis of lumbar disc herniation based on magnetic resonance imaging. Comput Methods Programs Biomed. 2022 Jan;213:106498. doi: 10.1016/j.cmpb.2021.106498. Epub 2021 Oct 29.
Li R, Fu D, Han H, Zhan Z, Wu Y, Meng B. Comparative analysis of percutaneous endoscopic interlaminar discectomy for highly downward-migrated disc herniation. J Orthop Surg Res. 2023 Aug 14;18(1):602. doi: 10.1186/s13018-023-04090-z.
Berg B, Gorosito MA, Fjeld O, Haugerud H, Storheim K, Solberg TK, Grotle M. Machine Learning Models for Predicting Disability and Pain Following Lumbar Disc Herniation Surgery. JAMA Netw Open. 2024 Feb 5;7(2):e2355024. doi: 10.1001/jamanetworkopen.2023.55024.
Harada GK, Siyaji ZK, Mallow GM, Hornung AL, Hassan F, Basques BA, Mohammed HA, Sayari AJ, Samartzis D, An HS. Artificial intelligence predicts disk re-herniation following lumbar microdiscectomy: development of the "RAD" risk profile. Eur Spine J. 2021 Aug;30(8):2167-2175. doi: 10.1007/s00586-021-06866-5. Epub 2021 Jun 7.
Wang H, Zhou Y, Li C, Liu J, Xiang L. Risk factors for failure of single-level percutaneous endoscopic lumbar discectomy. J Neurosurg Spine. 2015 Sep;23(3):320-5. doi: 10.3171/2014.10.SPINE1442. Epub 2015 Jun 12.
Huang W, Han Z, Liu J, Yu L, Yu X. Risk Factors for Recurrent Lumbar Disc Herniation: A Systematic Review and Meta-Analysis. Medicine (Baltimore). 2016 Jan;95(2):e2378. doi: 10.1097/MD.0000000000002378.
Li H, Deng W, Wei F, Zhang L, Chen F. Factors related to the postoperative recurrence of lumbar disc herniation treated by percutaneous transforaminal endoscopy: A meta-analysis. Front Surg. 2023 Jan 19;9:1049779. doi: 10.3389/fsurg.2022.1049779. eCollection 2022.
Ren G, Liu L, Zhang P, Xie Z, Wang P, Zhang W, Wang H, Shen M, Deng L, Tao Y, Li X, Wang J, Wang Y, Wu X. Machine Learning Predicts Recurrent Lumbar Disc Herniation Following Percutaneous Endoscopic Lumbar Discectomy. Global Spine J. 2024 Jan;14(1):146-152. doi: 10.1177/21925682221097650. Epub 2022 May 2.
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Other Identifiers
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JiajiaChen
Identifier Type: -
Identifier Source: org_study_id
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