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Development and validation of machine learning-based predictive model for clinical outcome of decompression surgery for lumbar spinal canal stenosis

      Abstract

      BACKGROUND CONTEXT

      Although the results of decompression surgery for lumbar spinal canal stenosis (LSS) are favorable, it is still difficult to predict the postoperative health-related quality of life of patients before surgery.

      PURPOSE

      The purpose of this study was to develop and validate a machine learning model to predict the postoperative outcome of decompression surgery for patients with LSS.

      STUDY DESIGN/SETTING

      A multicentered retrospective study.

      PATIENT SAMPLE

      A total of 848 patients who underwent decompression surgery for LSS at an academic hospital, tertiary center, and private hospital were included (age 71±9 years, 68% male, 91% LSS, level treated 1.8±0.8, operation time 69±37 minutes, blood loss 48±113 mL, and length of hospital stay 12±5 days).

      OUTCOME MEASURES

      Baseline and 2 years postoperative health-related quality of life.

      METHODS

      The subjects were randomly assigned in a 7:3 ratio to a model building cohort and a testing cohort to test the models’ accuracy. Twelve predictive algorithms using 68 preoperative factors were used to predict each domain of the Japanese Orthopedic Association Back Pain Evaluation Questionnaire and visual analog scale scores at 2 years postoperatively. The final predictive values were generated using an ensemble of the top five algorithms in prediction accuracy.

      RESULTS

      The correlation coefficients of the top algorithms for each domain established using the preoperative factors were excellent (correlation coefficient: 0.95–0.97 [relative error: 0.06–0.14]). The performance evaluation of each Japanese Orthopedic Association Back Pain Evaluation Questionnaire domain and visual analog scale score by the ensemble of the top five algorithms in the testing cohort was favorable (mean absolute error [MAE] 8.9–17.4, median difference [MD] 8.1–15.6/100 points), with the highest accuracy for mental status (MAE 8.9, MD 8.1) and the lowest for buttock and leg numbness (MAE 1.7, MD 1.6/10 points). A strong linear correlation was observed between the predicted and measured values (linear correlation 0.82–0.89), while 4% to 6% of the subjects had predicted values of greater than±3 standard deviations of the MAE.

      CONCLUSIONS

      We successfully developed a machine learning model to predict the postoperative outcomes of decompression surgery for patients with LSS using patient data from three different institutions in three different settings. Thorough analyses for the subjects with deviations from the actual measured values may further improve the predictive probability of this model.

      Keywords

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      References

        • Pearson A
        • Blood E
        • Lurie J
        • Tosteson T
        • Abdu WA
        • Hillibrand A
        • et al.
        Degenerative spondylolisthesis versus spinal stenosis: does a slip matter? Comparison of baseline characteristics and outcomes (SPORT).
        Spine. 2010; 35: 298-305
        • Weinstein JN
        • Tosteson TD
        • Lurie JD
        • Tosteson AN
        • Blood E
        • Hanscom B
        • et al.
        Surgical versus nonsurgical therapy for lumbar spinal stenosis.
        N Engl J Med. 2008; 358: 794-810
        • Ghogawala Z
        • Benzel EC
        • Amin-Hanjani S
        • Barker 2nd, FG
        • Harrington JF
        • Magge SN
        • et al.
        Prospective outcomes evaluation after decompression with or without instrumented fusion for lumbar stenosis and degenerative Grade I spondylolisthesis.
        J Neurosurg Spine. 2004; 1: 267-272
        • Ghogawala Z
        • Resnick DK
        • Glassman SD
        • Dziura J
        • Shaffrey CI
        • Mummaneni PV.
        Randomized controlled trials for degenerative lumbar spondylolisthesis: which patients benefit from lumbar fusion?.
        J Neurosurg Spine. 2017; 26: 260-266
        • Ghogawala Z
        • Dziura J
        • Butler WE
        • Dai F
        • Terrin N
        • Magge SN
        • et al.
        Laminectomy plus fusion versus laminectomy alone for lumbar spondylolisthesis.
        N Engl J Med. 2016; 374: 1424-1434
        • Försth P
        • Ólafsson G
        • Carlsson T
        • Frost A
        • Borgström F
        • Fritzell P
        • et al.
        A randomized, controlled trial of fusion surgery for lumbar spinal stenosis.
        N Engl J Med. 2016; 374: 1413-1423
        • Deyo RA
        • Weinstein JN.
        Low back pain.
        N Engl J Med. 2001; 344: 363-370
        • Kobayashi Y
        • Ogura Y
        • Kitagawa T
        • Yonezawa Y
        • Takahashi Y
        • Yasuda A
        • et al.
        Gender differences in pre- and postoperative health-related quality of life measures in patients who have had decompression surgery for lumbar spinal stenosis.
        Asian Spine J. 2020; 14: 238-244
        • Cushnie D
        • Thomas K
        • Jacobs WB
        • Cho RKH
        • Soroceanu A
        • Ahn H
        • et al.
        Effect of preoperative symptom duration on outcome in lumbar spinal stenosis: a Canadian spine outcomes and research network registry study.
        Spine J. 2019; 19: 1470-1477
        • Sinikallio S
        • Aalto T
        • Airaksinen O
        • Lehto SM
        • Kröger H
        • Viinamäki H.
        Depression is associated with a poorer outcome of lumbar spinal stenosis surgery: a two-year prospective follow-up study.
        Spine. 2011; 36: 677-682
        • Racine M
        • Tousignant-Laflamme Y
        • Kloda LA
        • Dion D
        • Dupuis G
        • Choinière M.
        A systematic literature review of 10 years of research on sex/gender and experimental pain perception - part 1: are there really differences between women and men?.
        Pain. 2012; 153: 602-618
        • Ikemoto T
        • Miki K
        • Matsubara T
        • Wakao N.
        Psychological treatment strategy for chronic low back pain.
        Spine Surg Relat Res. 2018; 3: 199-206
        • Kalichman L
        • Cole R
        • Kim DH
        • Li L
        • Suri P
        • Guermazi A
        • et al.
        Spinal stenosis prevalence and association with symptoms: the Framingham Study.
        Spine J. 2009; 9: 545-550
        • Paulozzi LJ
        • Ryan GW.
        Opioid analgesics and rates of fatal drug poisoning in the United States.
        Am J Prev Med. 2006; 31: 506-511
        • Kim CH
        • Chung CK
        • Park CS
        • Choi B
        • Hahn S
        • Kim MJ
        • et al.
        Reoperation rate after surgery for lumbar spinal stenosis without spondylolisthesis: a nationwide cohort study.
        Spine J. 2013; 13: 1230-1237
        • Nerland US
        • Jakola AS
        • Giannadakis C
        • Solheim O
        • Weber C
        • Nygaard ØP
        • et al.
        The effects of smoking and smoking cessation on spine surgery: a systematic review of the literature.
        Global Spine J. 2016; 6: 695-701
        • Nerland US
        • Jakola AS
        • Giannadakis C
        • Solheim O
        • Weber C
        • Nygaard ØP
        • et al.
        The risk of getting worse: predictors of deterioration after decompressive surgery for lumbar spinal stenosis: a multicenter observational study.
        World Neurosurg. 2015; 84: 1095-1102
        • Fukui M
        • Chiba K
        • Kawakami M
        • Kikuchi S
        • Konno S
        • Miyamoto M
        • et al.
        Japanese orthopaedic association back pain evaluation questionnaire: initial report.
        J Orthop Sci. 2007; 12: 443-450
        • Fukui M
        • Chiba K
        • Kawakami M
        • Kikuchi S
        • Konno S
        • Miyamoto M
        • et al.
        Japanese orthopaedic association back pain evaluation questionnaire. Part 2. Verification of its reliability.
        J Orthop Sci. 2007; 12: 526-532
        • Fukui M
        • Chiba K
        • Kawakami M
        • Kikuchi S
        • Konno S
        • Miyamoto M
        • et al.
        Japanese orthopaedic association back pain evaluation questionnaire. Part 3. Validity study and establishment of the measurement scale.
        J Orthop Sci. 2008; 13: 173-179
        • Jensen MP
        • Chen C
        • Brugger AM.
        Interpretation of visual analog scale ratings and change scores: a reanalysis of two clinical trials of postoperative pain.
        J Pain. 2003; 4: 407-414
        • Aun C
        • Lam YM
        • Collect B.
        Evaluation of the use of visual analogue scale in Chinese patients.
        Pain. 1986; 25: 215-221
        • Fukui M
        • Chiba K
        • Kawakami M
        • Kikuchi S
        • Konno S
        • Miyamoto M
        • et al.
        The subcommittee of the clinical outcome committee of the Japanese orthopaedic association on low back pain and cervical myelopathy evaluation.
        J Orthop Sci. 2009; 14: 348-365
        • Fukui M
        • Chiba K
        • Kawakami M
        • Kikuchi S
        • Konno S
        • Miyamoto M
        • et al.
        Japanese orthopaedic association back pain evaluation questionnaire. Part 3. Validity study and establishment of the measurement scale: subcommittee on low back pain and cervical myelopathy evaluation of the clinical outcome committee of the Japanese orthopaedic association.
        Japan. J Orthop Sci. 2008; 13: 173-179
        • Hashizume H
        • Konno S
        • Takeshita K
        • Fukui M
        • Takahashi K
        • Chiba K
        • et al.
        Japanese orthopaedic association back pain evaluation questionnaire (JOABPEQ) as an outcome measure for patients with low back pain: reference values in healthy volunteers.
        J Orthop Sci. 2015; 20: 264-280
        • Cheung PWH
        • Wong CKH
        • Cheung JPY.
        Psychometric validation of the adapted traditional Chinese version of the Japanese orthopaedic association back pain evaluation questionnaire (JOABPEQ).
        J Orthop Sci. 2018; 23: 750-757
        • Azimi P
        • Shahzadi S
        • Montazeri A.
        The Japanese orthopedic association back pain evaluation questionnaire (JOABPEQ) for low back disorders: a validation study from Iran.
        J Orthop Sci. 2012; 17: 521-525
        • Jung KS
        • Jung JH
        • Jang SH
        • Bang HS
        • In TS.
        The reliability and validity of the Korean version of the Japanese orthopaedic association back pain evaluation questionnaire.
        J Phys Ther Sci. 2017; 29: 1250-1253
        • Hashizume H
        • Konno S
        • Takeshita K
        • Fukui M
        • Takahashi K
        • Chiba K
        • et al.
        Japanese orthopaedic association back pain evaluation questionnaire (JOABPEQ) as an outcome measure for patients with low back pain: reference values in healthy volunteers.
        J Orthop Sci. 2015; 20: 264-280
        • Chimukangara M
        • Helm MC
        • Frelich MJ
        • Bosler ME
        • Rein LE
        • Szabo A
        • et al.
        A 5-item frailty index based on NSQIP data correlates with outcomes following paraesophageal hernia repair.
        Surg Endosc. 2017; 31: 2509-2519
        • Abbott D.
        Applied Predictive Analytics: Principles and Techniques for the Professional Data Analyst.
        1st ed. John Wiley & Sons, Inc., Indianapolis, IN2014
        • Faul F
        • Erdfelder E
        • Lang A-G
        • Buchner A
        G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences.
        Behav Res Methods. 2007; 39: 175-191
        • Ogura Y
        • Takahashi Y
        • Kitagawa T
        • Yonezawa Y
        • Yoshida K
        • Takeda K
        • et al.
        Impact of leg numbness on patient satisfaction following decompression surgery for lumbar spinal stenosis.
        J Clin Neurosci. 2021; 93: 112-115
        • Ogura Y
        • Kitagawa T
        • Kobayashi Y
        • Yonezawa Y
        • Takahashi Y
        • Yoshida K
        • et al.
        Risk factors for persistent numbness following decompression surgery for lumbar spinal stenosis.
        Clin Neurol Neurosurg. 2020; 196105952
        • Hara N
        • Oka H
        • Yamazaki T
        • Takeshita K
        • Murakami M
        • Hoshi K
        • et al.
        Predictors of residual symptoms in lower extremities after decompression surgery on lumbar spinal stenosis.
        Eur Spine J. 2010; 19: 1849-1854
        • Harada T
        • Matsumoto M
        • Nakamura M
        • Chiba K
        • Toyama Y.
        Residual numbness in the foot soles after surgery for lumbar spinal canal stenosis [in Japanese].
        J East Japanese Orthop Traumatol. 2005; 17: 65
        • Belanger TA
        • Rowe DE.
        Diffuse idiopathic skeletal hyperostosis: musculoskeletal manifestations.
        J Am Acad Orthop Surg. 2001; 9: 258-267
        • Sato S
        • Yagi M
        • Machida M
        • Yasuda A
        • Konomi T
        • Miyake A
        • et al.
        Reoperation rate and risk factors of elective spinal surgery for degenerative spondylolisthesis: minimum 5-year follow-up.
        Spine J. 2015; 15: 1536-1544
        • Yagi M
        • Suzuki S
        • Nori S
        • Takahashi Y
        • Tsuji O
        • Nagoshi N
        • et al.
        How decompression surgery improves the lower back pain in patient with lumbar degenerative stenosis: a propensity-score-matched analysis.
        Spine. 2022; 47: 557-564