Nomogram for predicting the unfavourable outcomes of percutaneous endoscopic transforaminal discectomy for lumbar disc herniation: a retrospective study

Xiaofeng Jiang; Lili Gu; Gang Xu; Xuezhong Cao; Jian Jiang; Daying Zhang; Mu Xu; Yi Yan

doi:10.3389/fsurg.2023.1188517

Nomogram for predicting the unfavourable outcomes of percutaneous endoscopic transforaminal discectomy for lumbar disc herniation: a retrospective study

Front Surg. 2023 Jun 2:10:1188517. doi: 10.3389/fsurg.2023.1188517. eCollection 2023.

Authors

Xiaofeng Jiang^#^{1

2}, Lili Gu^#^{3

2}, Gang Xu^{3

2}, Xuezhong Cao^{3

2}, Jian Jiang^{1

2}, Daying Zhang^{3

2}, Mu Xu^{3

2}, Yi Yan^{3

2}

Affiliations

¹ Department of Radiology, The First Affiliated Hospital of Nanchang University, Nanchang, China.
² Institute of Pain Medicine, Jiangxi Academy of Clinical and Medical Sciences, Nanchang, China.
³ Department of Pain Medicine, The First Affiliated Hospital of Nanchang University, Nanchang, China.

^# Contributed equally.

Abstract

Objective: To investigate and integrate multiple independent risk factors to establish a nomogram for predicting the unfavourable outcomes of percutaneous endoscopic transforaminal discectomy (PETD) for lumbar disc herniation (LDH).

Methods: From January 2018 to December 2019, a total of 425 patients with LDH undergoing PETD were included in this retrospective study. All patients were divided into the development and validation cohort at a ratio of 4:1. Univariate and multivariate logistic regression analyses were used to investigate the independent risk factors associated with the clinical outcomes of PETD for LDH in the development cohort, and a prediction model (nomogram) was established to predict the unfavourable outcomes of PETD for LDH. In the validation cohort, the nomogram was validated by the concordance index (C-index), calibration curve, and decision curve analysis (DCA).

Results: 29 of 340 patients showed unfavourable outcomes in the development cohort, and 7 of 85 patients showed unfavourable outcomes in the validation cohort. Body mass index (BMI), course of disease (COD), protrusion calcification (PC), and preoperative lumbar epidural steroid injection (LI) were independent risk factors associated with the unfavourable outcomes of PETD for LDH and were identified as predictors for the nomogram. The nomogram was validated by the validation cohort and showed high consistency (C-index = 0.674), good calibration and high clinical value.

Conclusions: The nomogram based on patients' preoperative clinical characteristics, including BMI, COD, LI and PC, can be used to accurately predict the unfavourable outcomes of PETD for LDH.

Keywords: lower back pain; lumbar disc herniation; nomogram; percutaneous endoscopic transforaminal discectomy; prediction model.

Grants and funding

This study was funded by the National Natural Science Foundation of China [81860216 to DZ] and the Natural Science Foundation of Jiangxi Province [20224BAB216046 to YY].