Development and validation of a nomogram to predict the risk of residual low back pain after tubular microdiskectomy of lumbar disk herniation

Fengzhao Zhu; Dongqing Jia; Yaqing Zhang; Chencheng Feng; Yan Peng; Ya Ning; Xue Leng; Jianmin Li; Yue Zhou; Changqing Li; Bo Huang

doi:10.1007/s00586-024-08255-0

Development and validation of a nomogram to predict the risk of residual low back pain after tubular microdiskectomy of lumbar disk herniation

Eur Spine J. 2024 Apr 22. doi: 10.1007/s00586-024-08255-0. Online ahead of print.

Authors

Fengzhao Zhu¹, Dongqing Jia², Yaqing Zhang¹, Chencheng Feng¹, Yan Peng³, Ya Ning¹, Xue Leng¹, Jianmin Li¹, Yue Zhou¹, Changqing Li¹, Bo Huang⁴

Affiliations

¹ Department of Orthopedics, Xinqiao Hospital, Army Medical University, No. 183, Xinqiao Main Street, Shapingba District, Chongqing, 400037, People's Republic of China.
² Department of Blood Transfusion, University-Town Hospital of Chongqing Medical University, Chongqing, People's Republic of China.
³ Department of Radiology, Xinqiao Hospital, Army Medical University, Chongqing, People's Republic of China.
⁴ Department of Orthopedics, Xinqiao Hospital, Army Medical University, No. 183, Xinqiao Main Street, Shapingba District, Chongqing, 400037, People's Republic of China. fmmuhb@126.com.

PMID: 38647605
DOI: 10.1007/s00586-024-08255-0

Abstract

Objective: Tubular microdiskectomy (tMD) is one of the most commonly used for treating lumbar disk herniation. However, there still patients still complain of persistent postoperative residual low back pain (rLBP) postoperatively. This study attempts to develop a nomogram to predict the risk of rLBP after tMD.

Methods: The patients were divided into non-rLBP (LBP VAS score < 2) and rLBP (LBP VAS score ≥ 2) group. The correlation between rLBP and these factors were analyzed by multivariate logistic analysis. Then, a nomogram prediction model of rLBP was developed based on the risk factors screened by multivariate analysis. The samples in the model are randomly divided into training and validation sets in a 7:3 ratio. The Receiver operating characteristic (ROC) curve, calibration curve, and decision curve analysis (DCA) were used to evaluate the diskrimination, calibration and clinical value of the model, respectively.

Results: A total of 14.3% (47/329) of patients have persistent rLBP. The multivariate analysis suggests that higher preoperative LBP visual analog scale (VAS) score, lower facet orientation (FO), grade 2-3 facet joint degeneration (FJD) and moderate-severe multifidus fat atrophy (MFA) are risk factors for postoperative rLBP. In the training and validation sets, the ROC curves, calibration curves, and DCAs suggested the good diskrimination, predictive accuracy between the predicted probability and actual probability, and clinical value of the model, respectively.

Conclusion: This nomogram including preoperative LBP VAS score, FO, FJD and MFA can serve a promising prediction model, which will provide a reference for clinicians to predict the rLBP after tMD.

Keywords: Facet joint degeneration; Facet orientation; Lumbar disk herniation; Microdiskectomy; Multifidus fatty atrophy; Nomogram model; Residual low back pain; Risk factor; Tubular; Visual analog scale.