Surgical Outcome P rognosis for the Patients with Degenerative L umbar S pine D isease
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Transcript of Surgical Outcome P rognosis for the Patients with Degenerative L umbar S pine D isease
Surgical Outcome Prognosis for the Patients with Degenerative Lumbar Spine Disease
Y.I. Zhuravlev, G.I. Nazarenko, A.M. Cherkashov, V.V. Ryazanov, A.G. Nazarenko
«Knowledge to foresee in order to be able»
To develop algorithms for outcome prognosis for the patients with degenerative lumbar spine disease
Auguste Comte
Objective:
Groups of Patients
1-stgroup
Radiofrequency destructionof facet nerves (RFG)
185 patients,average age 54.7 years
2-ndgroup
Percutaneous laser discectomy of lumbar discs with clinically significant protrusion detected (LD)
3-rdgroup
Microdiscectomy at one or more levels with intervertebral disc extrusion without stabilization of vertebral segments (MLD)
4-thgroup
Discectomy followedby stabilization, (Fusion)
39 patients,average age 44.6 years
182 patients,average age 44.3 years
105 patients,average age 47 years
511 patients with degenerative lumbar spine diseases were operated on from 1997 through 2010
4-thgroup
Groups of Patients
2-ndgroup
1-stgroup
3-rdgroup
Surgical OutcomeSurgical outcome was assessed according to the modified criteria of
Kawabata et al. (1973)
Marked improvementand no disabilities
(minor sensory deficitand paresis grade 4/5
with improvementat least 1 grade)
I good (class 1)
Some residual symptoms (minor complaints)
and abnormal objective findings (minor sensory
deficit, mild atrophy, and paresis grade 3/5 or 4/5 with
improvementon at least one grade)
II fair(class 2)
Poor, no improvement (major complaints, marked deficits
and atrophy)or deterioration
III poor(class 3)
II poor(class 2)
I good (class 1)
Association of Classes
I good (class 1)
II fair(class 2)
III poor(class 3)
N List of symptomsPoints
0 1 21 Low back pain none sometimes always
2 Cross Lasegue symptom negative 45-600 < 450
3 Low extremities muscles paresis none grade 3-4 grade 0-2
4 Knee-jerk reaction normal assymetric absent on both sides
5 Achilles-jerk reaction normal assymetric absent on both sides
7 X-ray features of degenerative disease no 1 segment 2 and > segments
8 Degeneration on MRI and CT no 1 segment 2 and > segments
9 Disc herniation no protrusion extrusion/sequestration
Measures for the patient evaluation
Measures for the Patient Evaluation, 28 Symptoms
I good (class 1)
II poor(class 2)
Data was analyzed with original “RECOGNITION” software, allowing the application of the patients’ identification algorithm to the possible outcomes
Recognition Software
DATABASERecognition
Software
For prognosis building following methodshave been applied:
Prognosis MethodsR
ecog
nitio
n So
ftw
are
Test Recognition Algorithm (TRA)
Decision Trees (DT)
Logical Patterns (LP)
Outcome prognosis was based on collective decision of these methods («voting»)
Voting PrincipleR
ecog
nitio
n So
ftw
are
Test Recognition Algorithm (TRA)
Decision Trees (DT)
Logical Patterns (LP)
II poor(class 2)
I good (class 1)
II poor(class 2)
II poor(class 2)
Prognostic Accuracy (rate of correct answers at cross-validation)
GroupI
For radiofrequency destruction of facet nerves 89.7 – 100%
GroupII
GroupIII
GroupIV
For laser discectomy 89.7 – 100%
For microdiscectomy 93.8 – 99.2%
For spinal stabilization 87.9 – 96.9%
Registry Architecture
Conclusion
• Algorithms obtained can be used for the outcome prognosis of the arbitrary new patients.
• The prognostic system allows to select an optimal operation type for the patients with degenerative lumbar spine disease
• Prognosis module is a part of «Russian Spine Registry»
• Prognosis module of «Russian Spine Registry» is available in English language
• www.spineregistry.ru