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Open Access 01-12-2021 | Research article

Establishment of a nomogram for predicting the surgical difficulty of anterior cervical spine surgery

Authors: Chengyue Ji, Yuluo Rong, Jiaxing Wang, Guoyong Yin, Jin Fan, Pengyu Tang, Dongdong Jiang, Wei Liu, Xuhui Ge, Shunzhi Yu, Weihua Cai

Published in: BMC Surgery | Issue 1/2021

Abstract

Background

For a long time, surgical difficulty is mainly evaluated based on subjective perception rather than objective indexes. Moreover, the lack of systematic research regarding the evaluation of surgical difficulty potentially has a negative effect in this field. This study was aimed to evaluate the risk factors for the surgical difficulty of anterior cervical spine surgery (ACSS).

Methods

This was a retrospective cohort study totaling 291 consecutive patients underwent ACSS from 2012.3 to 2017.8. The surgical difficulty of ACSS was defined by operation time longer than 120 min or intraoperative blood loss equal to or greater than 200 ml. Evaluation of risk factors was performed by analyzing the patient’s medical records and radiological parameters such as age, sex, BMI, number of operation levels, high signal intensity of spinal cord on T2-weighted images, ossified posterior longitudinal ligament (OPLL), sagittal and coronal cervical circumference, cervical length, spinal canal occupational ratio, coagulation function index and platelet count.

Results

Significant differences were reported between low-difficulty and high-difficulty ACSS groups in terms of age (p = 0.017), sex (p = 0.006), number of operation levels (p < 0.001), high signal intensity (p < 0.001), OPLL (p < 0.001) and spinal canal occupational ratio (p < 0.001). Multivariate logistic regression analysis revealed that number of operation levels (OR = 5.224, 95%CI = 2.125–12.843, p < 0.001), high signal intensity of spinal cord (OR = 4.994, 95%CI = 1.636–15.245, p = 0.005), OPLL (OR = 6.358, 95%CI = 1.932–20.931, p = 0.002) and the spinal canal occupational ratio > 0.45 (OR = 3.988, 95%CI = 1.343–11.840, p = 0.013) were independently associated with surgical difficulty in ACSS. A nomogram was established and ROC curve gave a 0.906 C-index. There was a good calibration curve for difficulty estimation.

Conclusion

This study indicated that the operational level, OPLL, high signal intensity of spinal cord, and spinal canal occupational ratio were independently associated with surgical difficulty and a predictive nomogram can be established using the identified risk factors. Optimal performance was achieved for predicting surgical difficulty of ACSS based on preoperative factors.

Sagi HC, Beutler W, Carroll E, Connolly PJ. Airway complications associated with surgery on the anterior cervical spine. Spine. 2002;27:949–53. https://doi.org/10.1097/00007632-200205010-00013.CrossRefPubMed

Mayo BC, Massel DH, Bohl DD, Long WW, Modi KD, Singh K. Anterior cervical discectomy and fusion: the surgical learning curve. Spine. 2016;41:1580–5. https://doi.org/10.1097/brs.0000000000001588.CrossRefPubMed

Fountas KN, Kapsalaki EZ, Nikolakakos LG, Smisson HF, Johnston KW, Grigorian AA, Lee GP, Robinson JS Jr. Anterior cervical discectomy and fusion associated complications. Spine. 2007;32:2310–7. https://doi.org/10.1097/BRS.0b013e318154c57e.CrossRefPubMed

Nanda A, Sharma M, Sonig A, Ambekar S, Bollam P. Surgical complications of anterior cervical diskectomy and fusion for cervical degenerative disk disease: a single surgeon’s experience of 1,576 patients. World Neurosurg. 2014;82(6):1380–7.

Zhang Y, Liu H, Yang H, Pi B. Anterior cervical corpectomy and fusion versus discectomy and fusion for the treatment of two-level cervical spondylotic myelopathy: analysis of sagittal balance and axial symptoms. Int Orthop. 2018;42:1877–82. https://doi.org/10.1007/s00264-018-3804-3.CrossRefPubMed

Nurjck S. The pathogenesis of the spinal cord disorder associated with cervical spondylosis. Brain. 1972;95:87–100. https://doi.org/10.1093/brain/95.1.87.CrossRef

Badhiwala JH, Wilson JR. The natural history of degenerative cervical myelopathy. Neurosurg Clin N Am. 2018;29:21–32.CrossRef

Patil PG, Turner DA, Pietrobon R. National trends in surgical procedures for degenerative cervical spine disease: 1990–2000. Neurosurgery. 2005;57:753–8.CrossRef

Fessler RG, Steck JC, Giovanini MA. Anterior cervical corpectomy for cervical spondylotic myelopathy. Neurosurgery. 1998;43:257–65.CrossRef

10.

Mazas S, Benzakour A, Castelain JE, Damade C, Ghailane S, Gille O. Cervical disc herniation: which surgery? Int Orthop. 2019;43:761–6. https://doi.org/10.1007/s00264-018-4221-3.CrossRefPubMed

11.

Natkaniec M, Dworak J, Pedziwiatr M, Pisarska M, Major P, Dembinski M, Winiarski M, Budzynski A. Patients criteria determining difficulty of the laparoscopic lateral transperitoneal adrenalectomy. A retrospective cohort study. Int J Surg (London, England). 2017;43:33–7. https://doi.org/10.1016/j.ijsu.2017.05.032.CrossRef

12.

Hasegawa Y, Wakabayashi G, Nitta H, Takahara T, Katagiri H, Umemura A, Makabe K, Sasaki A. A novel model for prediction of pure laparoscopic liver resection surgical difficulty. Surg Endosc. 2017;31:5356–63. https://doi.org/10.1007/s00464-017-5616-8.CrossRefPubMed

13.

D’Orazi V, Sacconi A, Trombetta S, Karpathiotakis M, Pichelli D, Di Lorenzo E, Ortensi A, Urciuoli P, Biffoni M, Ortensi A. May predictors of difficulty in thyroid surgery increase the incidence of complications? Prospective study with the proposal of a preoperative score. BMC Surg. 2019;18:116. https://doi.org/10.1186/s12893-018-0447-7.CrossRefPubMedPubMedCentral

14.

Liu Z, Gong C, Liu Y, Zhang L. Establishment of a scoring system for predicting the difficulty level of high-intensity focussed ultrasound ablation of uterine fibroids. Int J hyperthermia. 2018;34:77–86. https://doi.org/10.1080/02656736.2017.1325015.CrossRefPubMed

15.

Owens RK 2nd, Djurasovic M, Onyekwelu I, Bratcher KR, McGraw KE, Carreon LY. Outcomes and revision rates in normal, overweight, and obese patients 5 years after lumbar fusion. Spine J. 2016;16:1178–83. https://doi.org/10.1016/j.spinee.2016.06.005.CrossRefPubMed

16.

Yu S, Li F, Yan N, Yuan C, He S, Hou T. Anterior fusion technique for multilevel cervical spondylotic myelopathy: a retrospective analysis of surgical outcome of patients with different number of levels fused. PLoS ONE. 2014;9:e91329. https://doi.org/10.1371/journal.pone.0091329.CrossRefPubMedPubMedCentral

17.

Kou J, Fischgrund J, Biddinger A, Herkowitz H. Risk factors for spinal epidural hematoma after spinal surgery. Spine. 2002;27:1670–3. https://doi.org/10.1097/00007632-200208010-00016.CrossRefPubMed

18.

Chen Y, Guo Y, Lu X, Chen D, Song D, Shi J, Yuan W. Surgical strategy for multilevel severe ossification of posterior longitudinal ligament in the cervical spine. J Spinal Disord Tech. 2011;24:24–30. https://doi.org/10.1097/BSD.0b013e3181c7e91e.CrossRefPubMed

19.

Morishita S, Yoshii T, Okawa A, Fushimi K, Fujiwara T. Perioperative complications of anterior decompression with fusion versus laminoplasty for the treatment of cervical ossification of the posterior longitudinal ligament: propensity score matching analysis using a nation-wide inpatient database. Spine J. 2019;19:610–6. https://doi.org/10.1016/j.spinee.2018.10.013.CrossRefPubMed

20.

Takahashi M, Yamashita Y, Sakamoto Y, Kojima R. Chronic cervical cord compression: clinical significance of increased signal intensity on MR images. Radiology. 1989;173:219–24. https://doi.org/10.1148/radiology.173.1.2781011.CrossRefPubMed

Title: Establishment of a nomogram for predicting the surgical difficulty of anterior cervical spine surgery
Authors: Chengyue Ji
Yuluo Rong
Jiaxing Wang
Guoyong Yin
Jin Fan
Pengyu Tang
Dongdong Jiang
Wei Liu
Xuhui Ge
Shunzhi Yu
Weihua Cai
Publication date: 01-12-2021
Publisher: BioMed Central
Published in: BMC Surgery / Issue 1/2021
Electronic ISSN: 1471-2482
DOI: https://doi.org/10.1186/s12893-020-01022-0

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Establishment of a nomogram for predicting the surgical difficulty of anterior cervical spine surgery

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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