PMID- 33781244 OWN - NLM STAT- MEDLINE DCOM- 20210406 LR - 20210406 IS - 1471-2482 (Electronic) IS - 1471-2482 (Linking) VI - 21 IP - 1 DP - 2021 Mar 29 TI - Establishment of a nomogram for predicting the surgical difficulty of anterior cervical spine surgery. PG - 170 LID - 10.1186/s12893-020-01022-0 [doi] LID - 170 AB - 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. FAU - Ji, Chengyue AU - Ji C AD - Department of Orthopedics, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, Jiangsu, China. FAU - Rong, Yuluo AU - Rong Y AD - Department of Orthopedics, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, Jiangsu, China. FAU - Wang, Jiaxing AU - Wang J AD - Department of Orthopedics, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, Jiangsu, China. FAU - Yin, Guoyong AU - Yin G AD - Department of Orthopedics, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, Jiangsu, China. FAU - Fan, Jin AU - Fan J AD - Department of Orthopedics, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, Jiangsu, China. FAU - Tang, Pengyu AU - Tang P AD - Department of Orthopedics, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, Jiangsu, China. FAU - Jiang, Dongdong AU - Jiang D AD - Department of Orthopedics, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, Jiangsu, China. FAU - Liu, Wei AU - Liu W AD - Department of Orthopedics, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, Jiangsu, China. FAU - Ge, Xuhui AU - Ge X AD - Department of Orthopedics, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, Jiangsu, China. FAU - Yu, Shunzhi AU - Yu S AD - Department of Orthopedics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301 Yanchang Road, Shanghai, China. maotoutou@163.com. FAU - Cai, Weihua AU - Cai W AD - Department of Orthopedics, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, Jiangsu, China. caiwhspine@sina.com. LA - eng GR - BK20181490/Natural Science Foundation of Jiangsu/ GR - 320-2745-16-117/Wu Jieping Medical Foundation/ GR - 81974335/National Natural Science Foundation of China/ GR - TD-SWYY-010/Six Talent Peaks Project in Jiangsu Province/ PT - Evaluation Study PT - Journal Article DEP - 20210329 PL - England TA - BMC Surg JT - BMC surgery JID - 100968567 SB - IM MH - Aged MH - Aged, 80 and over MH - Cervical Vertebrae/diagnostic imaging/*surgery MH - Decompression, Surgical/*methods MH - Female MH - Humans MH - Incidence MH - Male MH - Middle Aged MH - Nomograms MH - Ossification of Posterior Longitudinal Ligament/*surgery MH - Predictive Value of Tests MH - Retrospective Studies MH - Treatment Outcome PMC - PMC8008533 OTO - NOTNLM OT - Anterior cervical spine surgery OT - Nomogram OT - Surgical difficulty COIS- The authors declare that they have no competing interests. EDAT- 2021/03/31 06:00 MHDA- 2021/04/07 06:00 PMCR- 2021/03/29 CRDT- 2021/03/30 05:53 PHST- 2020/07/27 00:00 [received] PHST- 2020/12/20 00:00 [accepted] PHST- 2021/03/30 05:53 [entrez] PHST- 2021/03/31 06:00 [pubmed] PHST- 2021/04/07 06:00 [medline] PHST- 2021/03/29 00:00 [pmc-release] AID - 10.1186/s12893-020-01022-0 [pii] AID - 1022 [pii] AID - 10.1186/s12893-020-01022-0 [doi] PST - epublish SO - BMC Surg. 2021 Mar 29;21(1):170. doi: 10.1186/s12893-020-01022-0.