Determining the risk factors for postoperative mechanical complication in degenerative scoliosis: a machine learning approach based on musculoskeletal metrics.

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Tác giả: Yinyu Fang, Zhong He, Jie Li, Zhen Liu, Yong Qiu, Zhen Tian, Hui Xu, Yanjie Xu, Zezhang Zhu

Ngôn ngữ: eng

Ký hiệu phân loại: 368.062 Risks to tangible property

Thông tin xuất bản: Germany : European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society , 2025

Mô tả vật lý:

Bộ sưu tập: NCBI

ID: 644235

OBJECTIVE: To determine the risk factors for mechanical complications (MC) following corrective surgery for degenerative scoliosis through a machine learning (ML) algorithm. METHODS: Patients with degenerative scoliosis who received corrective surgery were enrolled. A total of 213 cases were ultimately included and randomized into the training set (70%) and test set (30%) to develop the machine learning-based algorithm. The demographic data, comorbidities, regional and global radiographic parameters, paraspinal muscle (PSM) fat infiltration rate (FI%), and vertebral bone quality (VBQ) score were analyzed. RESULTS: A total of 101 patients (47.4%) had MC, including 46 patients with proximal junctional kyphosis or failure (PJK/PJF), 7 patients with distal junctional kyphosis or failure (DJK/DJF), and 25 patients with rod or screw breakage. In the testing set, Gaussian Naive Bayes (GNB) exhibited the highest AUC at 0.77, while Random Forest (RF) exhibited the highest PRC at 0.63. GNB, RF, and Logistic Regression (LR) models all achieved an accuracy of 0.69, while RF exhibited the highest sensitivity at 0.60 and lowest Brier score of 0.20. Shapley Additive Explanation (SHAP) analysis identified higher FI% of PSM, elevated VBQ score, higher preoperative T1-pelvic angle (T1PA), and postoperative lordosis maldistribution as major risk factors for MC. Based on RF model, local interpretable model-agnostic explanations (LIME) visualization was successfully developed for individual risk calculation. CONCLUSION: The RF and GNB models showed the best overall performance. Both RF and GNB models identified top-ranked/major risk factors including higher paraspinal muscle fat infiltration, elevated VBQ score, higher preoperative T1PA angle, and postoperative lordosis maldistribution providing valuable insights for surgical decision-making.
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