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Prediction of Proximal Junctional Kyphosis After Posterior Scoliosis Surgery With Machine Learning in the Lenke 5 Adolescent Idiopathic Scoliosis Patient.

ABSTRACT: Objective:To build a model for proximal junctional kyphosis (PJK) prognostication in Lenke 5 adolescent idiopathic scoliosis (AIS) patients undergoing long posterior instrumentation and fusion surgery by machine learning and analyze the risk factors for PJK. Materials and Methods:In total, 44 AIS patients (female/male: 34/10; PJK/non-PJK: 34/10) who met the inclusion criteria between January 2013 and December 2018 were retrospectively recruited from West China Hospital. Thirty-seven clinical and radiological features were acquired by two independent investigators. Univariate analyses between PJK and non-PJK groups were carried out. Twelve models were built by using four types of machine learning algorithms in conjunction with two oversampling methods [the synthetic minority technique (SMOTE) and random oversampling]. Area under the receiver operating characteristic curve (AUC) was used for model discrimination, and the clinical utility was evaluated by using F1 score and accuracy. The risk factors were simultaneously analyzed by a Cox regression and machine learning. Results:Statistical differences between PJK and non-PJK groups were as follows: gender (p = 0.001), preoperative factors [thoracic kyphosis (p = 0.03), T1 slope angle (T1S, p = 0.078)], and postoperative factors [T1S (p = 0.097), proximal junctional angle (p = 0.003), upper instrumented vertebra (UIV) - UIV + 1 (p = 0.001)]. Random forest using SMOTE achieved the best prediction performance with AUC = 0.944, accuracy = 0.909, and F1 score = 0.667 on independent testing dataset. Cox model revealed that male gender and larger preoperative T1S were independent prognostic factors of PJK (odds ratio = 10.701 and 57.074, respectively). Gender was also at the first place in the importance ranking of the model with best performance. Conclusion:The random forest using SMOTE model has the great value for predicting the individual risk of developing PJK after long instrumentation and fusion surgery in Lenke 5 AIS patients. Moreover, the combination of the outcomes of a Cox model and the feature ranking extracted by machine learning is more valuable than any one alone, especially in the interpretation of risk factors.

SUBMITTER: Peng L

PROVIDER: S-EPMC7573316 | biostudies-literature | 2020

REPOSITORIES: biostudies-literature

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Prediction of Proximal Junctional Kyphosis After Posterior Scoliosis Surgery With Machine Learning in the Lenke 5 Adolescent Idiopathic Scoliosis Patient.

Peng Li L Lan Lan L Xiu Peng P Zhang Guangming G Hu Bowen B Yang Xi X Song Yueming Y Yang Xiaoyan X Gu Yonghong Y Yang Rui R Zhou Xiaobo X

Frontiers in bioengineering and biotechnology 20201006

<h4>Objective</h4>To build a model for proximal junctional kyphosis (PJK) prognostication in Lenke 5 adolescent idiopathic scoliosis (AIS) patients undergoing long posterior instrumentation and fusion surgery by machine learning and analyze the risk factors for PJK.<h4>Materials and methods</h4>In total, 44 AIS patients (female/male: 34/10; PJK/non-PJK: 34/10) who met the inclusion criteria between January 2013 and December 2018 were retrospectively recruited from West China Hospital. Thirty-sev ...[more]

PMID: 33123512

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Project description:BackgroundAfter surgical treatment of adolescent idiopathic scoliosis (AIS), doctors should not only focus on the short-term surgical effect, but also pay special attention to whether the patients can live normally in the long-term. This work compared the long-term effects of thoracoscopy-assisted anterior spinal fusion (ASF) and posterior spinal fusion (PSF) in AIS.MethodsTwenty-two patients underwent thoracoscopy-assisted ASF, and twenty-three patients underwent PSF from 2004 to 2009 were involved , including 14 males and 31 females with an average age of 14.8±2.6 years, and all patients suffered from only Lenke type 1 AIS. The mean follow-up time was 102 months, the radiographic parameters and operation time, hospitalization time, fusion segments and estimated blood loss were evaluated. Comparisons between groups were made such as Cobb's angle, thoracic kyphosis, the instrumented levels, curve correction, preoperative parameters, SF-36/SRS-22 questionnaire scores, and pulmonary function.ResultsThere was no significant difference in age, gender, Risser sign and follow-up period between two groups. The instrumentation level had an average of 6 in the thoracoscopy-assisted ASF group and 9.7 in the PSF group (P<0.001). The average correction rate of the main curve was 67.4% in ASF group versus 79.2% in PSF group (P>0.05). The postoperative thoracic kyphosis was 16.2°±3.9° in ASF group and 25.6°±4.4° in PSF group (P=0.023). Patients had momentous advancement in self-image, vitality and mental health in the SRS-22 and SF-36 questionnaires. Compared to preoperatively, the pulmonary function of both groups was satisfactorily improved at the final follow-up.ConclusionsSince there was no statistically significant difference in the general conditions of the two groups selected for this study, so we finally concluded that thoracoscopy-assisted ASF had a satisfactory correction rate, famous long-term radiography outcomes and desirable pulmonary function results. However, compared to PSF, it has a longer operation time, a more complicated surgical procedure and a weaker three-dimensional correction effect, and PSF has affirmative long-term outcomes, fewer complications, and satisfactory sagittal balance, all of which make PSF the standard operation to treat AIS.

Project description:INTRODUCTION:Altered trunk shape and body alignment in Lenke 1 thoracic adolescent idiopathic scoliosis (AIS) may affect the body's balance control during activities. The current study aimed to identify the effects of Lenke 1 thoracic AIS on the balance control during level walking in terms of the inclination angles (IA) of the center of mass (COM) relative to the center of pressure (COP), the rate of change of IA (RCIA), and the jerk index of IA. The association between the Cobb angle, IA and RCIA was also evaluated. MATERIALS AND METHODS:Sixteen adolescents with AIS (age: 14.0±1.8 years, height: 154.8±4.7 cm, mass: 42.0±7.5 kg) and sixteen healthy controls (age: 14.4±2.0 years, height: 158.4±6.2 cm, body mass: 48.6±8.9 kg) performed level walking in a gait laboratory. The kinematic and ground reaction force data were measured for both concave-side and convex-side limb cycles, and used to calculate the IA and RCIA, the jerk index of IA, and the temporal-spatial parameters. Correlations between the Cobb angle, IA and RCIA were quantified using Pearson's correlation coefficients (r). RESULTS:The patients showed less smooth COM-COP motion with increased jerk index of IA in the sagittal plane during single limb support (SLS) of the concave-limb (p = 0.05) and in the frontal plane during double limb support (DLS) (p < 0.05). The patients also showed significantly increased posterior RCIA on both the concave and convex side during initial (p = 0.04, p = 0.03) and terminal (p = 0.04, p = 0.03) DLS when compared to healthy controls. In the frontal plane, the patients walking on the concave-side limb showed decreased IA over SLS (p = 0.01), and at contralateral toe-off (p<0.01) and contralateral heel-strike (p = 0.02), but increased mean IA magnitude over terminal DLS (p = 0.01). The frontal IA at contralateral toe-off and SLS for AIS-A showed a moderate to strong correlation with Cobb angles (r = -0.46 and -0.61), and the sagittal RCIA over the initial DLS for AIS-A also showed a significant, strong correlation with Cobb angles (r = -0.50). CONCLUSIONS:The patients with Lenke 1 thoracic scoliosis in the current study showed altered and jerkier COM-COP control during level walking when compared to healthy controls. During DLS, the patients increased the posterior RCIA in the sagittal plane with increased IA jerk index in the frontal plane for both the concave- and the convex-side limb, indicating their difficulty in maintaining a smooth transfer of the body weight. During SLS of the concave-side limb, the patients adopted a conservative COM-COP control strategy, as indicated by a decreased IA in the frontal plane, but showed a jerky COM-COP control in the sagittal plane. The COM-COP control of the patients was associated with the severity of the spinal deformity. The current results suggest that this patient group should be monitored for signs of an increased risk of loss of balance during weight transfer on the concave-side limb.

Project description:BackgroundSurgical management of adolescent idiopathic scoliosis (AIS) can be performed using standard posterior spinal fusion (PSF) or with a posterior minimally invasive approach. Minimally invasive scoliosis surgery (MISS) has several theoretical advantages, such as less tissue dissection, less blood loss, and earlier recovery. However, the difference in safety and effectiveness between MISS and PSF still needs to be clarified. This updated meta-analysis aimed to compare the outcomes of MISS and standard PSF for the management of AIS.MethodsA comprehensive literature search of PubMed, EMBASE, MEDLINE, and Cochrane Library without time restriction was performed to identify relevant studies. MISS and PSF were compared in terms of radiographic parameters, estimated blood loss (EBL), blood transfusion rate, operative time (ORT), length of hospital stay (LOS), overall Scoliosis Research Society-22 (SRS-22) score, postoperative pain, and complication rate.ResultsA total of seven studies comprising 767 patients (329 MISS and 438 PSF) with AIS were included. MISS and PSF yielded comparable deformity correction at the last follow-up. There were no significant differences in the overall SRS-22 scores or complication rates between the groups. Nevertheless, greater restoration of thoracic kyphosis (WMD, 2.98; 95% CI 0.58 to 5.37, P = 0.015), less EBL (WMD, -218.76; 95% CI -256.41 to -181.11, P < 0.001), a lower blood transfusion rate (RR, 0.31; 95% CI 0.20 to 0.48, P < 0.001), a shorter LOS (WMD, -1.48; 95% CI -2.48 to -0.48, P = 0.004), less postoperative pain (WMD, 0.57; 95% CI 0.16 to 0.98, P = 0.006), and a longer ORT (WMD, 84.85; 95% CI 33.30 to 136.40, P = 0.001) were observed in the MISS group.ConclusionDespite its inherent technical challenges, MISS is a feasible and effective alternative to standard PSF for AIS patients with moderate and flexible curves. MISS was associated with adequate deformity correction, better restoration of sagittal alignment, less EBL, fewer transfusions, shorter LOS, and better pain management compared to PSF. Further research is required to determine the detailed indications for the MISS procedure.

Project description:BACKGROUND:Selective thoracolumbar/lumbar fusion technique was introduced to treat adolescent idiopathic scoliosis (AIS) patients with major thoracolumbar/lumbar curves. Theoretically, this surgical strategy could also be applied to syringomyelia patients. No previous study has specifically addressed the effectiveness of selective thoracolumbar/lumbar fusion for patients with syringomyelia-associated scoliosis. The aim of the study was to investigate the effectiveness of selective thoracolumbar/lumbar fusion for the surgical treatment of patients with syringomyelia-associated scoliosis. METHODS:From February 2010 to September 2016, 14 syringomyelia-associated patients with major thoracolumbar/lumbar curves were retrospectively reviewed. Besides, 30 Lenke 5C AIS patients were enrolled as a control group. Posterior selective thoracolumbar/lumbar fusion was performed for both groups. Patients' demographic, operative, radiological, and quality of life data were reviewed with follow-up. Intragroup comparisons were performed for each parameter. RESULTS:The two groups were matched by age, gender, curve characteristics, duration of follow-up, and all preoperative radiographic parameters except for thoracic kyphosis. After surgery, the average correction rate of the major thoracolumbar/lumbar curve was 82.2?±?7.8% in the syringomyelia group, which was not significantly different from that of AIS group (82.5?±?10.6%, P?=?0.47). A similar improvement of unfused thoracic curve was observed between the two groups (50.1?±?16.5% vs. 48.5?±?26.9%, P?=?0.29). During the follow-up, the correction effect of scoliosis was well maintained, without aggravation of the original neural symptoms or fresh permanent neurological deficits. Of note, the number of fusion levels was significantly larger in syringomyelia group than that in AIS group (7.6?±?1.4 vs. 6.5?±?1.2, P?<?0.01). The average follow up was 47.6?months (36-81?months). CONCLUSION:Similar to AIS cases, syringomyelia-associated scoliosis can be effectively and safely corrected by selective thoracolumbar/lumbar fusion with satisfactory surgical outcomes. However, the syringomyelia group, on average, required an additional fused segment for treatment as compared to the AIS group (7.6 versus 6.5 in the AIS group).

Project description:IntroductionAlthough much attention has been given to the global three-dimensional aspect of adolescent idiopathic scoliosis (AIS), the accurate three-dimensional morphology of the primary and compensatory curves, as well as the intervening junctional segments, in the scoliotic spine has not been described before.MethodsA unique series of 77 AIS patients with high-resolution CT scans of the spine, acquired for surgical planning purposes, were included and compared to 22 healthy controls. Non-idiopathic curves were excluded. Endplate segmentation and local longitudinal axis in endplate plane enabled semi-automatic geometric analysis of the complete three-dimensional morphology of the spine, taking inter-vertebral rotation, intra-vertebral torsion and coronal and sagittal tilt into account. Intraclass correlation coefficients for interobserver reliability were 0.98-1.00. Coronal deviation, axial rotation and the exact length discrepancies in the reconstructed sagittal plane, as defined per vertebra and disc, were analyzed for each primary and compensatory curve as well as for the junctional segments in-between.ResultsThe anterior-posterior difference of spinal length, based on "true" anterior and posterior points on endplates, was +3.8% for thoracic and +9.4% for (thoraco)lumbar curves, while the junctional segments were almost straight. This differed significantly from control group thoracic kyphosis (-4.1%; P<0.001) and lumbar lordosis (+7.8%; P<0.001). For all primary as well as compensatory curves, we observed linear correlations between the coronal Cobb angle, axial rotation and the anterior-posterior length difference (r≥0.729 for thoracic curves; r≥0.485 for (thoraco)lumbar curves).ConclusionsExcess anterior length of the spine in AIS has been described as a generalized growth disturbance, causing relative anterior spinal overgrowth. This study is the first to demonstrate that this anterior overgrowth is not a generalized phenomenon. It is confined to the primary as well as the compensatory curves, the junctional zones do not exhibit this growth discrepancy, however, they are straight.

Dataset Information

Prediction of Proximal Junctional Kyphosis After Posterior Scoliosis Surgery With Machine Learning in the Lenke 5 Adolescent Idiopathic Scoliosis Patient.

Publications

Prediction of Proximal Junctional Kyphosis After Posterior Scoliosis Surgery With Machine Learning in the Lenke 5 Adolescent Idiopathic Scoliosis Patient.

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