Table 3.
Authors (year) | No. of cases | Variables considered for model | Variables in final model | C-index | AUC/ROC | R2 | Positive predictive value (PPV) | Validation cohort | Model (application) available |
---|---|---|---|---|---|---|---|---|---|
Asher et al. (2017) [27] | 4694 | NR | Age; gender; race; smoking status; employment; occupation type; past surgery; number of spinal levels; ASA grade; BMI; diabetes; osteoporosis; CAD; education level; anxiety; depression; dominant symptom; motor deficit; symptom duration; principal spinal diagnosis; workers’ compensation; liability insurance for disability; insurance type; ambulatory status; lumbar fusion, anterior, posterior or combined approach; preoperative ODI, EQ-5D, and NRS-BP/LP scores | 0.71 (good) | NR | NR | NR | BS | http:// statcomp2.vanderbilt.edu:37212/app_0/ |
Devin et al. (2018) [29] | 4689 | Age; gender; ethnicity; insurance status; education level; occupation level; occupation intensity; employment type; workers’ compensation status; smoking status; diabetes mellitus; CAD; PVD; anxiety; depression; osteoporosis; median BMI; ASA grade; symptom duration; predominant symptom; ambulation; presence of motor deficit; presence of cervical instability; pseudarthrosis; adjacent-segment disease; ACDF; disc herniation; foraminal stenosis; central stenosis; minimally invasive surgery; number of levels fused; NDI; VAS; NASS satisfaction score at 3 months | Age; full time vs part time; education level; employment; occupation intensity; workers’ compensation; baseline NDI; symptom duration; predominant symptom; levels fused | 0.81 (excellent) | NR | NR | NR | BS | Nomogram created |
Genov et al. (2018) [28] | 291,272 | Age; gender; BMI; education Level; smoking; pain at rest and in motion; pain intensity, duration and frequency; analgesic use; VAS; situational and Personal Anxiety Index; Beck Depression Index; Tampa Scale of Kinesiophobia; Pain Catastrophizing Scale; pain threshold and pain tolerance | Mild dynamic pain on 1st postoperative day: motion pain before surgery (VAS); expected pain (VAS); pain threshold; gender; **Constant chronic pain syndrome 5–7 months after surgery: age; motion pain on the 1st postoperative day (VAS); **Constant | NR | NR | NR |
1st-postop day pain: PPV: 70%, 95% CI (63–76) CPS 5–7 months after surgery PPV: 65%; 95% CI (59–71) |
BS | Formula given; MS Excel |
Hegarty and Shorten (2012) [24] | 53 | Gender; age; VAS; PPI; McGill Word; RMF; Pain Catastrophizing Scale; Anxiety score; Depression score | Age, RMF, PPI | 0.658 | NR | NR | NR | BS | NR |
Khor et al. (2018) [5] | 1965 | NR | Age; sex; race; insurance; ASA score; smoking status; diagnoses; prior surgery status; prescription opioid use; asthma; and baseline PRO scores | 0.66–0.79 |
ODI: 0.66 NRS-BP: 0.79 NRS-LP: 0.69 |
NR | NR | 15% of sample | https://becertain.shinyapps.io/lumbar_fusion_calculator |
Lee et al. (2016) [31] | 376 | ED-5Q domains: mobility (M); self-care (S); usual activities (A); pain/discomfort (P); anxiety/depression (D) | Regression equation for ED-5Q subcategories to determine risk: S + A + 2xP + D > = 9 | NR | NR | NR | NR | Positive predictions 86% with cutoff value = 9 | S + A + 2xP + D > = 9 domains from ED-5Q |
Lubelski et al. (2018) [3] | 952 | Age; gender; race; marital status; BMI; smoking status; income; comorbidities; presenting symptoms; symptom duration; type of surgery; indications for surgery; total number of operated spinal levels | 30-day ED visit: race; BMI; zip code; median income; surgical approach; spondylosis; total number of operated levels 30-day readmission: race; BMI; diagnosis of disc herniation or myelopathy; surgical approach; number of levels; terminal level; history of cancer 90-day reoperation: BMI; presenting symptoms; presence of disc herniation; surgical approach; presence of diabetes; change ED-5Q: herniation; myelopathy; surgical approach; diabetes mellitus; preoperative EQ-5D; preoperative PDQ change PHQ-9: age; herniation; surgical approach; diabetes mellitus; preoperative PHQ-9 change in PDQ: BMI; smoking status; spondylosis; surgical approach; preoperative EQ-5D |
*3-day ED visit: 0.63 *30-day readmission: 0.78 *90-day Reoperation: 0.91 |
NR |
EQ-5D: 0.43 PHQ-9: 0.35 PDQ: 0.47 |
NR | BS | http://riskcalc.org/PatientsEligibleforCervicalSpineSurgery/ |
McGirt (2017) [6] | 7618 | Age; gender; BMI; race; education level; history of surgery; smoking status; comorbid conditions; ASA grade; symptom duration; predominant presenting symptom; workers’ compensation; liability insurance; insurance status; ambulatory ability; baseline PROs; surgery-specific variables: number of levels, need for arthrodesis and surgical approach | Age; gender; BMI; race; education level; history of prior surgery; smoking status; comorbid conditions; ASA grade; symptom duration; indication for surgery; number of levels surgically treated; history of fusion surgery; surgical approach; receipt of workers’ compensation; liability insurance; insurance status; ambulatory ability; baseline PROMs |
Disability: 0.69 QOL: 0.69 Back pain: 0.67 Leg pain: 0.64 |
NR | NR | NR | NR | Not functional http://statcomp2.vanderbilt.edu:37212/app_0/ |
McGirt (2015) [23] | 1803 | Age; gender; race; BMI; employment; symptom duration; prior surgeries; narcotic use; smoking status; insurance; acute or chronic; neurologic symptoms; past medical history; baseline PRO scores; fracture; deformity; spinal diagnosis | Age; gender; baseline ODI; prior surgery; narcotic use (days); private insurance; number of levels involved; ASA grade ≥ 2; hypertension; arthritis; diabetes; BMI; MSPQ; fusion | NR |
0.72–0.84 for 5 predictive models 0.82 for unplanned postoperative outcome Complications: 0.82* Readmission: 0.79* Inpatient rehabilitation: 0.84* Return to work: 0.83 Unplanned outcome: 0.78* |
12-month ODI: 0.51 Validated—12-month ODI: 0.47 |
NR | 20% of cohort | NR |
Merali et al. (2019) [26] |
6-month: 605 12-month: 583 24-month: 539 |
Patient demographics; clinical presentation; surgical treatment; detailed medical co-morbidities |
6 months: 41 features 12 months: 108 features 24 months: 101 features |
NR |
SF-6D 6 months: 0.71 12 months: 0.70 24 months: 0.73 mJOA 6 months: 0.73 12 months: 0.73 24 months: 0.67 |
NR |
SF-6D 6 months: 0.90 12 months: 0.98 24 months: 0.92 mJOA 6 months: 0.82 12 months: 0.91 24 months: 0.96 |
70% training/validation,30% testing dataset | NR |
Sharma et al. (2019) [30] | 191 | Age; sex; race; BMI; diagnosis; EQ-5D score; history of spinal trauma; history of spinal surgery; operative approach (anterior vs posterior); number of spinal levels fused; comorbid dyslipidemia, obesity, hypertension, diabetes mellitus, tobacco use disorder | Pre-op EDQ score, sex, pre-op diagnosis (degenerative, idiopathic, iatrogenic), previous spinal surgery history, obesity, sex-by-obesity interaction term |
0.739 BS sample = .764 |
0.89 | NR | NR | BS | Nomogram provided in paper |
Siccoli et al. (2019) [25] | 635 | Baseline PROs; sex; age; height; weight; BMI; smoking status; regular alcohol intake; ASA grade; prior surgery at index level; single or multi-level decompression; index levels; present of concomitant spondylolisthesis; predominant presenting symptoms (claudication or radiculopathy) | NR | NR |
6 weeks: ODI: 0.71 NRS-BP: 0.75 NRS-LP: 0.87 *Reop overall: 0.63 *Reop at level: 0.70 *Prolonged surgery: 0.61 *Extended stay: 0.77 12 months: ODI:0.73 NRS-BP: 0.72 NRS-LP: 0.75 *Reop overall: 0.66 *Reop at level: 0.61 *Prolonged surgery: 0.54 *Extended stay: 0.58 |
NR |
6 weeks: ODI: 0.73 NRS-BP: 0.84 NRS-LP: 0.79 12 months: ODI: 0.80 NRS-BP: 0.76 NRS-LP: 0.72 |
BS; 70% training, 30% testing | NR |
Staartjes et al. (2018) [32] | 422 | Age; gender; height (cm); weight (kg); BMI; smoking status; alcohol consumption; recreational drug use; ASA grade; prior discectomy at the index level; location of herniation; classification as a far-lateral or sequestered herniation; classification as broad bulging disc without annular rupture compressing nerve roots; presence of stenosis or spondylolisthesis at index level; baseline PROMs—ODI, NRS-BP, NRS-LP | Age; BMI; gender: ASA score; smoking status; prior discectomy at index level; sequestered disc herniation; NRS leg pain; NRS back pain; ODI; predicted likelihood of achieving MCID in leg pain, back pain, and functional disability | NR |
NRS-LP = .87 (deep learning), 0.78 (regression) NRS-BP = .90 (deep learning), 0.55 (regression) ODI = 0.84 (deep learning), 0.72 (regression) |
NR | NR | Training/validation/testing cohorts of 60%/20%/20% of data | NR |
NR not reported, ACDF anterior cervical discectomy and fusion, ASA American Society of Anesthesiologists, BS bootstrapping, BMI body mass index, CAD coronary artery disease, ODI Oswestry Disability Index, NDI Neck Disability Index, ED-5D EuroQOL-5 Dimension Questionnaire, PRO patient-reported outcome, PVD peripheral vascular disease, MCID minimal clinically important difference, NASS North American Spine Society, NRS Numeric Rating Scale, BP back pain, LP leg pain, VAS Visual Analog Scale, QOL quality of life, PDQ Pain/Disability Questionnaire, PHQ-9 Patient Health Questionnaire-9, PPI persistent pain intensity, Reop reoperation, RMF Roland-Morris Functional score
*Statistic reported as a component of a given risk assessment model but does not fit inclusion criteria and therefore is not discussed in this review
**Constant value included in model