Эффективность системы прогнозирования результатов хирургического лечения пациентов с грыжами поясничных межпозвонковых дисков

Objective . To evaluate the effectiveness of a multivariate logistic regression model for the predicting surgical treatment results in patients with lumbar disc herniation. Materials and Methods . Study design: monocentric retrospective study. The study included patients operated on for lumbar disc herniation at levels L4–L5, L5–S1, with a 3-year follow-up. Two groups were identified: Group I included 350 patients (their data served as a basis for creation of multivariate logistic regression predicting model), and Group II – 514 patients (in this group, the effectiveness of the model was evaluated). Group II was divided into two subgroups: Subgroup IIa (recurrence probability 50 %) – 17 (3.3 %) patients. Patients in Subgroup IIa underwent microdisectomy, and in Subgroup IIb – spinal fusion. In order to obtain homogeneous pre-operative indicators of both group parameters, the PSM method was used. Statistical calculations were performed in the RStudio program. Results . In Group II, significant differences in indicators in the subgroups were noted for the following parameters (p < 0.05): smoking, disc height index, segmental volume of movement, lumbar lordosis angle, type of intervertebral hernia (except for sequestration), Modic changes, and stage of intervertebral disc degeneration according to Pfirrmann. In Subgroup IIa, 8 (1.6 %) reoperations were performed, in Subgroup IIb – 2 (0.4 %). Using the PSM method, the data of groups I and II were flattened out for significantly different indicators. The sample size was 37 patients in each group. The number of reoperations in the groups differed statistically significantly: Group I – 35 % [22 %; 51 %]; Group II – 5 % [1 %; 18 %]. The risk of reoperation in Group II is 0.13 [0.03; 0.58] times lower than in Group I (p = 0.002). Conclusions . The proposed system for predicting the results of surgical treatment of patients with intervertebral disc hernia can be used as a tool to determine the surgical tactics aimed at reducing the frequency of reoperations.