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Surgical Outcome P rognosis for the Patients with Degenerative L umbar S pine D isease

Surgical Outcome P rognosis for the Patients with Degenerative L umbar S pine D isease. Y.I. Zhuravlev , G.I. Nazarenko , A.M. Cherkashov , V.V. Ryazanov , A.G. Nazarenko. « Knowledge to foresee in order to be able ». Auguste Comte. Objective:.

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Surgical Outcome P rognosis for the Patients with Degenerative L umbar S pine D isease

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  1. Surgical Outcome Prognosis for the Patients with Degenerative Lumbar Spine Disease Y.I. Zhuravlev, G.I. Nazarenko, A.M. Cherkashov, V.V. Ryazanov, A.G. Nazarenko

  2. «Knowledge to foresee in order to be able» Auguste Comte Objective: To develop algorithms for outcome prognosis for the patients with degenerative lumbar spine disease

  3. Groups of Patients • 511patients with degenerative lumbar spine diseases were operated on from 1997 through 2010 185 patients,average age 54.7 years Radiofrequency destructionof facet nerves (RFG) 1-stgroup Percutaneous laser discectomy of lumbar discs with clinically significant protrusion detected (LD) 39 patients,average age 44.6 years 2-ndgroup Microdiscectomy at one or more levels with intervertebral disc extrusion without stabilization of vertebral segments (MLD) 182patients,average age 44.3 years 3-rdgroup 105patients,average age 47 years Discectomy followedby stabilization, (Fusion) 4-thgroup

  4. Groups of Patients 4-thgroup 2-ndgroup 1-stgroup 3-rdgroup

  5. Surgical Outcome Surgical outcome was assessed according to the modified criteria of Kawabata et al. (1973) I good (class 1) II fair (class 2) III poor (class 3) Marked improvementand no disabilities(minor sensory deficitand paresis grade 4/5with improvementat least 1 grade) Some residual symptoms (minor complaints)and abnormal objective findings (minor sensory deficit, mild atrophy, and paresis grade 3/5 or 4/5 with improvementon at least one grade) Poor, no improvement (major complaints, marked deficits and atrophy)or deterioration

  6. Association of Classes I good (class 1) II fair (class 2) III poor (class 3) I good (class 1) II poor (class 2)

  7. Measures for the Patient Evaluation, 28 Symptoms Measures for the patient evaluation

  8. Recognition Software Recognition Software DATABASE I good (class 1) II poor (class 2) Data was analyzed with original “RECOGNITION” software, allowing the application of the patients’ identification algorithm to the possible outcomes

  9. Prognosis Methods Test Recognition Algorithm (TRA) Decision Trees (DT) Recognition Software Logical Patterns (LP) For prognosis building following methods have been applied:

  10. Voting Principle II poor (class 2) Test Recognition Algorithm (TRA) II poor (class 2) II poor (class 2) Decision Trees (DT) Recognition Software I good (class 1) Logical Patterns (LP) Outcome prognosis was based on collective decision of these methods («voting»)

  11. Prognostic Accuracy (rate of correct answers at cross-validation) For radiofrequency destruction of facet nerves 89.7 – 100% Group I 89.7 – 100% Group II For laser discectomy 93.8 – 99.2% Group III For microdiscectomy 87.9 – 96.9% Group IV For spinal stabilization

  12. Conclusion • Algorithms obtained can be used for theoutcome prognosis of the arbitrary new patients. • The prognostic system allows to select an optimal operation type for the patients with degenerative lumbar spine disease

  13. Prognosis module is a part of «Russian Spine Registry» • Prognosis module of «Russian Spine Registry»is available in English language • www.spineregistry.ru

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