Artificial intelligence in predicting early-onset adjacent segment degeneration following anterior cervical discectomy and fusion
Samuel S. Rudisill, Alexander L. Hornung, J. Nicolás Barajas, Jack J. Bridge, G. Michael Mallow, Wylie Lopez, Arash J. Sayari, Philip K. Louie, Garrett K. Harada, Youping Tao, Hans-Joachim Wilke, Matthew W. Colman, Frank M. Phillips, Howard S. An, Dino Samartzis
May 2022, pp 1 - 11 Supplement Article Read Full Article 10.1007/s00586-022-07238-3
First Online: 11 May 2022
Purpose
Anterior cervical discectomy and fusion (ACDF) is a common surgical treatment for degenerative disease in the cervical spine. However, resultant biomechanical alterations may predispose to early-onset adjacent segment degeneration (EO-ASD), which may become symptomatic and require reoperation. This study aimed to develop and validate a machine learning (ML) model to predict EO-ASD following ACDF.
Methods
Retrospective review of prospectively collected data of patients undergoing ACDF at a quaternary referral medical center was performed. Patients > 18 years of age with > 6 months of follow-up and complete pre- and postoperative X-ray and MRI imaging were included. An ML-based algorithm was developed to predict EO-ASD based on preoperative demographic, clinical, and radiographic parameters, and model performance was evaluated according to discrimination and overall performance.
Results
In total, 366 ACDF patients were included (50.8% male, mean age 51.4 ± 11.1 years). Over 18.7 ± 20.9 months of follow-up, 97 (26.5%) patients developed EO-ASD. The model demonstrated good discrimination and overall performance according to precision (EO-ASD: 0.70, non-ASD: 0.88), recall (EO-ASD: 0.73, non-ASD: 0.87), accuracy (0.82), F1-score (0.79), Brier score (0.203), and AUC (0.794), with C4/C5 posterior disc bulge, C4/C5 anterior disc bulge, C6 posterior superior osteophyte, presence of osteophytes, and C6/C7 anterior disc bulge identified as the most important predictive features.
Conclusions
Through an ML approach, the model identified risk factors and predicted development of EO-ASD following ACDF with good discrimination and overall performance. By addressing the shortcomings of traditional statistics, ML techniques can support discovery, clinical decision-making, and precision-based spine care.
Read Full Article