Assessment of Clinical Decision Support System Efficiency in Spinal Neurosurgery for Personalized Minimally Invasive Technologies Used on Lumbar Spine

Abstract

The aim of the study was to assess clinical decision support system (CDSS) in spinal surgery for personalized minimally invasive technologies on lumbar spine. Materials and Methods The prospective study involved 59 patients operated on using CDSS based on a personalized surgical algorithm considering patient-specific parameters of lumbar segments. Among them, 11 patients underwent total disk replacement (TDR), 25 and 23 patients had minimally invasive (MI-TLIF) and open (O-TLIF) dorsal rigid stabilization, respectively, according to an original technology. The comparative analysis was carried out using retrospective findings of 196 patients operated on involving TDR (n=42), MI-TLIF (n=79), and O-TLIF (n=75). The efficiency of CDSS medical algorithms was assessed by pain syndrome in the lumbar spine and lower limbs, as well as by patients’ functional status on discharge according to ODI, 3 and 6 months after the operation. Results The comparison by gender characteristics and anthropometric data revealed no significant intergroup differences among the groups under study (p>0.05). Intergroup analysis of functional status by ODI, pain intensity in lower limbs and lumbar spine showed better clinical outcomes in patients operated using CDSS compared to a retrospective group (p<0.05): 6 months after TDR and O-TLIF, and 3 months after MI-TLIF. Conclusion The study findings demonstrated high efficiency of CDSS developed for personalized surgical treatment of patients with degenerative lumbar spine diseases taking into consideration individual biometric parameters of lumbar segments.

Clinical Decision Support System Used in Spinal Disorders: Scoping Review

“…Of the 31 CDSS studies reviewed, studies exploring the use of CDSS for treatment recommendations for spinal disorders were divided into 2 categories based on their focus: 2 (6%) CDSSs for recommendations for spinal surgery [ 55 , 58 ] and 4 (13%) CDSSs for treatment of LBP [ 38 , 41 , 56 , 57 ] ( Table 5 ). All CDSSs were knowledge based, except for 1, which was structured on medical ontology and fuzzy logic principles [ 55 ]. The system inputs required to generate personalized treatment recommendations include symptoms, clinical findings, and instrumental findings.…”

“…Byvaltsev and Kalinin [ 55 ] studied using a CDSS to recommend total disc replacement, minimally invasive rigid stabilization, and open rigid stabilization [ 55 ]. The researchers observed lower pain levels and improved functional status 6 months after surgery among those who received treatment recommendations using the CDSS [ 55 ]. Those who underwent minimally invasive rigid stabilization had better outcomes 3 months after surgery [ 55 ].…”

“…The researchers observed lower pain levels and improved functional status 6 months after surgery among those who received treatment recommendations using the CDSS [ 55 ]. Those who underwent minimally invasive rigid stabilization had better outcomes 3 months after surgery [ 55 ]. In the work of Benditz et al [ 38 ], although 49.6% (55/111 cases) of the treatment recommendations made by the CDSS were consistent with those of spinal surgeons, 36% (40/111) were overestimated and 14.4% (16/111) were underestimated [ 38 ].…”