Development and Validation of a Novel Nomogram to Predict the Risk of Intervertebral Disc Degeneration

Abstract

Intervertebral disc degeneration (IVDD) has been a complex disorder resulted from genetic and environmental risk factors. The aim of this study was to identify the risk factors associated with IVDD in orthopaedic patients and develop a prediction model for predicting the risk of IVDD. A total of 309 patients were retrospectively included in the study and randomly divided into the training group and the validation group. The least absolute shrinkage and selection operator regression (LASSO) and the univariate logistic regression analysis were used to optimize factors selection for the IVDD risk model. Multivariable logistic regression analysis was used to establish a predicting nomogram model incorporating the factors. In addition, discrimination, calibration, and clinical usefulness of the nomogram model were evaluated via the C-index, receiver operating characteristic (ROC) curve, calibration plot, and decision curve analysis (DCA). Then, based on the results above, the relationship between IVDD and angiotensin II (AngII) level in peripheral blood was examined prospectively. The predictors of the nomogram include age, sex, hypertension, diabetes, gout, working posture, and exercising hours per week. The C -index values of the training and validation groups were 0.916 (95% CI, 0.876-0.956) and 0.949 (95% CI, 0.909-0.989), respectively, which indicated that the model displayed good discrimination. In addition, the area under the curve (AUC) values of the ROC curve of the training and the validation group were 0.815 (95% CI, 0.759-0.870) and 0.805 (95% CI, 0.718-0.892), respectively, revealing the satisfactory discrimination performance of the model. The prospective investigation showed that the average AngII level in the degenerated group ( 97.62 ± 44.02 pg/mL) was significantly higher than that in the nondegenerated group ( 52.91 ± 9.01 pg/mL) ( p < 0.001 ). This present study explored the risk factors for IVDD and established a prediction model, which would effectively predict the risk of IVDD. In addition, based on the prediction model, AngII was revealed to be a potentially auxiliary clinical diagnostic marker for IVDD.

Ozone in the adjunct medical treatment. The round personality of a molecule with hormetic properties

“…The inflammatory response is triggered by the leakage of the gel-like nucleus pulposus material from the herniated disc, which acts as an irritant to surrounding tissues. [103][104][105] As a consequence, an infiltration of an immune population of cells rapidly occurs. 104 In response to the leaked nucleus pulposus material, immune cells, such as macrophages, neutrophils, and lymphocytes, migrate to the site of inflammation.…”

“…The regulation of this inflammatory milieu is of paramount importance. 105 Degeneration may follow an increased vascularity. 106 The herniated disc becomes more vascularized during inflammation.…”

“…The inflammatory mediators can induce the production of enzymes, such as matrix metalloproteinases (MMPs), which degrade the extracellular matrix components of the disc, including collagen and proteoglycans. This degradation weakens the disc structure and can contribute to further disc degeneration 104,105 and nerve sensitization.…”

Achilles’ Heel—The Significance of Maintaining Microenvironmental Homeostasis in the Nucleus Pulposus for Intervertebral Discs

“…The management of age-related disc degeneration involves various strategies aimed at reducing or mitigating the progression of disc degeneration. Hypertension, inadequate physical activity, and gout have been identified as potential factors contributing to disc degeneration, according to a study [130]. Furthermore, there exists a correlation between obesity and the degeneration of intervertebral discs [131].…”

Diffusion Idiopathic Skeletal Hyperostosis (DISH), a Link between Gut Microbiota and Spinal Degenerative Diseases<strong> </strong>

“…An imbalance in the gut microbiome, referred to as dysbiosis, has been associated with gut inflammation. Some studies suggest that gut dysbiosis might be linked to systemic inflammation that could impact IDD [120]. Inflammation in the gut can impair nutrient absorption.…”