Predicting the Failure Risk of Internal Fixation Devices in Chinese Patients Undergoing Spinal Internal Fixation Surgery: Development and Assessment of a New Predictive Nomogram

Abstract

The current study is aimed at developing and validating a nomogram of the risk of failure of internal fixation devices in Chinese patients undergoing spinal internal fixation. We collected data from a total of 1139 patients admitted for spinal internal fixation surgery at the First Affiliated Hospital of Guangxi Medical University from May 2012 to February 2019. Of these, 1050 patients were included in the spinal internal fixation group and 89 patients in the spinal internal fixation device failure group. Patients were divided into training and validation tests. The risk assessment of the failure of the spinal internal fixation device used 14 characteristics. In the training test, the feature selection of the failure model of the spinal internal fixation device was optimized using the least absolute shrinkage and selection operator (LASSO) regression model. Based on the characteristics selected in the LASSO regression model, multivariate logistic regression analysis was used for constructing the model. Identification, calibration, and clinical usefulness of predictive models were assessed using C-index, calibration curve, and decision curve analysis. A validation test was used to validate the constructed model. In the training test, the risk prediction nomogram included gender, age, presence or absence of scoliosis, and unilateral or bilateral fixation. The model demonstrated moderate predictive power with a C-index of 0.722 (95% confidence interval: 0.644–0.800) and the area under the curve (AUC) of 0.722. Decision curve analysis depicted that the failure risk nomogram was clinically useful when the probability threshold for internal fixation device failure was 3%. The C-index of the validation test was 0.761. This novel nomogram of failure risk for spinal instrumentation includes gender, age, presence or absence of scoliosis, and unilateral or bilateral fixation. It can be used for evaluating the risk of instrumentation failure in patients undergoing spinal instrumentation surgery.

Comparison of Clinical Data Between Patients With Complications and Without Complications After Spinal Tuberculosis Surgery: A Propensity Score Matching Analysis

“…There was a potential risk of cerebrospinal fluid leakage and reduced albumin after surgery for spinal tuberculosis ( 10 , 11 ). In addition, we also found a risk of internal fixation failure following spinal surgery ( 12 ). In a recent study of spinal tuberculosis, our team found that spinal tuberculosis was prone to recurrence after surgery and the risk of pulmonary embolism after multiple surgical treatments ( 13 ).…”

Screw Osteointegration—Increasing Biomechanical Resistance to Pull-Out Effect

“…Often used in various combinations, spinal fixation devices aid in holding the vertebrae together as one solid unit [ 13 ]. Consequently, such internal fixation systems are responsible for stabilizing spine structure, restoring its endurance, and ensuring its functionality [ 10 ]. To achieve these roles, they must be made of biocompatible or biologically inert materials with a Young’s modulus similar to that of natural bone, high tensile strength, stiffness, fatigue strength, and low artifacts on imaging.…”

“…Since then, ensuring the mechanical stability of the spine has become a must for obtaining successful surgical outcomes, with scientists developing more and more varied and effective orthopedical implants [ 2 , 7 , 8 ]. Utilizing internal fixation systems, such as screws, rigid rods, plates, wires, and cages, is vital for stabilizing the spine’s structure, restoring its endurance, and protecting its function [ 2 , 5 , 6 , 9 , 10 ].…”