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A Comprehensive Radiological Parameter-Based Online Nomogram for Predicting Slower Functional Improvement After
Wei Zhang1, Yang Zhang2, Haibin Zhang2
1Spinal Surgery Center, The Second Affiliated Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia, China; Graduate School, Inner Mongolia Medical University, Hohhot, Inner Mongolia, China.
World Neurosurgery
|December 13, 2025
Summary
A new nomogram predicts slower functional improvement (SFI) after unilateral biportal endoscopic lumbar decompression (UBELD). It uses factors like Oswestry Disability Index and muscle attenuation to identify at-risk patients for better surgical planning.
Area of Science:
- Neurosurgery
- Orthopedic Surgery
- Medical Imaging
Background:
- Unilateral biportal endoscopic lumbar decompression (UBELD) is a common treatment for lumbar spinal stenosis.
- Some patients experience slower functional improvement (SFI) post-UBELD, necessitating predictive tools.
- Advanced imaging parameters can potentially predict SFI risk.
Purpose of the Study:
- To develop and validate a nomogram predicting SFI risk after UBELD.
- To integrate preoperative imaging and clinical factors for enhanced prediction accuracy.
- To provide a tool for individualized perioperative decision-making.
Main Methods:
- Patients were classified into SFI and non-SFI groups based on recovery.
- Predictors were screened using LASSO regression and multivariable logistic regression.
- A nomogram was constructed and validated in training/validation cohorts (7:3 ratio).
Main Results:
- 34.1% of 311 patients experienced SFI.
- Key predictors for SFI included lower Oswestry Disability Index, reduced psoas muscle attenuation, and lower facet preservation.
- The nomogram demonstrated good discrimination (AUC 0.878 training, 0.848 validation).
Conclusions:
- A novel nomogram effectively predicts SFI risk after UBELD.
- The nomogram integrates key clinical and imaging factors for predictive accuracy.
- This tool aids in identifying high-risk patients for tailored perioperative care.
