Nomogram that can predict failure of conservative treatment for thoracolumbar burst fracture was established

Abstract

Abstract Objective: This research aimed to identify risk factors for the failure of conservative treatment for thoracolumbar burst fracture (TBF) and develop a nomogram to predict it. Methods: A total of 152 patients with TBF who underwent conservative treatment were evaluated, including successfully-received-conservative-treatment (SRCT) group (120 cases) and converted-to-surgical-treatment (CST) group (32 cases), in our medical center from December 2016, to December 2022. The risk factors for CST were identified using univariate and multivariate logistic regression analyses. Then, a nomogram was created and evaluated using the bootstrap method. The discrimination, calibration, and clinical value of the nomogram were assessed using the receiver operating characteristic curve (ROC), a calibration curve, a clinical impact curve (CIC), and decision curve analysis (DCA). Results: Age, smoking, interpedicular distance, canal compromise, and local kyphotic angles were regarded as independent risk variables for CST (p < 0.05). The area under the ROC was 0.87 (0.79–0.94). The calibration curve and the ideal curve were fitted using the bootstrap method, which was internally repeated 1000 times. The average absolute error was 0.04, and the projected values were in good agreement with the actual values. DCA demonstrated a high risk threshold range (0.10–0.86). CIC showed that the nomogram exhibited clinical applicability, and it may be utilized to predict the high-risk population at various levels. Conclusions: Age, smoking, interpedicular distance, canal compromise, and local kyphosis angle are independent risk factors for CST. The nomogram established in this study, with high sensitivity and specificity, may effectively predict CST risk.