Scholarlink

Purpose <p>Central sensitization (CS)-related symptoms are associated with poor outcomes after lumbar spine surgery, but universal screening may be inefficient when only a minority of patients are affected. This study aimed to develop and internally validate a clinical prediction rule (CPR) to screen for elevated CS-related symptom burden (Central Sensitization Inventory-9 [CSI-9] ≥ 20) using routinely collected clinical variables.</p> Methods <p>In this cross-sectional diagnostic prediction model study, 674 consecutive patients scheduled for lumbar spine surgery were included; 97 (14.4%) had CSI-9 scores ≥ 20. Seven candidate predictors were evaluated using logistic regression with backward elimination. A 3-item CPR was derived by dichotomizing retained predictors at Youden-optimal cutpoints. Internal validation used 1,000 bootstrap resamples.</p> Results <p>Three predictors were retained: age ≤ 60 years, ≥ 5 pain sites, and sleep disturbance (Oswestry Disability Index sleep item ≥ 1). The CPR showed discrimination comparable to the full model (AUC, 0.730; DeLong <i>P</i> = 0.872). At the optimal cutoff (≥ 2 points), sensitivity was 73.2%, specificity 65.0%, and negative predictive value 93.5%. Low-risk patients (score 0–1; 59.5% of the cohort) had an event rate of 6.5%. Decision curve analysis confirmed positive net benefit across threshold probabilities of 5–40%.</p> Conclusion <p>A simple 3-item CPR demonstrated moderate discrimination with high negative predictive value for elevated CS-related symptom burden before lumbar spine surgery. The rule may serve as a practical first-stage screen to guide selective CSI-9 administration.</p>

错误：搜索内容不能为空，请输入英文关键词
错误：关键词超出字数限制，请精简
高级检索

Central sensitization-related symptoms in patients undergoing lumbar spine surgery: development and internal validation of a clinical prediction rule for first-stage screening

  • 期刊论文

  • 发表日期：

    2026年6月14日

查看全文
  • Yu Kondo,
  • Yuta Watanabe,
  • Keita Tsushima,
  • Ryo Otsuki,
  • Kota Miura,
  • Yuna Kamewari,
  • Reika Wachi,
  • Takahiro Miki,
  • Tsuneo Takebayashi

摘要

Purpose

Central sensitization (CS)-related symptoms are associated with poor outcomes after lumbar spine surgery, but universal screening may be inefficient when only a minority of patients are affected. This study aimed to develop and internally validate a clinical prediction rule (CPR) to screen for elevated CS-related symptom burden (Central Sensitization Inventory-9 [CSI-9] ≥ 20) using routinely collected clinical variables.

Methods

In this cross-sectional diagnostic prediction model study, 674 consecutive patients scheduled for lumbar spine surgery were included; 97 (14.4%) had CSI-9 scores ≥ 20. Seven candidate predictors were evaluated using logistic regression with backward elimination. A 3-item CPR was derived by dichotomizing retained predictors at Youden-optimal cutpoints. Internal validation used 1,000 bootstrap resamples.

Results

Three predictors were retained: age ≤ 60 years, ≥ 5 pain sites, and sleep disturbance (Oswestry Disability Index sleep item ≥ 1). The CPR showed discrimination comparable to the full model (AUC, 0.730; DeLong P = 0.872). At the optimal cutoff (≥ 2 points), sensitivity was 73.2%, specificity 65.0%, and negative predictive value 93.5%. Low-risk patients (score 0–1; 59.5% of the cohort) had an event rate of 6.5%. Decision curve analysis confirmed positive net benefit across threshold probabilities of 5–40%.

Conclusion

A simple 3-item CPR demonstrated moderate discrimination with high negative predictive value for elevated CS-related symptom burden before lumbar spine surgery. The rule may serve as a practical first-stage screen to guide selective CSI-9 administration.