Establishment of a nomogram for predicting the surgical difficulty of anterior cervical spine surgery

Abstract Background For a long time, surgical difficulty is mainly evaluated based on subjective perception rather than objective indexes. Moreover, the lack of systematic research regarding evaluation potentially has negative effect in this field. This study was aimed to evaluate risk factors for anterior cervical spine surgery (ACSS). Methods retrospective cohort totaling 291 consecutive patients underwent ACSS from 2012.3 2017.8. The defined by operation time longer 120 min or intraoperative blood loss equal greater 200 ml. Evaluation performed analyzing patient’s medical records and radiological parameters such as age, sex, BMI, number levels, high signal intensity spinal cord T2-weighted images, ossified posterior longitudinal ligament (OPLL), sagittal coronal circumference, length, canal occupational ratio, coagulation function index platelet count. Results Significant differences were reported between low-difficulty high-difficulty groups terms age ( p = 0.017), sex 0.006), levels < 0.001), OPLL 0.001) ratio 0.001). Multivariate logistic regression analysis revealed that (OR 5.224, 95%CI 2.125–12.843, 4.994, 1.636–15.245, 0.005), 6.358, 1.932–20.931, 0.002) > 0.45 3.988, 1.343–11.840, 0.013) independently associated with ACSS. A nomogram established ROC curve gave 0.906 C-index. There good calibration estimation. Conclusion indicated operational level, OPLL, cord, predictive can be using identified factors. Optimal performance achieved predicting preoperative