A Nomogram To Predict The Effectiveness Of Cervical Traction In Chronic Nonspecific Neck Pain Patients With Unsatisfactory NSAIDs Control

Objective.The effectiveness of cervical traction varies among young and middle-aged patients who are suffering from chronic nonspecific neck pain(CNNP)with unsatisfactory nonsteroidal anti-inflammatory drugs(NSAIDs)control.Neck muscle fat infiltration and clinical features may associate with the effectiveness.This study aims to establish a nomogram to predict the effectiveness of cervical traction in young and middle-aged patients who are suffering from CNNP with unsatisfactory NSAIDs control.Methods.A total of 186 suitable patients were classified into a training dataset(from August 2015 to July 2018,n = 118)and validation dataset(from August 2018 to June2019,n = 68)with time sequence.Magnetic resonance imaging scan was performed to all patients to calculate posterior cervical fat and muscle features,followed by unified cervical traction in an outpatient clinic.The least absolute shrinkage and selection operator(LASSO)regression model was used in selecting potentially relevant features for the prediction of the effectiveness of cervical traction.Multivariable logistic regression analysis was used in developing the predicting model,presenting with a nomogram.The performance of nomogram was assessed based on its calibration,discrimination,and clinical utility.Results.Through the Lasso regression model,four predictors were identified as follows: gender,good exercise compliance,the ratio of the cross-sectional area(CSA)between fat and muscle on the C5 level(C5 fat CSA/muscle CSA),and the ratio of CSA between fat and centrum on the C5 level(C5 fat CSA/centrum muscle CSA).The nomogram provided good calibration and discrimination in the training cohort,showing an area under the curve(AUC)of 0.704(95% CI,0.608–0.799)and good concordance between the predicted and actual probabilities with Spiegelhalter’s Z-test(P = 0.835).Discrimination of the model in the validation dataset was acceptable,with AUC of 0.691(95%CI,0.564–0.817).Decision curve analysis revealed that the nomogram was clinically useful.Conclusion.Male,good exercise compliance,lower C5 fat CSA/centrum CSA,and C5 fat CSA/muscle CSA could be favorable features for predicting the effectiveness of cervical traction in patients who are suffering from CNNP with unsatisfactory NSAID control.This study establishes and validates a nomogram including clinical features and MRI parameters.It can be effectively used for individualized prediction of effectiveness of cervical traction in young and middle-aged patients with chronic nonspecific neck pain.