• Amir Hadanny, Tessa Harland, Olga Khazen, Marisa DiMarzio, Anthony Marchese, Ilknur Telkes, Vishad Sukul, and Julie G Pilitsis.
• Department of Neurosurgery, Albany Medical College, Albany, New York, USA.
• Neurosurgery. 2022 May 1; 90 (5): 523532523-532.

BackgroundDespite spinal cord stimulation's (SCS) proven efficacy, failure rates are high with no clear understanding of which patients benefit long term. Currently, patient selection for SCS is based on the subjective experience of the implanting physician.ObjectiveTo develop machine learning (ML)-based predictive models of long-term SCS response.MethodsA combined unsupervised (clustering) and supervised (classification) ML technique was applied on a prospectively collected cohort of 151 patients, which included 31 features. Clusters identified using unsupervised K-means clustering were fitted with individualized predictive models of logistic regression, random forest, and XGBoost.ResultsTwo distinct clusters were found, and patients in the cohorts significantly differed in age, duration of chronic pain, preoperative numeric rating scale, and preoperative pain catastrophizing scale scores. Using the 10 most influential features, logistic regression predictive models with a nested cross-validation demonstrated the highest overall performance with the area under the curve of 0.757 and 0.708 for each respective cluster.ConclusionThis combined unsupervised-supervised learning approach yielded high predictive performance, suggesting that advanced ML-derived approaches have potential to be used as a functional clinical tool to improve long-term SCS outcomes. Further studies are needed for optimization and external validation of these models.Copyright © Congress of Neurological Surgeons 2022. All rights reserved.

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