The role of cerebrospinal fluid cross-section area ratio in the prediction of dural ossification and clinical outcomes in patients with thoracic ossification of ligamentum flavum

• Published in: BMC musculoskeletal disorders 2021-08, Vol.22 (1), p.1-701, Article 701
• Main Authors: Zhai, Jiliang, Guo, Shigong, Zhao, Yu, Li, Chunxu, Niu, Tong
• Format: Article
• Language: English
• Subjects: Cerebrospinal fluid; Cerebrospinal fluid cross-section area ratio; Cerebrospinal fluid leakage; Clinical outcomes; Compression; Cross-sectional area; Decompression; Diagnosis; Dura mater; Dural ossification; Health aspects; Magnetic resonance imaging; Musculoskeletal diseases; Ossification; Ossification of the ligamentum flavum; Patients; Predictions; Software; Spinal cord; Spinal diseases; Statistical analysis; Surgeons; Surgery; Thoracic surgery; Thorax; Vertebrae, Thoracic
• ISSN: 1471-2474; 1471-2474
• DOI: 10.1186/s12891-021-04574-1

Background It is imperative to preoperatively distinguish dural ossification (DO) and thus anticipate the risks and outcome of the surgery for patients with ossification of ligamentum flavum (OLF). However, studies have disagreed as to the efficacy of the radiographic signs or factors to predict DO and surgical outcome. In additon, the association between the cerebrospinal fluid cross-section area ratio (CCAR) and DO or clinical outcome had not been reported. The purpose of this study was to analyse CCAR and its role in prediction of DO and neurological function recovery rate in patients with OLF. Methods Fifty-two consecutive patients with OLF, who underwent posterior thoracic decompression and fusion between September 2012 and March 2019 at a single institution, were retrospectively reviewed. Demographic data, radiographic signs of DO, CCAR, pre- and postoperative modified Japanese Orthopedic Association (mJOA) score were recorded. Results There were 27 patients in the DO group and 25 patients in the non-DO group, with a mean age at surgery of 57.4 years and 53.9 years, respectively. No significant differences were found in sex, age, segment of maximum compression and preoperative mJOA score between the two groups. The receiver operating characteristic curve showed that the value of CCAR had a relatively high value for diagnosis of DO and prediction of neurological function recovery rate (P = .000). According to the value of CCAR, three zones were defined as DO zone ([less than or equai to]14.3%), non-DO zone ([greater than or equai to]44.5%), and gray zone (14.3 to 44.5%). When the value of CCAR[less than or equai to]14.3%, the recovery rate was poor or fair, while it had good or excellent recovery when CCAR[greater than or equai to]45.2%. Conclusion The value of CCAR had a high diagnostic value for prediction of DO and neurological function recovery rate in patients with OLF. Keywords: Ossification of the ligamentum flavum, Dural ossification, Cerebrospinal fluid leakage, Cross-sectional area, Cerebrospinal fluid cross-section area ratio