Incidence and risk factors of dural ossification in patients with thoracic ossification of the ligamentum flavum

Yongzhao ZhaoDepartment of Orthopaedics, Peking University Third Hospital, Beijing;
Beijing Key Laboratory of Spinal Disease Research, Beijing; and
Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China

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Qian XiangDepartment of Orthopaedics, Peking University Third Hospital, Beijing;
Beijing Key Laboratory of Spinal Disease Research, Beijing; and
Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China

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Shuai JiangDepartment of Orthopaedics, Peking University Third Hospital, Beijing;
Beijing Key Laboratory of Spinal Disease Research, Beijing; and
Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China

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Jialiang LinDepartment of Orthopaedics, Peking University Third Hospital, Beijing;
Beijing Key Laboratory of Spinal Disease Research, Beijing; and
Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China

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Longjie WangDepartment of Orthopaedics, Peking University Third Hospital, Beijing;
Beijing Key Laboratory of Spinal Disease Research, Beijing; and
Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China

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Chuiguo SunDepartment of Orthopaedics, Peking University Third Hospital, Beijing;
Beijing Key Laboratory of Spinal Disease Research, Beijing; and
Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China

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Weishi LiDepartment of Orthopaedics, Peking University Third Hospital, Beijing;
Beijing Key Laboratory of Spinal Disease Research, Beijing; and
Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China

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OBJECTIVE

Dural ossification (DO) is a common clinical feature in patients with thoracic ossification of the ligamentum flavum (OLF) and associated with the increased risk of perioperative complications. However, few studies have been conducted to determine the incidence and independent risk factors of DO in patients with thoracic OLF. The aim of this retrospective study was to determine the incidence and independent risk factors of DO in patients with thoracic OLF.

METHODS

A total of 107 patients with thoracic OLF who were admitted to the authors’ hospital from December 2020 to December 2021 were included in this study. The independent risk factors of DO in patients with thoracic OLF were determined through univariate analysis followed by multivariate logistic regression analysis with p < 0.05. The diagnostic efficacy of the DO in OLF (DO-OLF) risk classification model was determined on the basis of independent risk factors and evaluated on the basis of sensitivity, specificity, and agreement rate.

RESULTS

The incidence of DO in patients with thoracic OLF was 35% (37/107 patients). The tuberous type according to the Sato classification (OR 9.75, p < 0.01) and larger (≥ 9°) supine local kyphosis angle (LKA) (OR 8.13, p < 0.01) were two independent risk factors of DO in thoracic OLF. The DO-OLF risk classification, a novel approach for the diagnosis of DO in patients with thoracic OLF, was established on the basis of the combination of the tuberous type according to the Sato classification and larger supine LKA. The sensitivity, specificity, and agreement rate of this approach for distinguishing between patients with thoracic OLF at high and low risk of DO were 87%, 93%, and 91%, respectively.

CONCLUSIONS

The incidence of DO in patients with thoracic OLF was 35%. The tuberous type according to the Sato classification and larger supine LKA (≥ 9°) were independent risk factors of DO in patients with thoracic OLF. The novel DO-OLF risk classification approach could serve as an efficient method for predicting DO in patients with thoracic OLF.

ABBREVIATIONS

CCAR = cross-sectional area ratio; CSAOR = cross-sectional area occupying ratio; DO = dural ossification; DO-OLF = DO in OLF; LKA = local kyphosis angle; mJOA = modified Japanese Orthopaedic Association; OLF = ossification of the ligamentum flavum; TOLF–DO = thoracic OLF–DO.
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Illustration from Beck et al. (pp 147–152). © Department of Neurosurgery, Freiburg Medical Center; published with permission.

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