Clinical Risk Factors for Thoracic Ossification of the Ligamentum Flavum: A Cross-Sectional Study Based on Spinal Thoracic Three-Dimensional Computerized Tomography

Zhang, Hao; Deng, Nian; Zhang, Lu; Zhang, Lei; Wang, Chao

doi:10.2147/rmhp.s361730

“…High BMI is not only associated with TOLF but is also more likely to be comorbid with a variety of other chronic diseases, affecting patients' QoL in many ways. In regression analyses, high BMI is highly correlated with both the Usual activities dimension and overall QoL, similar to the results of other studies 22,23 . Therefore, for overweight as well as obese patients, there is an obligation to inform the patient that the long‐term QoL after surgery may still be less satisfactory.…”

Section: Discussionsupporting

confidence: 83%

The Quality of Life of the Patients with Thoracic Ossification of the Ligamentum Flavum after Surgery Using EQ‐5D‐5L

Li,

Deng,

Wang

et al. 2023

Orthopaedic Surgery

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ObjectiveThere is a lack of studies on the quality of life (QoL) after posterior laminectomy in patients with thoracic ossification of the ligamentum flavum (TOLF), and risk factors associated with poor prognosis remain controversial. Therefore, the present study was conducted to illustrate the QoL for TOLF patients after surgery and determine its relationship with their demographic, surgery‐related, clinical characteristics and imaging data.MethodsOne hundred and eighteen patients diagnosed with thoracic myelopathy because of TOLF were enrolled in this retrospective study. They all underwent posterior decompressive laminectomy from August 2010 to January 2022. The QoL was evaluated based on the EQ‐5D‐5L. Collecting gender, age, number of operations, compressed segments, Frankel grade, complications, body mass index (BMI), symptoms and duration, modified Japanese Orthopaedic Association (mJOA) score (preoperative), follow‐up time and type of ossification, increased signal on Sagittal T2‐weighted Images (ISST2I), occupancy rate and analyzing by Mann–Whitney U‐test, Kruskal–Wallis test, the χ2‐test, and logistic regression tests.ResultsAverage follow‐up 70.8 months (18–149), the mean age was 59.74 ± 9.81 years and the mean score for the QoL based on the EQ‐5D‐5 L and visual analogue scale (VAS) score were 0.71 ± 0.28 and 78.88 ± 10.21 at the final follow‐up. Moderate and severe problems were found in the pain/discomfort in 22.0% of the patients. These mobility and usual activities numbers were slightly higher (24.6% and 30.4%, respectively). The mean scores for QoL and VAS were significantly higher in patients with mild and moderate neurological impairment, normal BMI, <60 years of age, no dural tears, symptom relief at hospital discharge, unilateral and bilateral ossification on axial CT scan, ≤ 50% spinal canal occupancy on CT and MRI, and none or fuzzy on ISST2I.ConclusionQoL after posterior laminectomy in TOLF patients is generally satisfactory compared to preoperative levels. Preoperative mJOA score, Age, comorbid diabetes, the major symptom is activity limitation, BMI, ISST2I, Intraoperative dural tears and spinal canal occupancy rate correlate significantly with the corresponding dimensions and are predictive. Age, spinal canal occupancy rate, ISST2I, preoperative mJOA score, BMI are significantly associated with and have predictive value for overall postoperative QoL.

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“…Thoracic OLF has been considered as a multifactorial disease, and several pathogenic factors, including genetic inheritance, metabolic disorders, inflammation, and mechanical stress, contribute to its onset and development [5][6][7]. Several studies have been conducted to identify the risk factors of thoracic OLF to further explore its underlying mechanisms [8][9][10][11][12]. Zhang et al found that age and body mass index (BMI) were independent risk factors of thoracic OLF [8].…”

Section: Introductionmentioning

confidence: 99%

“…Several studies have been conducted to identify the risk factors of thoracic OLF to further explore its underlying mechanisms [8][9][10][11][12]. Zhang et al found that age and body mass index (BMI) were independent risk factors of thoracic OLF [8]. Tang et al reported that new OLF was associated with high BMI and that the size progression of OLF was related to high BMI and smoking [9].…”

Section: Introductionmentioning

confidence: 99%

High Systemic Immune-Inflammation Index and Body Mass Index Are Independent Risk Factors of the Thoracic Ossification of the Ligamentum Flavum

Zhao

¹

,

Xiang

²

,

Lin

³

et al. 2022

Mediators of Inflammation

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Background. Inflammation has been considered to play an important role in the pathogenesis of the thoracic ossification of the ligamentum flavum (OLF). However, the inflammation-related risk factors of thoracic OLF have not been fully investigated to date. Methods. A total of 95 patients (48 in the OLF group and 47 in the control group) were included in this retrospective study to explore the independent risk factors of thoracic OLF. The following demographic and clinical variables were compared between the two groups: gender, age, body mass index (BMI), coexistence of hypertension or diabetes, and inflammation-related variables. Multivariate logistic regression analysis was utilized to determine the independent risk factors. Results. High systemic immune-inflammation index (SII) (≥621) (odds ratio OR = 12.16 , 95% confidence interval CI = 2.95 – 50.17 , p < 0.01 ) and BMI (≥25 kg/m2) ( OR = 9.17 , 95 % CI = 3.22 – 26.08 , p < 0.01 ) were independent risk factors of thoracic OLF. SII ( R = 0.38 , p < 0.01 ) and BMI ( R = 0.46 , p < 0.01 ) were positively associated with OLF score. Conclusion. High SII and BMI were the independent risk factors of thoracic OLF. Multicenter prospective studies with a large population should be conducted in the future to verify our findings.

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“…At the same time, ossification also expands superiorly and inferiorly, thus enlarging the range of OLF compression of the dura mater (24). This increases the contact area of relative movement between the OLF and the dura mater (25). When the severity of OLF horizontal compression of the dura mater and their vertical contact area develops to a certain degree, DO might occur.…”

Section: Discussionmentioning

confidence: 99%

Three-dimensional imaging analysis for the diagnosis of dural ossification in thoracic ossification of the ligamentum flavum: a multicenter study

Chen¹,

Ling²,

Zhao³

et al. 2023

Quant Imaging Med Surg

1

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Background: Unforeseen dural ossification (DO) increases the risk of complications in the surgical management of thoracic ossification of the ligamentum flavum (OLF). Several methods have been proposed to identify DO; however, these approaches either have low diagnostic accuracy or poor feasibility.Therefore, we aimed to determine the relationship between DO and the severity and range of thoracic OLF compression using a 3-dimensional (3D) imaging analysis and to evaluate its superiority in diagnosing DO over conventional measurement methods.Methods: A total of 114 consecutive patients who underwent decompressive laminectomy for thoracic OLF in 4 institutions were retrospectively enrolled and divided into DO and non-DO groups. Univariate analysis was performed to determine the relationship between OLF compression and DO. We measured the 3D occupying ratio (OR; 3D OR = OLF volume/normal canal volume × 100%), calculated its cutoff values, and compared its diagnostic value in DO with that of conventional 1D and 2D radiological parameters in the whole thoracic spine.Results: The 3D OR in the DO group (50.9%±7.9%) was significantly higher than that in the non-DO group (30.8%±7.5%; P<0.01). The overall reliability and reproducibility for measurements of the 3D OR (intra-and interobserver correlation coefficients 0.94 and 0.90, respectively) were excellent. Thus, the 3D OR could be used as an indicator to distinguish between DO and non-DO, with high diagnostic accuracy (91.2%). Moreover, a 3D OR of >43%, known as the "ossification zone", was indicative of DO in OLF, whereas a value of <37% was considered the "safe zone". Additionally, the 3D OR [area under the curve (AUC) =0.98, 95% confidence interval (CI): 0.93-0.99] showed a statistically higher diagnostic value for DO in the upper, middle, lower, and whole thoracic spine than did both 1D (AUC =0.81; 95% CI: 0.73-0.88) and 2D (AUC =0.87; 95% CI: 0.79-0.92) parameters (P<0.01).Conclusions: DO was significantly associated with the severity and range of OLF compression. The 3D OR could be used as a critical diagnostic indicator for identifying DO in the whole thoracic spine, owing to its superiority over conventional radiological parameters. Classification of the 3D OR could maximize the clinical feasibility and thus help surgeons to decrease the incidence of DO-related surgical complications.

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Clinical Risk Factors for Thoracic Ossification of the Ligamentum Flavum: A Cross-Sectional Study Based on Spinal Thoracic Three-Dimensional Computerized Tomography

Cited by 11 publications

References 25 publications

The Quality of Life of the Patients with Thoracic Ossification of the Ligamentum Flavum after Surgery Using EQ‐5D‐5L

The Quality of Life of the Patients with Thoracic Ossification of the Ligamentum Flavum after Surgery Using EQ‐5D‐5L

High Systemic Immune-Inflammation Index and Body Mass Index Are Independent Risk Factors of the Thoracic Ossification of the Ligamentum Flavum

Three-dimensional imaging analysis for the diagnosis of dural ossification in thoracic ossification of the ligamentum flavum: a multicenter study

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