Diagnosis and treatment of ossification of the ligamentum flavum associated with dural ossification

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>In this paper, the authors aimed to summarize the clinical characteristics of ossification of the ligamentum flavum (OLF) associated with dural ossification (DO) and to identify improved methods for preoperative diagnosis.</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>Thirty-six patients who had undergone OLF surgery between February 2005 and September 2009 were included in this retrospective study. The patients were divided into 2 groups: one that included patients with intraoperative evidence of DO and a second group that included patients without DO. The clinical features of DO were summarized and the neurological status of the patients was evaluated pre- and postoperatively.</jats:p></jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>The incidence rate of DO associated with OLF was 39% (14/36). The sensitivity and specificity of the tram track sign were found to be 93% and 59%, respectively. Dural ossification was found among 86% of the patients with tuberous type Sato classification. The postoperative neurological status of patients was generally improved relative to that observed prior to surgery, although neurological recovery did not differ between the 2 groups. Cerebrospinal fluid leakage was the main complication, occurring predominantly in the patients with DO, and all leaks resolved in all patients after comprehensive treatments.</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>The tram track sign and Sato classification were found to be useful for preoperative diagnosis of DO and for determining the surgical procedure to be performed. Dural ossification had no effect on postoperative neurological recovery.</jats:p></jats:sec>

Clinical characteristics and surgical outcome of thoracic myelopathy caused by ossification of the ligamentum flavum: a retrospective analysis of 85 cases

“…The intraoperative manipulation should be gentle to avoid dural tears as much as possible, and once a dura mater tear is noticed, immediate repair should be carried out. 56,68,70 Eight cases underwent dura mater repair and no CSF leakage happened after the operation, and the surgical effect was satisfactory. Although the procedure and success of intraoperative repair is important, comprehensive treatments after operation should not be ignored.…”

“…[66][67][68] Because dural adhesion and DO are more common in thoracic OLF than in cervical or lumbar spine, the incidence of CSF leakage in OLF patients may be higher. 56,[68][69][70] Miyakoshi et al 56 reported that dural adhesion was observed in 62% of the 34 patients with OLF, and found that dural adhesion was frequently observed in larger types of OLF. Aizawa et al 11 reported that 9 of 72 patients with OLF had dual tears during surgery and 8 of them had DO.…”

Dural ossification associated with ossification of ligamentum flavum in the thoracic spine: a retrospective analysis

“…However, owing to the relatively small study population and lack of awareness of these specific image signs accurate diagnosis of DO could not be obtained in previous studies 210 Since the incidence of OLF and DO is relatively low, few studies have focused on this issue 29 10 The incidence and distribution of DO were also unclear.…”

“…10 Since the incidence of OLF and DO is relatively low, few studies have focused on this issue 29 10 The incidence and distribution of DO were also unclear. The present study aimed to investigate the incidence, distribution and radiological characteristics of DO in thoracic OLF.…”

Ossification Ligamentum Flavum

“…The pressure of the epidural venous plexus and dural pulsation are considered to contribute to this phenomenon [30]. Dural ossification develops in 11% to 40% [15,[31][32][33][34][35]. There are two CT findings which predict dural ossification.…”