The Frequency and Treatment of Dural Tears and Cerebrospinal Fluid Leakage in 266 Patients With Thoracic Myelopathy Caused by Ossification of the Ligamentum Flavum

Sun, Xinzhi; Sun, Chuiguo; Liu, Xiaoguang; Liu, Zhongjun; Qi, Qiang; Guo, Zhixin; Leng, Huijie; Chen, Zhongqiang

doi:10.1097/brs.0b013e31824586a8

Cited by 93 publications

(86 citation statements)

References 24 publications

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“…Our findings are consistent with previous studies that have reported the incidence of dural tears and CSF leaks to be 11% to 32%. 7,11,12,24,25 One potential explanation for the significant rate of dural tears and CSF leaks is the potential technical challenge encountered by the presence of dural ossification, which has been described by several authors. 16,17,19 The pathophysiology of OLF can lead to ossification of the dura mater, resulting in fusion of the ligamentum flavum and dura into a single inseparable layer of bony tissue.…”

Section: Discussionmentioning

confidence: 99%

Outcomes and Complications Following Laminectomy Alone for Thoracic Myelopathy due to Ossified Ligamentum Flavum

Osman

Cheung

Hussain

et al. 2018

Spine

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Study Design. Systematic review and meta-analysis. Objective. Examine the functional outcomes and complications following laminectomy for thoracic myelopathy due to ossification of the ligamentum flavum (OLF). Summary of Background Data. OLF is a rare condition that can cause thoracic myelopathy. Laminectomy is a procedure that can be performed to decompress the spinal cord in patients with thoracic myelopathy due to OLF. Few studies have examined postoperative outcomes and complications following laminectomy for thoracic myelopathy secondary to OLF. Methods. A systematic review and meta-analysis was performed. Literature search yielded six studies that met our selection criteria. Study characteristics and baseline patient demographics were extracted from each study. Primary outcomes included pre- and postoperative Japanese Orthopedic Association (JOA) scores and perioperative complications including dural tears, cerebrospinal fluid (CSF) leaks, neurological deficits, surgical site infections, and other complications. We calculated pooled proportion estimates for JOA scores and complications using a random effects model. Results. A total of 137 patients were included. The pooled pre-and postoperative JOA scores were 5.08 (95% confidence interval [CI], 2.70–7.47; I2 = 98%) and 8.29 (95% CI, 7.73–8.85; I2 = 18%), respectively, with a mean improvement of +3.03 points (95% CI, 1.08–4.98; I2 = 88%). Pooled proportion estimates for dural tears, CSF leaks, infections, and early neurological deficits were 18.4% (95% CI, 12.6–26.1; I2 = 0%), 12.1% (95% CI, 6.6–21.2; I2 = 0%), 5.8% (95% CI, 2.1–15.4; I2 = 0%), and 5.7% (95% CI, 2.2–14.3; I2 = 0%), respectively. Conclusion. Thoracic myelopathy secondary to OLF can be treated with laminectomy. However, despite some improvement in JOA score, functional status remains poor postoperatively. Perioperative complications are common, with dural tears and CSF leaks occurring most frequently. OLF is an uncommon condition and more research is needed to better understand how we can improve the outcomes of laminectomy alone for the treatment of thoracic myelopathy due to OLF.

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Section: Discussionmentioning

confidence: 99%

Outcomes and Complications Following Laminectomy Alone for Thoracic Myelopathy due to Ossified Ligamentum Flavum

Osman

Cheung

Hussain

et al. 2018

Spine

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“…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.…”

Section: Discussionmentioning

confidence: 99%

“…Dural tears and CSF leakage are the most common complications of thoracic OLF surgery and can lead to CSF pseudocyst, respiratory obstruction, wound dehiscence and meningitis. [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.…”

Section: Discussionmentioning

confidence: 99%

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

Ren

Zhao

et al. 2015

Spinal Cord

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Study design: A retrospective comparative study. Objectives: To describe the clinical features and radiological findings, to assess the safety and effectiveness of posterior decompressive laminectomy and resection of the ossification of the ligamentum flavum (OLF), and to determine which presurgical and surgical variables were most closely related to postsurgical prognosis of thoracic myelopathy (TM) caused by OLF in China. Methods: Eighty-five patients with the diagnosis of TM caused by OLF received surgical treatment from July 1998 to May 2012. Clinical data were collected from medical and operative records. Correlations between the surgical outcome and various factors were also analyzed. Results: All cases were followed up for a mean of 49.2 months (range, 24-190 months) postoperatively. The mean Japanese Orthopaedic Association score was 3.8 points preoperatively and 8.2 points at the final follow-up, yielding a mean recovery rate of 63.0%. Postoperative complications included transient neurological deficits (9 cases), persistent neurological deficits (4 cases), dural tears (17 cases), cerebrospinal fluid leakage (9 cases), wound dehiscence (2 cases) and wound infection (3 cases). The OLF level (middle thoracic), preoperative duration of symptoms, intramedullary signal change on T2WI and preoperative severity of myelopathy were important predictors of surgical outcome. Conclusions: Biomechanical and anatomical factors may have a key role in thoracic OLF progression. Posterior decompressive laminectomy and resection of the OLF can be considered an effective, reliable and safe alternative procedure. The OLF level, preoperative duration of symptoms, intramedullary signal change on T2WI and preoperative severity of myelopathy were confirmed and significantly correlated with the surgical outcome.

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“…Specialists diagnosed TOLF based on clinical symptoms and radiological examination as previously described [47]. Ligamentum flavum samples were obtained from TOLF patients during spinal surgery via en bloc resection of the lamina and ligamentum flavum as previously described [48]. …”

Section: Methodsmentioning

confidence: 99%

MiR-132-3p Regulates the Osteogenic Differentiation of Thoracic Ligamentum Flavum Cells by Inhibiting Multiple Osteogenesis-Related Genes

Chen

Fan

et al. 2016

IJMS

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Ossification of the ligamentum flavum (OLF) is a disorder of heterotopic ossification of spinal ligaments and is the main cause of thoracic spinal canal stenosis. Previous studies suggested that miR-132-3p negatively regulates osteoblast differentiation. However, whether miR-132-3p is involved in the process of OLF has not been investigated. In this study, we investigated the effect of miR-132-3p and its target genes forkhead box O1 (FOXO1), growth differentiation factor 5 (GDF5) and SRY-box 6 (SOX6) on the osteogenic differentiation of ligamentum flavum (LF) cells. We demonstrated that miR-132-3p was down-regulated during the osteogenic differentiation of LF cells and negatively regulated the osteoblast differentiation. Further, miR-132-3p targeted FOXO1, GDF5 and SOX6 and down-regulated the protein expression of these genes. Meanwhile, FOXO1, GDF5 and SOX6 were up-regulated after osteogenic differentiation and the down-regulation of endogenous FOXO1, GDF5 or SOX6 suppressed the osteogenic differentiation of LF cells. In addition, we also found FOXO1, GDF5 and SOX6 expression in the ossification front of OLF samples. Overall, these results suggest that miR-132-3p inhibits the osteogenic differentiation of LF cells by targeting FOXO1, GDF5 and SOX6.

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The Frequency and Treatment of Dural Tears and Cerebrospinal Fluid Leakage in 266 Patients With Thoracic Myelopathy Caused by Ossification of the Ligamentum Flavum

Abstract: Dural ossification was the main reason for dural tears. In all, 78 of the 85 patients with CSF leakage or dural tear were successfully cured. The success rate was 91.8%, which indicated that a series of comprehensive treatments was an effective strategy to treat these patients.

Cited by 93 publications

References 24 publications

Outcomes and Complications Following Laminectomy Alone for Thoracic Myelopathy due to Ossified Ligamentum Flavum

Outcomes and Complications Following Laminectomy Alone for Thoracic Myelopathy due to Ossified Ligamentum Flavum

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

MiR-132-3p Regulates the Osteogenic Differentiation of Thoracic Ligamentum Flavum Cells by Inhibiting Multiple Osteogenesis-Related Genes

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