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Clinical relation among dural adhesion, dural ossification, and dural laceration in the removal of ossification of the ligamentum flavum

 Jeong-Hyuk Ju  ;  Sung-Jun Kim  ;  Kyung-Hyun Kim  ;  Dal-Sung Ryu  ;  Jeong-Yoon Park  ;  Dong-Kyu Chin  ;  Keun-Su Kim  ;  Yong-Eun Cho  ;  Sung-Uk Kuh 
 SPINE JOURNAL, Vol.18(5) : 747-754, 2018-05 
Journal Title
Issue Date
Adult ; Aged ; Decompression, Surgical / adverse effects* ; Decompression, Surgical / methods ; Dura Mater / diagnostic imaging ; Dura Mater / pathology ; Female ; Humans ; Lacerations / diagnostic imaging ; Lacerations / etiology* ; Laminectomy / adverse effects* ; Laminectomy / methods ; Ligamentum Flavum / diagnostic imaging ; Ligamentum Flavum / surgery* ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Ossification, Heterotopic / diagnostic imaging ; Ossification, Heterotopic / etiology* ; Postoperative Complications / diagnostic imaging ; Postoperative Complications / etiology* ; Radiography ; Tissue Adhesions / diagnostic imaging ; Tissue Adhesions / etiology*
Cerebrospinal fluid leakage ; Dural adhesion ; Dural laceration ; Dural ossification ; Myelopathy ; Ossification of ligamentum flavum
Background context: Dural laceration frequently occurs during surgery in patients with ossification of the ligamentum flavum (OLF), mainly because of dural adhesion (DA) and dural ossification (DO) between the ligamentum flavum and the dura mater. However, the radiological predictive factors of DA in OLF have rarely been reported.

Purpose: The objective of this study was to determine the preoperative radiological signs for predicting intraoperative DA in OLF by using preoperative magnetic resonance imaging (MRI) and computed tomography (CT).

Study design: This is a retrospective study.

Patient sample: This study included 182 patients who underwent decompressive laminectomy and OLF removal from 2005 to 2014.

Outcome measure: Demographic data, preoperative neurologic status, surgical procedure and results, and intraoperative and postoperative complications were analyzed. Clinical outcome was assessed with the Japanese Orthopaedic Association score.

Materials and methods: Depending on the morphologic appearance of OLF in preoperative radiographs, we aimed to investigate the prevalence of intraoperative DA and DO. We used the following factors of representative classifications: (1) surface appearance, (2) "double-layer" or "tram-track" sign, (3) cross-sectional area of the stenosed level, (4) Sato classification as axial classification, (5) Kuh classification as sagittal classification, and (6) high-signal-intensity change on T2-weighted MRI.

Results: Intraoperative evidence of DA was observed in 52 patients (29%), and DO was observed in 23 patients (13%). Twenty-seven patients (15%) had dural laceration during surgery. Statistically, DA was closely associated with the non-uniform type of surface appearance (odds ratio 5.396, p=.001) and with the presence of either a double-layer sign or a tram-track sign (odds ratio 11.525, p<.001). In the preoperative CT and MRI, 21 out of 23 patients with DO showed a "double-layer sign" or a "tram-track sign."

Conclusions: This study identified two predictive factors of DA in OLF, which were the non-uniform surface appearance and the presence of a double-layer sign or a tram-track sign. The presence of DO in OLF was closely associated with a double-layer sign or a tram-track sign in the preoperative radiological images.
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1. College of Medicine (의과대학) > Dept. of Neurosurgery (신경외과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
Yonsei Authors
Kuh, Sung Uk(구성욱) ORCID logo https://orcid.org/0000-0003-2566-3209
Kim, Kyung Hyun(김경현)
Kim, Keun Su(김근수) ORCID logo https://orcid.org/0000-0002-3384-5638
Kim, Sungjun(김성준) ORCID logo https://orcid.org/0000-0002-7876-7901
Ryu, Dal Sung(류달성)
Park, Jeong Yoon(박정윤) ORCID logo https://orcid.org/0000-0002-3728-7784
Cho, Yong Eun(조용은) ORCID logo https://orcid.org/0000-0001-9815-2720
Chin, Dong Kyu(진동규) ORCID logo https://orcid.org/0000-0002-9835-9294
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