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Dural ossification associated with ossification of ligamentum flavum in the thoracic spine: a retrospective analysis
  1. Bo Li1,
  2. Guixing Qiu1,
  3. Shigong Guo2,
  4. Wenjing Li1,
  5. Ye Li1,
  6. Huiming Peng1,
  7. Chu Wang1,
  8. Yu Zhao1
  1. 1Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
  2. 2Department of Trauma & Orthopaedic Surgery, Hillingdon Hospital, London, UK
  1. Correspondence to Dr Yu Zhao; zhaoyupumch{at}126.com

Abstract

Objectives To investigate the incidence, distribution and radiological characteristics of dural ossification (DO) associated with ossification of ligamentum flavum (OLF) in the thoracic spine.

Design A retrospective radiographical analysis.

Setting This study was conducted at a single institution in China.

Participants 53 patients with OLF who underwent posterior decompression surgery between January 2011 and July 2015 in a single institution were enrolled in this study. The decompression segments were grouped according to imaging evaluation and intraoperative evidences.

Outcome measures The demographic distribution, radiological data and detailed surgical records were collected. First, preoperative CT images of decompressed segments were evaluated to identify imaging signs of DO. The ‘tram tack sign’ (TTS), ‘comma sign’ and ‘bridge sign’ were considered as characteristic imaging findings of DO in OLF. 4 kinds of confusing signs (false TTS) were identified and excluded. Then detailed surgical records were reviewed to finally identify segments with DO.

Results The incidence of DO in patients with OLF was 43.4%. The incidence of DO in OLF segments was 21.5%. OLF was more common in the lower thoracic spine, and more than half (53.8%) of the DO was located in T9-T12. TTS was the most common sign, but it might be misdiagnosed. After excluding 4 kinds of false TTS, the sensitivity and specificity of imaging diagnosis were 94.23% and 94.21%, respectively.

Conclusions DO was relatively common in thoracic OLF, especially in T9-T12. TTS might be misdiagnosed. After excluding 4 kinds of false TTS, the accuracy of imaging diagnosis was relatively high.

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Footnotes

  • Investigation performed at the Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.

  • Contributors YZ, BL, GQ and SG were involved in study design. YZ, BL, WL, YL, HP and CW were involved in data acquisition. YZ, BL, SG, WL and YL were involved in analysis and interpretation of data.

  • Funding This work was supported by grants from the National Natural Science Foundation of China (grant number 81572093) and Beijing Natural Science Foundation (7162153).

  • Competing interests None declared.

  • Ethics approval The Institutional Review Board (IRB) of Peking Union Medical College Hospital (PUMCH).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.

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