Analysis of the surgical strategy and postoperative clinical effect of thoracic ossification of ligament flavum with dural ossification

Abstract

Purpose: Our research was designed to analyse the postoperative clinical results of patients suffering from single-segment thoracic ossification of the ligamentum flavum (TOLF) combined with dural ossification (DO) who underwent posterior laminar decompression and internal fixation.

Methods: This retrospective research included thirty-two patients who underwent surgery for ossifying the ligamentum flavum in the thoracic spine between January 2016 and January 2020. Patients were fallen into one group included patients with evidence of DO during surgery, and the other group included patients without evidence of DO. We assessed and compared general clinical characteristics and health-related outcomes before surgery and during follow-up.

Results: The DO group had a longer operation duration, more blood loss, and longer hospital stay (operation time: 94.75 ± 6.78 min vs. 80.00 ± 10.13 min, p < 0.001; blood loss: 331.67 ± 50.06 ml vs. 253.00 ± 48.24 ml, p < 0.001; length of hospital stay: 13.83 ± 2.76 days vs. 10.05 ± 2.33 days, p < 0.001).

Complications: There were 12 cases of cerebrospinal fluid leakage and 1 case of superficial wound infection in the DO group. However, the neurological recovery and health-associated quality of life (HRQOL) scores showed no statistically significant changes between the DO and non-DO groups (p > 0.05).

Conclusions: Posterior laminectomy and internal fixation combined with intraoperative resection of the ossified ligamentum flavum and dura is an efficient and relatively safe method for treating TOLF with DO, which can provide satisfactory results. Moreover, DO had no significant effect on postoperative neurological recovery and health-related quality of life scores.

Keywords: dural ossification; ligamentum flavum ossification; posterior laminar decompression and internal fixation; postoperative clinical efficacy; single-Segment.

Figure 1

A patient with thoracic ossification of ligamentum flavum in T11/12. (A,B) Preoperative x-ray; (C-E) Preoperative coronal and axial section computed tomography scan; (F,G) Preoperative sagittal and axial section magnetic resonance imaging scan; (H,I) Postoperative x-ray; (J,K) Intraoperative photo and postoperative sample of ligamentum flavum ossification.

Figure 2

Distribution of OLF and DO: OLF was more common in the lower thoracic spine. More than half (75%) of the DO was located in T9-T12. DO, dural ossification; OLF, ossification of ligamentum flavum.