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Clinically significant radiographic parameter for thoracic myelopathy caused by ossification of the ligamentum flavum

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Abstract

Purpose

To investigate radiographic parameters to improve the accuracy of radiologic diagnosis for ossification of ligamentum flavum (OLF)-induced thoracic myelopathy and thereby establish a useful diagnostic method for identifying the responsible segment.

Methods

We classified 101 patients who underwent surgical treatment for OLF-induced thoracic myelopathy as the myelopathy group and 102 patients who had incidental OLF and were hospitalized with compression fracture as the non-myelopathy group between January 2009 and December 2016. We measured the thickness of OLF (TOLF), cross-sectional area of OLF (AOLF), anteroposterior canal diameter, and the ratio of each of these parameters.

Results

Most OLF cases with lateral-type axial morphology were in the non-myelopathy group and most with fused and tuberous type in the myelopathy group. Most grade-I and grade-II cases were also in the non-myelopathy group, whereas grade-IV cases were mostly observed in the myelopathy group. The AOLF ratio was found to be the best radiologic parameter. The optimal cutoff point of the AOLF ratio was 33.00%, with 87.1% sensitivity and 87.3% specificity. The AOLF ratio was significantly correlated with preoperative neurological status.

Conclusions

An AOLF ratio greater than 33% is the most accurate diagnostic indicator of OLF-induced thoracic myelopathy. In cases of multiple-segment OLF, confirmation of cord signal change on MRI and an AOLF measurement will help determine the responsible segment. AOLF measurement will also improve the accuracy of diagnosis of OLF-induced thoracic myelopathy in cases of grade III or extended-type axial morphology.

Graphical abstract

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Funding

No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript. The manuscript submitted does not contain information about medical device(s)/drug(s). The study was approved by the Institutional Review Board of Asan Medical Center (IRB No. 2017-0596).

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Authors and Affiliations

  1. Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro43-gil, Songpa-gu, Seoul, 05505, South Korea

    Byung-Jou Lee, Jin Hoon Park, Sang-Ryong Jeon, Seung-Chul Rhim & Sung Woo Roh

  2. Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43 gil, Songpa-gu, Seoul, 05505, Korea

    Jin Hoon Park & Sung Woo Roh

Authors
  1. Byung-Jou Lee
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  2. Jin Hoon Park
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  5. Sung Woo Roh
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Correspondence to Jin Hoon Park or Sung Woo Roh.

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The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

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Lee, BJ., Park, J.H., Jeon, SR. et al. Clinically significant radiographic parameter for thoracic myelopathy caused by ossification of the ligamentum flavum. Eur Spine J 28, 1846–1854 (2019). https://doi.org/10.1007/s00586-018-5750-6

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  • DOI: https://doi.org/10.1007/s00586-018-5750-6

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