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Prevalence, diagnosis, and impact on clinical outcomes of dural ossification in the thoracic ossification of the ligamentum flavum: a systematic review

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Abstract

Study design

Systematic review.

Background context

Thoracic ossification of the ligamentum flavum (TOLF) has become the principal cause of thoracic spinal stenosis. Dural ossification (DO) was a common clinical feature accompanying with TOLF. However, on account of the rarity, we know little about the DO in TOLF so far.

Purpose

This study was conducted to elucidate the prevalence, diagnostic measures, and impact on the clinical outcomes of DO in TOLF by integrating the existing evidence.

Methods

PubMed, Embase, and Cochrane Database were comprehensively searched for studies relevant to the prevalence, diagnostic measures, or impact on the clinical outcomes of DO in TOLF. All retrieved studies meeting the inclusion and criterion were included into this systematic review.

Results

The prevalence of DO in TOLF treated surgically was 27% (281/1046), ranging from 11 to 67%. Eight diagnostic measures have been put forward to predict the DO in TOLF using the CT or MRI modalities, including “tram track sign”, “comma sign”, “bridge sign”, “banner cloud sign”, “T2 ring sign”, TOLF-DO grading system, CSAOR grading system, and CCAR grading system. DO did not affect the neurological recovery of TOLF patients treated with the laminectomy. The rate of dural tear or CSF leakage in TOLF patients with DO was approximately 83% (149/180).

Conclusion

The prevalence of DO in TOLF treated surgically was 27%. Eight diagnostic measures have been put forward to predict the DO in TOLF. DO did not affect the neurological recovery of TOLF treated with laminectomy but was associated with high risk of complications.

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Data availability

The original contributions presented in the study are included in the article/supplementary material, further inquiries can be directed to the corresponding author.

Abbreviations

TOLF:

Thoracic ossification of ligamentum flavum

DO:

Dural ossification

CSF:

Cerebrospinal fluid

mJOA:

Modified Japanese Orthopedic Association

RR:

Recovery rate

GRADE:

Grading of Recommendations Assessment, Development and Evaluation

MD:

Mean difference

CT:

Computerized tomography

MRI:

Magnetic resonance imaging

CSA:

Cross-sectional area

CSAOR:

Cross-sectional area occupying ratio

CCAR:

Cerebrospinal fluid cross-section area ratio

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Acknowledgements

None.

Funding

This work was supported by the National Natural Science Foundation of China (Grant NO. 82172480).

Author information

Author notes

  1. Yongzhao Zhao, Qian Xiang, and Shuai Jiang have contributed equally to this research.

Authors and Affiliations

  1. Department of Orthopaedics, Peking University Third Hospital, No. 49 NorthGarden Road, Haidian District, Beijing, 100191, China

    Yongzhao Zhao, Qian Xiang, Shuai Jiang, Longjie Wang, Jialiang Lin, Chuiguo Sun & Weishi Li

  2. Beijing Key Laboratory of Spinal Disease Research, Beijing, 100191, China

    Yongzhao Zhao, Qian Xiang, Shuai Jiang, Longjie Wang, Jialiang Lin, Chuiguo Sun & Weishi Li

  3. Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, 100191, China

    Yongzhao Zhao, Qian Xiang, Shuai Jiang, Longjie Wang, Jialiang Lin, Chuiguo Sun & Weishi Li

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  1. Yongzhao Zhao
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Contributions

Weishi Li and Chuiguo Sun designed and supervised the study. Yongzhao Zhao, Qian Xiang, and Shuai Jiang extracted and assembled the data. Yongzhao Zhao and Longjie Wang analyzed the data. Yongzhao Zhao and Jialiang Lin wrote the manuscript. All authors read, edited, and approved the manuscript.

Corresponding author

Correspondence to Weishi Li.

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The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

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This study has been approved by the Ethics Committee of Peking University Third Hospital. The written informed consent was not necessary because all data was extracted from published studies.

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Zhao, Y., Xiang, Q., Jiang, S. et al. Prevalence, diagnosis, and impact on clinical outcomes of dural ossification in the thoracic ossification of the ligamentum flavum: a systematic review. Eur Spine J 32, 1245–1253 (2023). https://doi.org/10.1007/s00586-023-07625-4

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  • DOI: https://doi.org/10.1007/s00586-023-07625-4

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