Department of Orthopaedics, Peking University Third Hospital, Haidian District, No. 49 North Garden Road, Beijing, 100191, China.
Beijing Key Laboratory of Spinal Disease Research, Beijing, China.
Eur Spine J. 2022 Jul;31(7):1719-1727. doi: 10.1007/s00586-022-07267-y. Epub 2022 May 27.
Dural ossification (DO) is common in patients with ossification of the ligamentum flavum (OLF) and is the leading cause of dural tears. However, the methods used for DO diagnosis are limited. The purpose of this study was to propose a novel CT-based imaging sign, Banner cloud sign (BCs), and clarify its clinical characteristics and correlations with DO.
57 OLF patients who underwent thoracic spine decompression surgery in our single-center between January- and October-2018 were recruited and divided into two groups based on the presence of DO. Patient demographics and radiographic data were analyzed. Hematoxylin-eosin staining and micro-CT were used to detect the micro-morphological changes of DO. The diagnostic value of BCs for DO was assessed by sensitivity and specificity.
12 patients with a total of 19 segments were diagnosed as DO. The incidence of DO was 21.1% (12/57) in OLF patients and 9.5% (19/200) in OLF segments. Patients with DO had a shorter disease duration and a higher incidence of cerebrospinal fluid leakage than those without DO. Hematoxylin-eosin staining and micro-CT showed that the dura mater was ossified and fused with ossified ligamentum flavum, and diffusion along the dura mater, like a banner cloud flying on the mountain. The sensitivity and specificity of BCs in DO diagnosis were 78.9 and 90.6%, respectively.
BCs can vividly and intuitively describe the imaging features of DO and has high diagnostic accuracy. It could be a promising and valuable method for the diagnosis of DO.
硬脊膜骨化（DO）在黄韧带骨化（OLF）患者中很常见，是硬脊膜撕裂的主要原因。然而，用于 DO 诊断的方法有限。本研究旨在提出一种新的基于 CT 的影像学征象——横幅云征（BCs），并阐明其临床特征及其与 DO 的相关性。
本研究纳入了 2018 年 1 月至 10 月期间在我院行胸段脊柱减压手术的 57 例 OLF 患者，并根据是否存在 DO 将患者分为两组。分析患者的人口统计学和影像学数据。采用苏木精-伊红染色和微 CT 检测 DO 的微观形态变化。通过灵敏度和特异性评估 BCs 对 DO 的诊断价值。
12 例患者共 19 个节段被诊断为 DO。OLF 患者 DO 的发生率为 21.1%（12/57），OLF 节段为 9.5%（19/200）。与无 DO 的患者相比，有 DO 的患者疾病持续时间更短，脑脊液漏发生率更高。苏木精-伊红染色和微 CT 显示硬脊膜骨化并与骨化黄韧带融合，沿硬脊膜扩散，犹如 banner cloud 在山间飞舞。BCs 对 DO 诊断的灵敏度和特异性分别为 78.9%和 90.6%。
BCs 可以生动直观地描述 DO 的影像学特征，且具有较高的诊断准确性。它可能是一种有前途且有价值的 DO 诊断方法。
