Chen Jiabao, Yu Qingsong, Wang Haidong, An Huangda, Dou Chenhao, Lu Zhe, Ding Aoran, Ma Lei
Hebei Medical University Third Affiliated Hospital, Shijiazhuang, China.
Heliyon. 2023 Jul 23;9(8):e18541. doi: 10.1016/j.heliyon.2023.e18541. eCollection 2023 Aug.
Dural ossification (DO) is strongly correlated with an increased incidence of complications during the surgery for the patients with thoracic ossification of the ligamentum flavum (OLF). Some methods for predicting DO have emerged, but the accuracy remains to be improved. We aimed to find a more accurate way to predict the appearance of DO.
Retrospective study was adopted in this study. According to the intraoperative findings, ninety-one patients with thoracic OLF were ultimately included and divided into two groups based on the presence or absence of DO. Patient characteristics and radiographic data were recorded. The residual area ratio (RAR, residual area/cross-section area of normal spinal canal × 100%) and the short shaft ratio (SSR, the length of short shaft of the ellipse-like shape/the length of the spinal canal × 100%) were measured and calculated by 2 independent observers, followed by statistical analysis. The receiver operating characteristic curve was used to evaluate the accuracy of the SSR and RAR in predicting DO.
No significant differences were found in sex, age and BMI between the DO group and the non-DO group. The mean RAR (and standard deviation) in the Non-DO group (62.6% ± 10.2%) was significantly higher (p < 0.001) than that in the DO group (46.1% ± 10.5%). The mean SSR (and standard deviation) in the Non-DO group (61.6% ± 6.0%) was significantly higher (p < 0.001) than that in the DO group (43.6% ± 9.2%). The receiver operating characteristic curve indicated that the SSR and RAR can be used as the efficient indicators to identify DO, and the SSR has a higher accuracy in indicating the presence of DO, with a cutoff value of ＜48.71% (sensitivity of 100% and specificity of 85.0%).
The SSR can be used as a supplement parameter to traditional methods to predict DO, and it could be a better predictor. And, compared with bilateral and bridged type, unilateral type of OLF was more likely to develop DO with a larger SSR.
硬膜骨化（DO）与胸椎黄韧带骨化（OLF）患者手术期间并发症发生率的增加密切相关。已经出现了一些预测DO的方法，但其准确性仍有待提高。我们旨在找到一种更准确的方法来预测DO的出现。
本研究采用回顾性研究。根据术中发现，最终纳入91例胸椎OLF患者，并根据是否存在DO分为两组。记录患者特征和影像学数据。由2名独立观察者测量并计算残余面积比（RAR，残余面积/正常椎管横截面积×100%）和短轴比（SSR，椭圆形短轴长度/椎管长度×100%），随后进行统计分析。采用受试者工作特征曲线评估SSR和RAR预测DO的准确性。
DO组和非DO组在性别、年龄和BMI方面未发现显著差异。非DO组的平均RAR（及标准差）（62.6%±10.2%）显著高于DO组（46.1%±10.5%）（p<0.001）。非DO组的平均SSR（及标准差）（61.6%±6.0%）显著高于DO组（43.6%±9.2%）（p<0.001）。受试者工作特征曲线表明，SSR和RAR可作为识别DO的有效指标，SSR在指示DO存在方面具有更高的准确性，临界值<48.71%（敏感性为100%，特异性为85.0%）。
SSR可作为传统方法的补充参数来预测DO，并且可能是更好的预测指标。并且，与双侧型和桥接型相比，单侧型OLF更有可能发生DO，且SSR更大。
