A novel computed tomography scoring system for evaluating the risk of dural defects in anterior surgery for cervical ossification of the posterior longitudinal ligament

To develop and validate a computed tomography (CT)-based scoring system for evaluating the risk of dural defects (DDs) in anterior surgery for cervical ossification of the posterior longitudinal ligament (OPLL). We retrospectively analyzed CT imaging features of 114 OPLL patients in our institute wh...

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Bibliographic Details
Published in:Clinical neurology and neurosurgery 2024-07, Vol.242, p.108315, Article 108315
Main Authors: Du, Yue-Qi, Cui, Guo-Qing, Qi, Mao-Yang, Zhang, Bo-Yan, Guan, Jian, Jian, Feng-Zeng, Duan, Wan-Ru, Chen, Zan
Format: Article
Language:English
Subjects:
Anterior surgery
Cervical spine
Computed tomography
Decompression
Dural defects
Ligaments
Medical imaging
Ossification
Ossification of the posterior longitudinal ligament
Patients
Regression analysis
Risk factors
Scoring system
Surgery
Variables
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Summary:To develop and validate a computed tomography (CT)-based scoring system for evaluating the risk of dural defects (DDs) in anterior surgery for cervical ossification of the posterior longitudinal ligament (OPLL). We retrospectively analyzed CT imaging features of 114 OPLL patients in our institute who received anterior decompression surgery. Intraoperative DDs were found in 16 patients. A multivariable logistic regression was used to evaluate the predictors. According to the odd ratio of the included risk factors, we developed a CT scoring system for evaluating the risk of DDs in anterior OPLL surgery. The system was further validated in an independent group of 39 OPLL patients. We developed a CT scoring system as follows: hook sign (2 points), K-line (-) (1 point) and broad base (1 point). Thus, the system comprised 4 total points, and patients were at high risks of dural defects when the score ≥3 points. The operating characteristics of a score ≥3 for predicting DDs in the validation group were: sensitivity of 0.83, specificity of 0.94, LR positive of 13.75, LR negative of 0.18 and AUC of 0.886. The discriminatory ability of the proposed score could be demonstrated in the validation cohort. The relatively simple and easy-to-use scoring system we propose integrates the 3 most reliable spinal CT findings observed in patients with OPLL and a DD. The likelihood to identify the underlying risks of spinal CSF leaks may be useful to triage patients who may benefit from indirect decompression techniques. •Dural defects and cerebrospinal fluid leaks was frequently encountered during anterior OPLL surgery, causing threatening complications.•In this study, we defined a sensitive and reliable CT scoring system based on CT findings in patients with OPLL to predict dural defects.•This robust classification system may lead to more standardized diagnostic and surgical approaches for OPLL.
ISSN:0303-8467
1872-6968
1872-6968
DOI:10.1016/j.clineuro.2024.108315