| ObjectiveTo summarize the imaging characteristics of thoracic ossifcation of the ligamentum flavum(TOLF)associated with dural adhesions and to evaluate the diagnostic value of CT combined with MRI in dural adhesions by analyzing retrospectively the imaging signs of ossification of TOLF associated with dural adhesions for the purpose of guiding the surgery.And to investigate the effect of TOLF with dural adhesions on postoperative outcome.Methods63 patients who had undergone TOLF surgery by the same physician in the Affiliated Hospital of Qingdao University between Between July 2010 and September 2016 were included in this retrospective study.The patient's course of disease,operation time,intraoperative blood loss,postoperative hospital stay and postoperative complications were recorded.The JOA score of thoracic spinal stenosis was used to evaluate the preoperative and postoperative follow-up.All patients were examined by X ray,CT and MRI.The patients were assigned into the study and control group according to the preoperative imaging signs.There are 19 cases which had the sign of “Tram track sign”?“Comma sign” or “Bridge sign” and had the sign of “Jagged line sign” in study group,and 44 cases in the control group.All the patients underwent imaging examinations were collected and reported by the radiology department of our hospital,the imaging features of the signs have been reviewed by 2 senior physicians.Adherence between dura mater and ligamentum flavum was observed during operation as the gold standard for the diagnosis of dural adhesion.The characteristics imaging of dual adhesions in TOLF were recorded,and the sensitivity,specificity and positive likelihood ratio(>5 having reference value,and >10 having diagnostic value)were calculated.Compare the operation time,intraoperative blood loss,postoperative hospital stay,postoperative recovery rate and postoperative cerebrospinal fluid leakage between the adhesion group and no adhesion group confirmed by operation.Results1.20 cases were included in the study group for the typical imaging founded in CT and MRI;19 cases having typical CT imaging,3 cases having “Jagged line sign” and 21 cases no typical imaging were included in the control group.There were “Tram track sign” sign in 11 cases,“Comma sign” in 5 cases and “Bridge sign” in 3 cases in all of 19 cases.2.Dural adhesion was obseeved in 19 patients in the operation,with 19 patients in the study group and 4 cases control group.3.In patients having the sign of “Tram track sign” or “Bridge sign” or “Comma sign” in CT and “Jagged line sign” in MRI,the positive likelihood ratio was 6.93.In patients having the sign of “Tram track sign” in CT,the positive likelihood ratio was 4.81.In patients having the sign of “Comma sign” in CT,the positive likelihood ratio was 1.54.In patients having the sign of “Bridge sign” in CT,the positive likelihood ratio was 1.73.And In patients having the sign of “Jagged line sign” in MRI,the positive likelihood ratio was 3.22.4.Adhesion group operation time was 90.9±30.9 minutes per section,no adhesion group operation time was 64.5±23.3 minutes per section,the difference was statistically significant(P<0.05);The hospitalization day was 10.44±2.15 days for adhesion group and 8.84±2.08 days for nonadhesion group respectively,the difference was statistically significant(P<0.05);The incidence of postoperative cerebrospinal fluid leakage was 57.9%in the adhesion group and 18.2% in the non adhesion group.Conclusions1.For patients with thoracic spinal stenosis causing from TOLF associated with dural adhesions,preoperative CT combined with MRI is valuable.2.Dural adhesions will extend the operation time,increase the risk of surgery,anesthesia,the incidence of postoperative cerebrospinal fluid leakage,and extend the recovery period after operation.The definite diagnosis before operation is significant for the evaluation of the postoperative and understanding of conditions for patients. |
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