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

Yue-Qi Du; Guo-Qing Cui; Mao-Yang Qi; Bo-Yan Zhang; Jian Guan; Feng-Zeng Jian; Wan-Ru Duan; Zan Chen

doi:10.1016/j.clineuro.2024.108315

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

Clin Neurol Neurosurg. 2024 May 1:242:108315. doi: 10.1016/j.clineuro.2024.108315. Online ahead of print.

Authors

Yue-Qi Du¹, Guo-Qing Cui¹, Mao-Yang Qi¹, Bo-Yan Zhang¹, Jian Guan¹, Feng-Zeng Jian¹, Wan-Ru Duan², Zan Chen³

Affiliations

¹ Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China; Lab of Spinal Cord Injury and Functional Reconstruction, China International Neuroscience Institute, Beijing, China.
² Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China; Lab of Spinal Cord Injury and Functional Reconstruction, China International Neuroscience Institute, Beijing, China. Electronic address: duanwanru@xwhosp.org.
³ Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China; Lab of Spinal Cord Injury and Functional Reconstruction, China International Neuroscience Institute, Beijing, China. Electronic address: chenzan66@163.com.

PMID: 38749356
DOI: 10.1016/j.clineuro.2024.108315

Abstract

Objective: 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).

Methods: 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.

Results: 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.

Conclusions: 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.

Keywords: Anterior surgery; Cervical spine; Computed tomography; Dural defects; Ossification of the posterior longitudinal ligament; Risk factors; Scoring system.