The clinical value of three-dimensional measurement in the diagnosis of thoracic myelopathy caused by ossification of the ligamentum flavum

Chen Yan; Hao-Yuan Tan; Cheng-Long Ji; Xue-Wei Yu; Huai-Cheng Jia; Fu-Dong Li; Gui-Cheng Jiang; Wei-Shi Li; Fei-Fei Zhou; Zhen Ye; Jing-Chuan Sun; Jian-Gang Shi

doi:10.21037/qims-20-713

The clinical value of three-dimensional measurement in the diagnosis of thoracic myelopathy caused by ossification of the ligamentum flavum

Quant Imaging Med Surg. 2021 May;11(5):2040-2051. doi: 10.21037/qims-20-713.

Authors

Chen Yan^{1

2}, Hao-Yuan Tan^{1

2}, Cheng-Long Ji¹, Xue-Wei Yu^{1

2}, Huai-Cheng Jia^{1

2}, Fu-Dong Li¹, Gui-Cheng Jiang¹, Wei-Shi Li³, Fei-Fei Zhou³, Zhen Ye⁴, Jing-Chuan Sun¹, Jian-Gang Shi¹

Affiliations

¹ Second Department of Spine Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China.
² Undergraduate Incubation Center, Second Military Medical University, Shanghai, China.
³ Department of Orthopaedics, Peking University Third Hospital, Beijing, China.
⁴ Shanghai Electric Group Limited Liability Company Central Academe, Shanghai, China.

Abstract

Background: Thoracic ossification of the ligamentum flavum (OLF) is a major cause of thoracic myelopathy, which is often accompanied by multiple segmental stenosis or other degenerative spinal diseases. However, in the above situations, it is difficult to determine the exact segment responsible. The objective of this study was to analyze three-dimensional (3D) radiological parameters in order to establish a novel diagnostic method for discriminating the responsible segment in OLF-induced thoracic myelopathy, and to evaluate its superiority compared to the conventional diagnostic methods.

Methods: Eighty-one patients who underwent surgery for thoracic myelopathy caused by OLF from 2016 to 2020 were enrolled in this study as the myelopathy group, and 79 patients who had thoracic OLF but displayed no definite neurological signs from 2018 to 2020 were enrolled as the non-myelopathy group. We measured the one-dimensional (1D), two-dimensional (2D), and 3D radiological parameters, calculated their optimal cutoff values, and compared their diagnostic values.

Results: Significant differences were observed in the 1D, 2D, and 3D radiological parameters between the myelopathy and non-myelopathy groups (P<0.01). As a 3D radiological parameter, the OLF volume (OLFV) ratio (OLFV ratio = OLFV/normal canal volume × 100%) was the most accurate parameter for diagnosing OLF-induced thoracic myelopathy, with a diagnostic coincidence rate of 88.1%. We also found that an OLFV ratio of 26.3% could be used as the optimal cutoff value, with a sensitivity of 87.7% and a specificity of 88.6%. Moreover, the OLFV ratio [area under the curve (AUC): 0.92, 95% confidence interval (CI): 0.86-0.95] showed a statistically higher diagnostic value than the 1D and 2D parameters (AUC: 0.75, 95% CI: 0.67-0.81; AUC: 0.84, 95% CI: 0.77-0.89, respectively) (P<0.05). Pearson correlation analysis illustrated that the OLFV ratio was significantly negatively correlated with preoperative modified Japanese Orthopedic Association (mJOA) score (r=-0.73, 95% CI: -0.81 to -0.60, P<0.01).

Conclusions: Our results demonstrate the superiority of the OLFV ratio over the conventional 1D and 2D computed tomography (CT)-based radiological parameters for the diagnosis of OLF-induced thoracic myelopathy. The novel diagnostic method based on the OLFV ratio will help to determine the responsible segment in multi-segmental thoracic OLF or when thoracic OLF coexists with other degenerative spinal diseases. The OLFV ratio also accurately reflects the clinical state of symptomatic patients with thoracic OLF.

Keywords: Ossification of the ligamentum flavum (OLF); computed tomography (CT); diagnostic imaging; thoracic myelopathy; three-dimensional image (3D image).