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European Spine Journal

, Volume 24, Issue 8, pp 1673–1680 | Cite as

A new method to determine whether ossified posterior longitudinal ligament can be resected completely and safely: spinal canal “Rule of Nine” on axial computed tomography

  • Haisong Yang
  • Xuhua Lu
  • Xinwei Wang
  • Deyu ChenEmail author
  • Wen Yuan
  • Lili Yang
  • Yang Liu
Original Article

Abstract

Purpose

To introduce the new method of spinal canal “Rule of Nine” on axial computed tomography (CT) to determine whether ossified posterior longitudinal ligament (OPLL) can be resected completely and safely.

Methods

From January 2008 to January 2013, we retrospectively analyzed 308 patients with cervical OPLL who underwent anterior corpectomy. Patients were examined by cervical plain X-ray, CT, and magnetic resonance imaging. The characteristics of OPLL on axial CT, dural mater adhesion and ossification, complete resection of the ossified mass, cerebrospinal fluid (CSF) leakage, spinal cord injury (SCI), and postoperative outcome were all studied. OPLL was characterized at the maximum ossified level using spinal canal “Rule of Nine” on axial CT.

Results

OPLL was completely and safely resected in 129 patients, whose ossified mass was within the safety zone. No CSF leakage or SCI occurred. The most ossified material was resected when OPLL was within the danger zone in 21 patients. There were two cases of SCI and seven of CSF leakage. In the other 158 patients, the ossified mass was within the intermediate zone. In 96 patients the width of the ossified mass was <2 resection units. It was completely resected and one case had CSF leakage. In the other 62 cases, the ossified mass was >2 resection units and there were nine cases of CSF leakage. CSF leakage and SCI increased significantly when the ossified mass was ≥6 units. The inter- and intraobserver κ values were 0.76 and 0.84, respectively, showing a good reliability.

Conclusions

Our new method can be used to determine whether OPLL can be resected completely and safely, and identify potential risks and complications.

Keywords

Ossification of the posterior longitudinal ligament Rule of nine Computed tomography Dural ossification Postoperative complications 

Notes

Conflict of interest

None.

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Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Haisong Yang
    • 1
  • Xuhua Lu
    • 1
  • Xinwei Wang
    • 1
  • Deyu Chen
    • 1
    • 2
    Email author
  • Wen Yuan
    • 1
  • Lili Yang
    • 1
  • Yang Liu
    • 1
  1. 1.Department of Orthopaedic SurgeryChangzheng HospitalShanghaiChina
  2. 2.Department of Spine Surgery CenterChangzheng HospitalShanghaiChina

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