Skip to main content
SpringerLink
Log in

Dural ossification associated with ossification of posterior longitudinal ligament in the cervical spine: a retrospective analysis

  • Original Article
  • Published:
European Spine Journal Aims and scope Submit manuscript

Abstract

Objective

Dural ossification (DO) is common in patients with ossification of the posterior longitudinal ligament (OPLL). The existence of DO makes surgery challenging and increases the risk of complications. The aim of this study was to investigate the incidence, distribution and radiological characteristics of DO associated with OPLL.

Methods

From January 2017 to January 2019, 55 patients with cervical OPLL were treated in our single center using an anterior cervical approach microsurgery. Preoperative CT images of decompressed segments were evaluated to identify imaging signs of DO. The ‘double-layer sign’ (DLS), ‘parenthese sign’ (PS) and ‘hook sign’ (HS) were considered to be characteristic imaging findings of DO in OPLL. Two kinds of confusing signs (false double-layer) were identified.

Results

Nineteen segments from 15 patients with OPLL had DO related to OPLL. The incidence of DO in OPLL segments was 30.16% (19/63), and the incidence of DO in patients with OPLL was 27.27% (15/55). DO occurred at the intervertebral space level in 14 cases and at the posterior level of the vertebral body in 5 cases. The sensitivity and specificity of imaging diagnosis were 89.47% (17/19) and 81.82% (36/44), respectively. The positive predictive value was relatively low, 68.00% (17/25), due to the false-positive double-layer sign. The negative predictive value was 94.74% (36/38).

Conclusion

DO was relatively common in cervical OPLL. DLS might be misdiagnosed. PS and HS can vividly and intuitively describe the imaging features of DO and have high diagnostic accuracy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Epstein NE (1994) The surgical management of ossification of the posterior longitudinal ligament in 43 North Americans. Spine (Phila Pa 1976) 19(6):664–72

    Article  CAS  Google Scholar 

  2. Mizuno J et al (2005) Dural ossification associated with cervical ossification of the posterior longitudinal ligament: frequency of dural ossification and comparison of neuroimaging modalities in ability to identify the disease. J Neurosurg Spine 2(4):425–430

    Article  Google Scholar 

  3. Mizuno J (2018) Radiologic evaluation of ossification of the posterior longitudinal ligament with dural ossification. Neurosurg Clin N Am 29(1):55–61

    Article  Google Scholar 

  4. Hida K et al (1997) Bone window computed tomography for detection of dural defect associated with cervical ossified posterior longitudinal ligament. Neurol Med Chir (Tokyo) 37(2):173–176

    Article  CAS  Google Scholar 

  5. Uei H et al (2018) Efficacy of posterior decompression and fixation based on ossification-kyphosis angle criteria for multilevel ossification of the posterior longitudinal ligament in the thoracic spine. J Neurosurg Spine 29(2):150–156

    Article  Google Scholar 

  6. Epstein N (2001) Anterior approaches to cervical spondylosis and ossification of the posterior longitudinal ligament: review of operative technique and assessment of 65 multilevel circumferential procedures. Surg Neurol 55(6):313–324

    Article  CAS  Google Scholar 

  7. Onari K et al (2001) Long-term follow-up results of anterior interbody fusion applied for cervical myelopathy due to ossification of the posterior longitudinal ligament. Spine (Phila Pa 1976) 26(5):488–93

    Article  CAS  Google Scholar 

  8. Joseph V, Kumar GS, Rajshekhar V (2009) Cerebrospinal fluid leak during cervical corpectomy for ossified posterior longitudinal ligament: incidence, management, and outcome. Spine (Phila Pa 1976) 34(5):491–494

    Article  Google Scholar 

  9. Head J et al (2019) Ossification of the posterior longitudinal ligament: surgical approaches and associated complications. Neurospine 16(3):517–529

    Article  Google Scholar 

  10. Macdonald RL et al (1997) Multilevel anterior cervical corpectomy and fibular allograft fusion for cervical myelopathy. J Neurosurg 86(6):990–997

    Article  CAS  Google Scholar 

  11. Sun M et al (2017) Microscope enhanced the efficacy and safety of anterior cervical surgery for managing cervical ossification of the posterior longitudinal ligament. Med Sci Monit 23:3088–3094

    Article  Google Scholar 

  12. Epstein N (1993) The surgical management of ossification of the posterior longitudinal ligament in 51 patients. J Spinal Disord 6(5):432–454

    Article  CAS  Google Scholar 

  13. Chen Y et al (2009) Diagnosis and surgery of ossification of posterior longitudinal ligament associated with dural ossification in the cervical spine. Eur Spine J 18(10):1541–1547

    Article  Google Scholar 

  14. Min JH, Jang JS, Lee SH (2007) Significance of the double-layer and single-layer signs in the ossification of the posterior longitudinal ligament of the cervical spine. J Neurosurg Spine 6(4):309–312

    Article  Google Scholar 

  15. Nam DC et al (2019) Molecular pathophysiology of ossification of the posterior longitudinal ligament (OPLL). Biomol Ther (Seoul) 27(4):342–348

    Article  Google Scholar 

  16. Yayama T et al (2007) Thoracic ossification of the human ligamentum flavum: histopathological and immunohistochemical findings around the ossified lesion. J Neurosurg Spine 7(2):184–193

    Article  Google Scholar 

  17. Yildizhan A et al (1991) Intradural disc herniations pathogenesis, clinical picture, diagnosis and treatment. Acta Neurochir (Wien) 110(3–4):160–165

    Article  CAS  Google Scholar 

  18. Mizuno J et al (2005) Surgery for dural ossification in association with cervical ossification of the posterior longitudinal ligament via an anterior approach. Neurol India 53(3):354–357

    Article  Google Scholar 

  19. Sun J et al (2018) Anterior controllable antidisplacement and fusion surgery for the treatment of multilevel severe ossification of the posterior longitudinal ligament with myelopathy: preliminary clinical results of a novel technique. Eur Spine J 27(6):1469–1478

    Article  Google Scholar 

  20. Yamaura I et al (1999) Anterior floating method for cervical myelopathy caused by ossification of the posterior longitudinal ligament. Clin Orthop Relat Res 359:27–34

    Article  Google Scholar 

Download references

Funding

This study was supported by Beijing Municipal Science and Technology Commission (Grant number: Z191199996619048 and L212007) and Beijing Municipal Commission of Education (Grant numbers: KZ202010025043 and 1192070315).

Author information

Author notes

  1. Jian Guan and Chenghua Yuan contributed equally to this work.

Authors and Affiliations

  1. Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, China-INI, 45 Changchun Street, Beijing, 100053, People’s Republic of China

    Jian Guan, Chenghua Yuan, Yueqi Du, Shanhang Jia, Can Zhang, Zhenlei Liu, Kai Wang, Wanru Duan, Zuowei Wang, Xingwen Wang, Hao Wu, Zan Chen & Fengzeng Jian

  2. Spine Center, China International Neuroscience Institute China-INI, Beijing, People’s Republic of China

    Jian Guan, Chenghua Yuan, Yueqi Du, Shanhang Jia, Can Zhang, Zhenlei Liu, Kai Wang, Wanru Duan, Zuowei Wang, Xingwen Wang, Hao Wu, Zan Chen & Fengzeng Jian

  3. Research Center of Spine and Spinal Cord, Beijing Institute of Brain Disorders, Capital Medical University, Beijing, People’s Republic of China

    Jian Guan, Chenghua Yuan, Yueqi Du, Shanhang Jia, Can Zhang, Zhenlei Liu, Kai Wang, Wanru Duan, Zuowei Wang, Xingwen Wang, Hao Wu, Zan Chen & Fengzeng Jian

  4. National Center for Neurological Disorders, Beijing, People’s Republic of China

    Jian Guan, Chenghua Yuan, Yueqi Du, Shanhang Jia, Can Zhang, Zhenlei Liu, Kai Wang, Wanru Duan, Zuowei Wang, Xingwen Wang, Hao Wu, Zan Chen & Fengzeng Jian

Authors
  1. Jian Guan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Chenghua Yuan
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yueqi Du
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Shanhang Jia
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Can Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Zhenlei Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Kai Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Wanru Duan
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Zuowei Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Xingwen Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Hao Wu
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Zan Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Fengzeng Jian
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding authors

Correspondence to Zan Chen or Fengzeng Jian.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical standard

The study was approved by the institutional research ethics committee of Xuanwu Hospital.

Informed consent

Not applicable.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Guan, J., Yuan, C., Du, Y. et al. Dural ossification associated with ossification of posterior longitudinal ligament in the cervical spine: a retrospective analysis. Eur Spine J 31, 3462–3469 (2022). https://doi.org/10.1007/s00586-022-07402-9

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00586-022-07402-9

Keywords

Search

Navigation