The Frequency and Treatment of Dural Tears and Cerebrospinal Fluid Leakage in 266 Patients With Thoracic Myelopathy Caused by Ossification of the Ligamentum Flavum

Study Design. Retrospective review. Objective. To perform a single-institution analysis of incidence, treatment, and clinical outcome in patients with thoracic ossification of the ligamentum flavum (OLF) who experienced dural tears and cerebrospinal fluid (CSF) leakage. Summary of Background Data. There is a paucity of clinical reports focusing on dural tears and CSF leakage after thoracic OLF surgery. Because dural adhesion and dural ossification are common features of thoracic OLF, the incidence of CSF leakage in OLF patients is high and represents a significant clinical challenge. Methods. A total of 266 patients with thoracic OLF were admitted to our hospital from 1995 to 2011. Each patient's medical records were reviewed to identify cases of dural tears and CSF leakage. Information on therapeutic strategy used to repair the dural tears and complications related to CSF leakage was extracted. Results. The incidence of dural tears and CSF leakage in OLF patients was 32% (85/266). The incidence of dural ossification was 25.2%. The dural tears were repaired with a range of materials, including gelatin sponge, muscle/fascia, artificial dura, silk suture, and fibrin glue. The intraoperative repair procedure did not resolve CSF leakage in 65 cases, and 16 of those cases experienced complications related to the continued CSF leakage, including CSF pseudocyst, wound dehiscence, and meningitis. Fifty-eight patients with CSF leakage were eventually cured by a series of comprehensive treatments, which included prone position, continuous pressure by sandbag, ultrasound-guided puncture, and aspiration. Only 7 patients required reoperation. Conclusion. Dural ossification was the main reason for dural tears. In all, 78 of the 85 patients with CSF leakage or dural tear were successfully cured. The success rate was 91.8%, which indicated that a series of comprehensive treatments was an effective strategy to treat these patients.

[1]  J. Yeom,et al.  Clinical analysis of thoracic ossified ligamentum flavum without ventral compressive lesion , 2011, European Spine Journal.

[2]  P. Campbell,et al.  Application of a new hydrogel dural sealant that reduces epidural adhesion formation: evaluation in a large animal laminectomy model. , 2010, Journal of neurosurgery. Spine.

[3]  K. Cheung,et al.  Prevalence, Distribution, and Morphology of Ossification of the Ligamentum Flavum: A Population Study of One Thousand Seven Hundred Thirty-Six Magnetic Resonance Imaging Scans , 2010, Spine.

[4]  N. Muthukumar.  Dural Ossification in Ossification of the Ligamentum Flavum: A Preliminary Report , 2009, Spine.

[5]  P. Gerszten,et al.  Effect of fibrin glue on the prevention of persistent cerebral spinal fluid leakage after incidental durotomy during lumbar spinal surgery , 2009, European Spine Journal.

[6]  V. Rajshekhar,et al.  Cerebrospinal Fluid Leak During Cervical Corpectomy for Ossified Posterior Longitudinal Ligament: Incidence, Management, and Outcome , 2009, Spine.

[7]  A. Minami,et al.  Clinical Results and Complications of Circumferential Spinal Cord Decompression Through a Single Posterior Approach for Thoracic Myelopathy Caused by Ossification of Posterior Longitudinal Ligament , 2008, Spine.

[8]  Shin-Yoon Kim,et al.  Surgical outcome of thoracic myelopathy secondary to ossification of ligamentum flavum. , 2007, Joint, bone, spine : revue du rhumatisme.

[9]  E. Itoi,et al.  Results of surgical treatment for thoracic myelopathy: minimum 2-year follow-up study in 132 patients. , 2007, Journal of neurosurgery. Spine.

[10]  N. Epstein.  The Frequency and Etiology of Intraoperative Dural Tears in 110 Predominantly Geriatric Patients Undergoing Multilevel Laminectomy With Noninstrumented Fusions , 2007, Journal of spinal disorders & techniques.

[11]  Shucai Deng,et al.  Thoracic ossification of ligamentum flavum caused by skeletal fluorosis , 2007, European Spine Journal.

[12]  S. Kokubun,et al.  Thoracic myelopathy caused by ossification of the ligamentum flavum: clinical features and surgical results in the Japanese population. , 2006, Journal of neurosurgery. Spine.

[13]  James D. Kang,et al.  Postoperative Management Protocol for Incidental Dural Tears During Degenerative Lumbar Spine Surgery: A Review of 3,183 Consecutive Degenerative Lumbar Cases , 2006, Spine.

[14]  J. Inamasu,et al.  A review of factors predictive of surgical outcome for ossification of the ligamentum flavum of the thoracic spine. , 2006, Journal of neurosurgery. Spine.

[15]  Fangcai Li,et al.  Surgical treatment of 40 patients with thoracic ossification of the ligamentum flavum. , 2006, Journal of neurosurgery. Spine.

[16]  P. Cabre,et al.  Symptomatic Ossification of the Ligamentum Flavum: A Clinical Series From the French Antilles , 2005, Spine.

[17]  Shih-Ming Jung,et al.  Surgical experience with symptomatic thoracic ossification of the ligamentum flavum. , 2005, Journal of neurosurgery. Spine.

[18]  E. Itoi,et al.  Factors related to long-term outcome after decompressive surgery for ossification of the ligamentum flavum of the thoracic spine. , 2003, Journal of neurosurgery.

[19]  H. Jemel,et al.  Thoracic myelopathy caused by ossification of the ligamentum flavum: a report of 18 cases. , 2003, Journal of neurosurgery.

[20]  Yat-Cheong So,et al.  Myelopathy Caused by Ossification of Ligamentum Flavum , 2002, Spine.

[21]  R. V. van Oostenbrugge,et al.  Spinal cord compression caused by unusual location and extension of ossified ligamenta flava in a Caucasian male. A case report and literature review. , 1999, Spine.

[22]  Jeffrey C. Wang,et al.  Dural Tears Secondary to Operations on the Lumbar Spine. Management and Results After a Two-Year-Minimum Follow-up of Eighty-eight Patients* , 1998, The Journal of bone and joint surgery. American volume.

[23]  Dong-jun Kim,et al.  A new method of stabilising the elevated laminae in open-door laminoplasty using an anchor system , 1998 .

[24]  B. A. Green,et al.  Closed subarachnoid drainage for management of cerebrospinal fluid leakage after an operation on the spine. , 1989, The Journal of bone and joint surgery. American volume.

[25]  W. J. Russell,et al.  Ossification of thoracic ligamenta flava. , 1983, AJR. American journal of roentgenology.