Correlation Between Spinal-Pelvic Parameters and Ossification of the Thoracolumbar Ligamentum Flavum: A Cross-Sectional Study.

Abstract

To investigate the correlation between spinal-pelvic parameters and ossification of the ligamentum flavum (OLF) in the thoracolumbar segment. A retrospective analysis was conducted on patients diagnosed with lumbar intervertebral disc degeneration between January 2021 and December 2024. All patients were divided into 2 groups: the non-OLF group and the OLF group. Comprehensive clinical data were collected for all participants, including age, sex, body mass index, disease duration, and the presence of comorbidities, as well as smoking and alcohol consumption history. Comparisons of spinal-pelvic parameters, including sacral slope (SS), pelvic tilt (PT), pelvic incidence, lumbar lordosis, and thoracolumbar kyphosis (TLK), were performed between the 2 groups. Multivariable logistic regression was used to assess the associations between each imaging parameter and the presence of OLF, and receiver operating characteristic curves were plotted. A total of 386 patients including 325 in non-OLF group and 61 in OLF group was included. Baseline analysis revealed that patients in the OLF group had significantly higher TLK and PI, greater SS, and were older compared to the non-OLF group. Additionally, hypertension was more prevalent in the OLF group. In contrast, gender distribution, smoking status, diabetes mellitus, body mass index, lumbar lordosis, and PT did not differ significantly between the 2 groups. Univariate logistic regression identified height, hypertension, SS, TLK, and age as significant factors associated with OLF. Multifactorial analysis confirmed that TLK was the only significant predictor for OLF occurrence. A receiver operating characteristic curve analysis developed based on TLK yielded a moderate area under the curve of 0.734. TLK was found to be significantly associated with the presence of OLF; notably, an increase in TLK correlated with an elevated risk of developing OLF. A predictive model incorporating TLK and basic demographic factors demonstrated moderate diagnostic value.