Objective To review the research progress of bone morphogenetic protein (BMP) and the liability of ossification of the posterior longitudinal ligament (OPLL). Methods Recent literature concerning BMP and the liability of OPLL was reviewed, analysed, and summarized. Results The single nucleotide polymorphisms (SNPs) of BMP gene may produce a minor cumulative effect and increase individual susceptibility to OPLL. A variety of environmental factors can promote the occurrence and development of OPLL by increasing the expression of BMP gene. Conclusion The SNPs of BMP gene may increase individual susceptibility to OPLL. However, interaction of cumulative effect of the SNPs and environmental factors can promote the liability to OPLL.
Objective To evaluate the effectiveness of combined posterior decompression with laminoplasty and anterior decompression with fusion for the treatment of cervical spinal canal stenosis with reverse arch. Methods Between May 2009 and February 2012, 13 cases of cervical spinal canal stenosis with reverse arch underwent posterior decompression with laminoplasty surgery in prone position and then anterior decompression with fusion surgery in supine position. There were 7 males and 6 females with an average age of 43.5 years (range, 38-62 years) and an average disease duration of 25 months (range, 18-60 months). All the patients had neck axial symptoms and spinal cord compressed symptoms, and lateral computer radiology (CR) of the neck showed reverse arch of cervical vertebrae. Segments of intervertebral disc protrusion included C3-6 in 4 cases, C4-7 in 4 cases, and C3-7 in 5 cases. After operation, anteroposterior and lateral CR was used to observe the cervical curvature change and fixation loosening, MRI to observe the change of the compression on spinal cord, visual analogue scale (VAS) score to evaluate the improvement of axial symptom, and Japanese Orthopaedic Association (JOA) score to assess the nerve function improvement. Results All incisions healed by first intention. All patients were followed up 9-32 months (mean, 15.4 months). Internal fixator had good position without loosening or breaking and the compression on spinal cord improved significantly after operation. All the patients obtained bony fusion at 6 months after operation. The axial symptoms and the nerve function at last follow-up were improved. VAS score at last follow-up (3.25 ± 1.54) was significantly lower than that at preoperation (6.55 ± 1.52) (P lt; 0.05); JOA score at last follow-up (10.45 ± 4.23) was significantly higher than that at preoperation (7.05 ± 1.32) (P lt; 0.05); and cervical curvature value at last follow-up [(6.53 ± 3.12) mm] was significantly higher than that at preoperation [(3.22 ± 5.15) mm] (P lt; 0.05). Conclusion Combined posterior decompression with laminoplasty and anterior decompression with fusion for the treatment of cervical spinal canal stenosis with reverse arch is a safe and effective surgical method.
Objective To summarize the characteristic imaging signs of ossification of the ligamentum flavum (OLF) associated with dural adhesions by analyzing retrospectively the imaging signs of OLF associated with dural adhesions. Methods A retrospective analysis was made on clinical data of 85 patients undergoing OLF surgery between January 2010 and September 2012. The patients were assigned into the study group and the control group according to the preoperative imaging signs. Of 85 patients, 34 had both “tram track sign” and “jagged line sign” as the study group and 51 had either “tram track sign” or “jagged line sign” and neither of them as the control group. Adherence between dura mater and ligamentum flavum was observed during operation as the “gold standard” for the diagnosis of dural adhesion. The imaging information of CT and MRI in sagittal and axial planes was analyzed. The typical characteristics of dural adhesions were found. Then the sensitivity, specificity, and positive likelihood ratio of the preoperative imaging examinations were calculated to estimate the reference value and diagnostic value (gt; 5 having reference value, and gt; 10 having diagnostic value). Results In the study group, dural adhesion was observed in 26 patients (10 males and 16 females), and the other 8 patients (6 males and 2 females) had no dural adhesion. In the control group, dural adhesion was found in 2 female patients who had “jagged line sign”, and 49 patients had no dural adhesion (14 males and 35 females). In patients having both “tram track sign” and “jagged line sign”, the sensitivity was 92.9%; the specificity was 86.0%; and the positive likelihood ratio was 6.6. In patients having “tram track sign”, the sensitivity was 92.9%; the specificity was 64.9%; and the positive likelihood ratio was 2.6. In patients having “jagged line sign”, the sensitivity was 100%; the specificity was 77.2%; and the positive likelihood ratio was 4.4. Conclusion For patients with OLF having both “tram track sign” and “jagged line sign”, preoperative CT and MRI have a reference value for diagnoses of the OLF associated with dural adhesions.