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.

Onset of TSS was generally insidious but may be triggered acutely by apparently trivial events. Myelopathy mainly affected the lower limbs. The most common cause was OLF in the lower thoracic spine. Cervical or lumbar spinal disease was often also evident; therefore, comprehensive clinical assessment is required to avoid delays in diagnosis and treatment.

ObjectivePercutaneous vertebroplasty (PVP) is a surgical procedure that has been widely used to treat patients suffering from osteoporotic vertebral compression fractures (OVCFs). The procedure involves injection of bone cement into a fractured vertebra. In this study, we investigated whether the distribution of the cement in the vertebral body is related to the occurrence of recompression after surgery.Patients and methodsA total of 172 patients diagnosed with OVCF, from January 2008 to June 2013, were retrospectively reviewed. Fifty of these patients experienced recompression after surgery during the follow-up period (recompression group), and 122 patients had no recompression observed during the follow-up period (control group). Statistical analysis was performed to compare clinical and operative parameters between these two groups.ResultsDifferences were found in bone cement distribution between the recompression group and control group (P=0.001). Patients with bone cement distributed around both upper and lower endplates had a significantly less incidence of recompression (4/50 patients), when compared to other patterns of cement distribution (eg, below upper endplate, above lower endplate, and in the middle of vertebral body). The logistic multiple regression analysis also indicated that patients with bone cement distributed around both the upper and lower endplates had a lower risk of recompression when compared to patients with bone cement distributed in the middle of vertebral body (odds ratio =0.223, P=0.003).ConclusionWe herein suggest that the control of bone cement distribution during surgery provides beneficial effects on reducing the risks of recompression after PVP treatment in patients with OVCF.

Object In this paper, the authors aimed to summarize the clinical characteristics of ossification of the ligamentum flavum (OLF) associated with dural ossification (DO) and to identify improved methods for preoperative diagnosis. Methods Thirty-six patients who had undergone OLF surgery between February 2005 and September 2009 were included in this retrospective study. The patients were divided into 2 groups: one that included patients with intraoperative evidence of DO and a second group that included patients without DO. The clinical features of DO were summarized and the neurological status of the patients was evaluated pre- and postoperatively. Results The incidence rate of DO associated with OLF was 39% (14/36). The sensitivity and specificity of the tram track sign were found to be 93% and 59%, respectively. Dural ossification was found among 86% of the patients with tuberous type Sato classification. The postoperative neurological status of patients was generally improved relative to that observed prior to surgery, although neurological recovery did not differ between the 2 groups. Cerebrospinal fluid leakage was the main complication, occurring predominantly in the patients with DO, and all leaks resolved in all patients after comprehensive treatments. Conclusions The tram track sign and Sato classification were found to be useful for preoperative diagnosis of DO and for determining the surgical procedure to be performed. Dural ossification had no effect on postoperative neurological recovery.

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Thoracic ossification of the ligamentum flavum (TOLF) is the most common cause for thoracic spinal stenosis. TOLF is usually complicated by thoracic disc herniation, ossification of the posterior longitudinal ligament and degenerative spinal diseases such as cervical spondylosis and lumbar spinal stenosis, and the ossification also usually has a discontinuous or continuous multi-segment distribution. The resultant superposition of several symptoms makes the clinical manifestations complex. Currently, the diagnosis of TOLF depends mainly on the patient's symptoms, physical examination and thoracic CT and MRI examinations. Identification of the location of TOLF depends more on the doctor's subjective judgement. Diagnostic problems are related to the specific region and level of surgical decompression: if the extent of decompression is insufficient, the treatment is inadequate, resulting in residual symptoms. Obversely, unnecessary trauma and a various complications will occur if the decompression is too extensive. Hence, the clinical features and process of diagnosis, especially the means of identifying the location, still require further improvement. It is necessary to establish a simple and accurate means of identifying the segment of TOLF that is responsible for the neurologic deficit: a number of spinal surgeons have been working hard on this. This article will provided an overview of the clinical features of TOLF and the related problems of clinical identification of the location of the segment causing the neurological deficit. The relationship between the imaging manifestations and clinical characteristics still need to be explored with the aim of establishing a simple and precise method for determining precisely whether TOLF is related to spinal cord injury or not, thus reducing surgical trauma and achieving an optimal prognosis.

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CT-guided percutaneous vertebral injection of a single simvastatin/poloxamer 407 thermosensitive hydrogel promotes bone formation in ovariectomized minipigs. The underlying mechanism appears to involve the higher expression of VEGF and BMP-2.