The factors significantly associated with favorable surgical results were maximum ossification located at the upper thoracic spine and use of instrumentation. T-OPLL at the nonkyphotic upper thoracic spine can be treated by laminoplasty that is relatively a safe surgical procedure for neural elements. The use of instrumentation allows correction of kyphosis or prevention of progression of kyphosis, thereby, enhancing and maintaining decompression effect, and its use should be considered with posterior decompression.

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Hypocalcemia is the most common major adverse event in patients with osteoporosis receiving the bone resorption inhibitor denosumab; however, limited information is available regarding risk factors of hypocalcemia. Therefore, this study aimed to identify the risk factors of hypocalcemia induced by denosumab treatment for osteoporosis. We retrospectively reviewed the records of patients who had received initial denosumab supplemented with activated vitamin D for osteoporosis. Serum levels of the following bone turnover markers (BTMs) were measured at baseline: bone-specific alkaline phosphatase (BAP), total N-terminal propeptide of type 1 procollagen (P1NP), tartrate-resistant acid phosphatase 5b (TRACP-5b), and urinary cross-linked N-telopeptide of type 1 collagen (NTX). Of the 85 denosumab-treated patients with osteoporosis studied, 22 (25.9%) developed hypocalcemia. Baseline serum total P1NP, TRACP-5b, and urinary NTX were significantly higher in patients with hypocalcemia than in those with normocalcemia following denosumab administration (all P<0.01). Multivariate logistic regression analysis revealed that patients with total P1NP >76.5 μg/L, TRACP-5b >474 mU/dL, or urinary NTX >49.5 nmol bone collagen equivalent/mmol creatinine had a higher risk of hypocalcemia (P<0.01). Our study suggests that denosumab may have a greater impact on serum calcium levels in patients with postmenopausal osteoporosis with higher baseline bone turnover than in patients with postmenopausal osteoporosis with normal baseline bone turnover, because maintenance of normal serum calcium in this subgroup is more dependent on bone resorption. Close monitoring of serum calcium levels is strongly recommended for denosumab-treated patients with high bone turnover, despite supplementation with activated vitamin D and oral calcium.

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The authors reviewed 47 cases of infantile subdural fluid collection with regard to diagnosis and postoperative course after placement of a subdural-peritoneal shunt. CT scan with contrast enhancement proved to be an important diagnostic modality, showing vessels in the subarachnoid space as high-density spots. Utilizing this technique, we were able to differentiate the following varieties of fluid collection: (1) subdural fluid collection, in which enhancing vessels were seen on the brain surface, (2) subarachnoid fluid collection, in which vessels were on the inner table of the cranium, and (3) coexistence of subdural and subarachnoid fluid collections, in which vessels were between the inner table of the cranium and the brain surface. The postoperative course of subdural fluid collection was characterized as follows: (1) the subdural fluid collection decreased first, with increased subarachnoid fluid collection; (2) the subarachnoid fluid collection remained after the disappearance of subdural fluid collection; and (3) the brain expanded again later. Subdural fluid collection disappeared about 1 month after the shunt operation, which could lead occlusion of the shunt system. Postoperative enlargement of the subarachnoid space was an early indicator of the efficacy of the subdural-peritoneal shunt.