These findings suggest that the increase in Cx43 expression induced by mechanical strain in OPLL fibroblasts could facilitate the progression of OPLL through the upregulation of osteogenic genes, which suggests that Cx43 is a key mediator of how OPLL fibroblasts respond to mechanical stress to cause pathological bone formation (Yang et al., 2011). This evidence concerns the gene GJA1 and ossification of the posterior longitudinal ligament of the spine.