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Papers by henrich cheng

Journal of Biomedical Science, Jul 17, 2014

Background: Acute spinal cord injury (SCI) leads to a series of reactive changes and causes sever... more Background: Acute spinal cord injury (SCI) leads to a series of reactive changes and causes severe neurological deficits. A pronounced inflammation contributes to secondary pathology after SCI. Astroglia respond to SCI by proliferating, migrating, and altering phenotype. The impact of reactive gliosis on the pathogenesis of SCI is not fully understood. Our previous study has identified an inflammatory modulating protein, proliferation related acidic leucine-rich protein (PAL31) which is upregulated in the microglia/macrophage of injured cords. Because PAL31 participates in cell cycle progression and reactive astroglia often appears in the injured cord, we aim to examine whether PAL31 is involved in glial modulation after injury. Results: Enhanced PAL31 expression was shown not only in microglia/macrophages but also in spinal astroglia after SCI. Cell culture study reveal that overexpression of PAL31 in mixed glial cells or in C6 astroglia significantly reduced LPS/IFNγ stimulation. Further, enhanced PAL31 expression in C6 astroglia protected cells from H 2 O 2 toxicity; however, this did not affect its proliferative activity. The inhibiting effect of PAL31 on LPS/IFNγ stimulation was observed in glia or C6 after co-culture with neuronal cells. The results demonstrated that the overexpressed PAL31 in glial cells protected neuronal damages through inhibiting NF-kB signaling and iNOS. Conclusions: Our data suggest that PAL31upregulation might be beneficial after spinal cord injury. Reactive gliosis might become a good target for future therapeutic interventions.

Journal of Spinal Cord Medicine, Oct 9, 2014

Objective: To assess whether functional activity, perceived health, and depressive symptoms diffe... more Objective: To assess whether functional activity, perceived health, and depressive symptoms differ between individuals with traumatic paraplegia with and without shoulder pain. Design: Cross sectional and comparative investigation using the unified questionnaire. Setting: Neural Regeneration and Repair Division unit of Taipei Veterans General Hospital in Taiwan. Participants: Seventy-six patients with paraplegia (23 with and 53 without shoulder pain) who had experienced spinal cord injury at American Spinal Injury Association Impairment Scale T2 to T12 neurologic level (at least 6 months previously). Outcome measures: Spinal Cord Independence Measure (SCIM), a single item from the Medical Outcomes Study 36-Item Short-Form Health Survey, and Patient Health Questionnaire-9 (PHQ-9) depression scale. Results: Shoulder pain was prevalent in 30% patients. Patients with shoulder pain had significantly worse perceived health and greater depressive symptoms than those without. No significant difference was found in functional ability between groups. Greater shoulder pain intensity was related to higher depressive scores (r = 0.278, P = 0.017) and lower self-perceived health scores (r = −0.433, P < 0.001) but not SCIM scores (P = 0.342). Conclusion: Although shoulder pain was unrelated to functional limitation, it was associated with lower perceived health and higher depressive mood levels.

Neurospine, Sep 30, 2018

The Dynesys-Transition-Optima (DTO) hybrid system was designed to achieve arthrodesis and stabili... more The Dynesys-Transition-Optima (DTO) hybrid system was designed to achieve arthrodesis and stabilization in patients with lumbar degeneration. Satisfactory outcomes were demonstrated previously. However, no study has evaluated the effects of using the DTO system in patients with lumbar spondylolisthesis or stenosis. Methods: This retrospective study included 35 consecutive patients with multilevel lumbar degeneration with or without spondylolisthesis who underwent surgery using the DTO system. Imaging studies included pre-and postoperative radiography, magnetic resonance imaging, and computed tomography. The clinical outcomes were measured by Japanese Orthopedic Association (JOA) scores, Oswestry Disability Index (ODI) scores, and a visual analogue scale (VAS) for back and leg pain. Results: Thirty patients (85.7%) with a mean age of 61.9 years completed the follow-up, with a mean duration of 35.1 months. There were 21 patients in the spondylolisthesis group and 9 in the stenosis group. The spondylolisthesis group had worse functional scores than the stenosis group preoperatively. After DTO surgery, all patients showed significant improvements in clinical outcomes, including VAS for back and leg pain, ODI, and JOA scores (p < 0.05). There were no significant differences in clinical outcomes between the 2 groups. At a 2-year follow-up, lumbar alignment was well maintained in both groups (p = 0.116). There were no significant differences in lumbar alignment between the 2 groups. Conclusion: During a follow-up period of over 2 years, both patients with spondylolisthesis and those with stenosis showed improvements and similar disability and pain scores after surgery using the DTO system. Lumbar alignment was also well maintained.

Biomedicines

Background: The ossification of the posterior longitudinal ligament (OPLL) is one of the contribu... more Background: The ossification of the posterior longitudinal ligament (OPLL) is one of the contributing factors leading to severe cervical spondylotic myelopathy (CSM). The mechanism causing ossification is still unclear. The current study was designed to analyze the specimens of patients with or without OPLL. Methods: The study collected 51 patients with cervical spondylosis. There were six serum samples in both the non-OPLL (NOPLL) and OPLL groups. For tissue analysis, there were seven samples in the NOPLL group and five samples in the OPLL group. The specimens of serum and tissue were analyzed by using Human Cytokine Antibody Arrays to differentiate biomarkers between the OPLL and NOPLL groups, as well as between serum and OPLL tissue. Immunohistochemical staining of the ligament tissue was undertaken for both groups. Results: For OPLL vs. NOPLL, the serum leptin levels are higher in the OPLL group, corroborating others’ observations that it may serve as a disease marker. In the ti...

Brain Sciences

This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY

Journal of Neurosurgery: Case Lessons

BACKGROUND The natural history of ossification of the posterior longitudinal ligament (OPLL) rema... more BACKGROUND The natural history of ossification of the posterior longitudinal ligament (OPLL) remains poorly understood and multiple etiologies have been reported. However, most have focused on the characteristics of the patient rather than alternation of mechanical stress after spinal fusion. OBSERVATIONS This report describes, for the first time, a de novo OPLL found at the subaxial cervical spine 7 years after an atlantoaxial fusion surgery. A 57-year-old female initially required atlantoaxial arthrodesis for os odontoideum and stenosis that caused myelopathy. The posterior fusion surgery went smoothly without complications and the patient had good recovery of neurological functions. There was no associated instability, trauma, or reoperations during the follow-up. Seven years later, the patient presented with slight neck pain and a newly developed OPLL at C3–4 caudal to the C1–2 fusion construct. LESSONS Conflicting with the conventional concept that OPLL is common in elderly men...

BMC Musculoskeletal Disorders, 2020

Background The conventional pedicle-screw-based dynamic stabilization process involves dissection... more Background The conventional pedicle-screw-based dynamic stabilization process involves dissection of the Wiltse plane to cannulate the pedicles, which cannot be undertaken with minimal surgical invasion. Despite some reports having demonstrated satisfactory outcomes of dynamic stabilization in the management of low-grade spondylolisthesis, the extensive soft tissue dissection involved during pedicle screw insertion substantially compromises the designed rationale of motion (muscular) preservation. The authors report on a novel method for minimally invasive insertion of dynamic screws and a mini case series. Methods The authors describe innovations for inserting dynamic screws via the cortical bone trajectory (CBT) under spinal navigation. All the detailed surgical procedures and clinical data are demonstrated. Results A total of four (2 females) patients (mean age 64.75 years) with spinal stenosis at L4–5 were included. By a combination of microscopic decompression and image-guided ...

Journal of Neurosurgery: Spine, 2020

OBJECTIVECigarette smoking has been known to increase the risk of pseudarthrosis in spinal fusion... more OBJECTIVECigarette smoking has been known to increase the risk of pseudarthrosis in spinal fusion. However, there is a paucity of data on the effects of smoking in dynamic stabilization following lumbar spine surgery. This study aimed to investigate the clinical outcomes and the incidence of screw loosening among patients who smoked.METHODSConsecutive patients who had lumbar spondylosis, recurrent disc herniations, or low-grade spondylolisthesis that was treated with 1- or 2-level surgical decompression and pedicle screw–based Dynesys dynamic stabilization (DDS) were retrospectively reviewed. Patients who did not complete the minimum 2 years of radiological and clinical evaluations were excluded. All screw loosening was determined by both radiographs and CT scans. Patient-reported outcomes, including visual analog scale (VAS) scores of back and leg pain, Japanese Orthopaedic Association (JOA) scores, and Oswestry Disability Index (ODI), were analyzed. Patients were grouped by smokin...

Journal of Neurosurgery: Spine, 2019

OBJECTIVECigarette smoking can adversely affect bone fusion in patients who undergo anterior cerv... more OBJECTIVECigarette smoking can adversely affect bone fusion in patients who undergo anterior cervical discectomy and fusion. However, there is a paucity of data on smoking among patients who have undergone cervical disc arthroplasty (CDA). The present study aimed to compare the clinical and radiological outcomes of smokers to those of nonsmokers following CDA.METHODSThe authors retrospectively reviewed the records of consecutive patients who had undergone 1- or 2-level CDA for cervical disc herniation or spondylosis and had a minimum 2-year follow-up. All patients were grouped into a smoking group, which consisted of those who had consumed cigarettes within 6 months prior to the CDA surgery, or a nonsmoking group, which consisted of those who had not consumed cigarettes at all or within 6 months of the CDA. Clinical outcomes were evaluated according to the visual analog scale for neck and arm pain, Neck Disability Index, Japanese Orthopaedic Association Scale, and Nurick Scale at ea...

Neurospine, 2018

As spine surgery flourished in Taiwan and neurosurgeons became more involved towards the end of t... more As spine surgery flourished in Taiwan and neurosurgeons became more involved towards the end of the 20 th century, the Taiwan Neurosurgical Spine Society (TNSS), earlier named the Taiwan Neurospinal Society, was established on March 11, 2001. As the main founder, Dr. Chun-I Huang was elected as the first president of the TNSS. The goals of the TNSS were set to promote research, hold academic seminars, participate in international conferences, and to exchange clinical experiences. The mission of the TNSS has been successful and the profession of spine surgery in Taiwan has been elevated during the first decade of the 21 st century, by the time the TNSS joined ASIA SPINE in 2010. Since its establishment, the TNSS has always been supportive of collaboration and communication with the Korean Spinal Neurosurgery Society (KSNS) and the Neurospinal Society of Japan (NSJ). Through periodical meetings, supported by the TNSS, surgeons worldwide have enjoyed a platform of sharing and mutual learning. To further promote academics, the TNSS has officially supported the journal Neurospine since 2018. With all the efforts from local and international surgeons, the TNSS will continue to hold its mission and advance the profession of spine surgery.

International journal of molecular sciences, 2017

Accumulated evidence indicates that autophagy is a response of cancer cells to various anti-cance... more Accumulated evidence indicates that autophagy is a response of cancer cells to various anti-cancer therapies. Autophagy is designated as programmed cell death type II, and is characterized by the formation of autophagic vacuoles in the cytoplasm. Numerous herbs, including Chinese herbs, have been applied to cancer treatments as complementary and alternative medicines, supplements, or nutraceuticals to dampen the side or adverse effects of chemotherapy drugs. Moreover, the tumor suppressive actions of herbs and natural products induced autophagy that may lead to cell senescence, increase apoptosis-independent cell death or complement apoptotic processes. Hereby, the underlying mechanisms of natural autophagy inducers are cautiously reviewed in this article. Additionally, three natural compounds-curcumin, 16-hydroxycleroda-3,13-dien-15,16-olide, and prodigiosin-are presented as candidates for autophagy inducers that can trigger cell death in a supplement or alternative medicine for ca...

Journal of Neurosurgery: Spine, 2017

OBJECTIVECervical disc arthroplasty (CDA) has been demonstrated to be as safe and effective as an... more OBJECTIVECervical disc arthroplasty (CDA) has been demonstrated to be as safe and effective as anterior cervical discectomy and fusion (ACDF) in the management of 1- and 2-level degenerative disc disease (DDD). However, there has been a lack of data to address the fundamental discrepancy between the two surgeries (CDA vs ACDF), and preservation versus elimination of motion, in the management of cervical myelopathy associated with congenital cervical stenosis (CCS). Although younger patients tend to benefit more from motion preservation, it is uncertain if CCS caused by multilevel DDD can be treated safely with CDA.METHODSConsecutive patients who underwent 3-level anterior cervical discectomy were retrospectively reviewed. Inclusion criteria were age less than 50 years, CCS (Pavlov ratio ≤ 0.82), symptomatic myelopathy correlated with DDD, and stenosis limited to 3 levels of the subaxial cervical (C3–7) spine. Exclusion criteria were ossification of the posterior longitudinal ligamen...

Neurosurgical focus, 2016

OBJECTIVE This study aimed to estimate the risk of spinal cord injury (SCI) in patients with cerv... more OBJECTIVE This study aimed to estimate the risk of spinal cord injury (SCI) in patients with cervical spondylotic myelopathy (CSM) with and without ossification of posterior longitudinal ligament (OPLL). Also, the study compared the incidence rates of SCI in patients who were managed surgically and conservatively. METHODS This retrospective cohort study covering 15 years analyzed the incidence of SCI in patients with CSM. All patients, identified from the National Health Insurance Research Database, were hospitalized with the diagnosis of CSM and followed up during the study period. These patients with CSM were categorized into 4 groups according to whether they had OPLL or not and whether they received surgery or not: 1) surgically managed CSM without OPLL; 2) conservatively managed CSM without OPLL; 3) surgically managed CSM with OPLL; and 4) conservatively managed CSM with OPLL. The incidence rates of subsequent SCI in each group during follow-up were then compared. Kaplan-Meier ...

BMC musculoskeletal disorders, Jan 28, 2015

The efficacy and safety of using cervical arthroplasty for degenerative disc disease have been de... more The efficacy and safety of using cervical arthroplasty for degenerative disc disease have been demonstrated by prospective, randomized and controlled clinical trials. However, there are scant data on using cervical arthroplasty for traumatic disc herniation. Therefore, this study aimed to investigate the outcomes of patients who underwent cervical arthroplasty for traumatic disc herniation. This cohort included patients who were admitted through the emergency department for trauma. Only patients who had newly-onset, one- or two-level cervical disc disease causing radiculopathy or myelopathy were identified. None of these patients had previously sought for medical attention for such problems. Those patients who had severe spinal cord injury (i.e. American Spinal Injury Association scale A, B or C) or severe myelopathy (i.e. Nurick scale 4 or 5), bony fracture, dislocation, perched facet, kyphotic deformity, or instability were also excluded. An age- and sex-matched one-to-one compari...

Advances in orthopedics, 2013

Objective. To compare the clinical and radiographic outcomes in patients of different ages who un... more Objective. To compare the clinical and radiographic outcomes in patients of different ages who underwent the Dynesys stabilization. Methods. This retrospective study included 72 patients (mean age 61.4 years) with one- or two-level lumbar spinal stenosis who underwent laminectomy and the Dynesys (Zimmer Spine, Minneapolis) dynamic stabilization system. Thirty-seven patients were younger than 65-year old while the other 35 were older. Mean followup was 46.7 months. Pre- and postoperative radiographic and clinical evaluations were analyzed. Results. The mean calibrated disc signal (CDS) at the index level was significantly improved from 60.2 ± 25.2 preoperatively to 66.9 ± 26.0 postoperatively (P > 0.001). Screw loosening occurred in 22.2% of patients and 5.1% of screws. The improvement in CDS at index level was seen to be significant in younger patients but not in older patients. Overall, the mean visual analogue scale (VAS) of back pain, VAS of leg pain, and the Oswestry disabili...

The journal of spinal cord medicine, Jan 9, 2014

Objective To assess whether functional activity, perceived health, and depressive symptoms differ... more Objective To assess whether functional activity, perceived health, and depressive symptoms differ between individuals with traumatic paraplegia with and without shoulder pain. Design Cross sectional and comparative investigation using the unified questionnaire. Setting Neural Regeneration and Repair Division unit of Taipei Veterans General Hospital in Taiwan. Participants Seventy-six patients with paraplegia (23 with and 53 without shoulder pain) who had experienced spinal cord injury at American Spinal Injury Association Impairment Scale T2 to T12 neurologic level (at least 6 months previously). Outcome measures Spinal Cord Independence Measure (SCIM), a single item from the Medical Outcomes Study 36-Item Short-Form Health Survey, and Patient Health Questionnaire-9 (PHQ-9) depression scale. Results Shoulder pain was prevalent in 30% patients. Patients with shoulder pain had significantly worse perceived health and greater depressive symptoms than those without. No significant diffe...

PLoS ONE, 2012

Purpose: To investigate the incidence and risk of stroke after percutaneous vertebroplasty in pat... more Purpose: To investigate the incidence and risk of stroke after percutaneous vertebroplasty in patients with osteoporosis. Methods: A group of 334 patients with osteoporosis, and who underwent percutaneous vertebroplasty during the study period, was compared to 1,655 age-, sex-and propensity score-matched patients who did not undergo vertebroplasty. All demographic covariates and co-morbidities were deliberately matched between the two groups to avoid selection bias. Every subject was followed-up for up to five years for stroke. Adjustments using a Cox regression model and Kaplan-Meier analyses were conducted. Results: A total of 1,989 osteoporotic patients were followed up for 3,760.13 person-years. Overall, the incidence rates of any stroke, hemorrhagic stroke and ischemic stroke were 22.6, 4.2 and 19.6 per 1,000 person-years, respectively. Patients who underwent vertebroplasty were not more likely to have any stroke (crude hazard ratio = 1.13, p = 0.693), hemorrhagic stroke (HR = 2.21, p = 0.170), or ischemic stroke (HR = 0.96, p = 0.90). After adjusting for demographics, co-morbidities and medications, the vertebroplasty group had no significant difference with the comparison group in terms of any, hemorrhagic and ischemic strokes (adjusted HR = 1.22, 3.17, and 0.96, p = 0.518, 0.055, and 0.91, respectively). Conclusions: Osteoporotic patients who undergo percutaneous vertebroplasty are not at higher risk of any stroke in the next five years after the procedure.

PLoS ONE, 2012

Background: Few studies focus on pediatric spinal cord injury (SCI) and there is little informati... more Background: Few studies focus on pediatric spinal cord injury (SCI) and there is little information regarding the cause, anatomic level, and high risk population of SCI in children. This study aims to investigate the incidence and risk factors of pediatric SCI. Methods: A nationwide cohort of 8.7 million children aged,18 years in an 11-year period was analyzed for causes, age at injury, anatomic sites, disability, and familial socioeconomic factors. Incidence rates and Cox regression analysis were conducted. Results: A total of 4949 SCI patients were analyzed. The incidence rates of cervical, thoracic, lumbar, and other SCI were 4.06, 0.34, 0.75, and 0.85 per 100,000 person-years, respectively. The proportional composition of gender, age, and socioeconomic status of SCI patients were significantly different than those of non-SCI patients (all p,0.001). Male children were significantly more likely to have SCI than females in both the cervical and the other SCI groups [Incidence rate ratio (IRR) = 2.03 and 1.52; both p,0.001]. Young adults and teenagers were also significantly more likely to have SCI than preschool age children in the cervical SCI (IRR = 28.55 and 10.50, both p,0.001) and other SCI groups (IRR = 18.8 and 7.47, both p,0.001). Children in families of lower socioeconomic status were also significantly more likely to have SCI (p,0.05). Conclusions: In the pediatric population, the overall SCI incidence rate is 5.99 per 100,000 person-years, with traumatic cervical SCI accounting for the majority. The incidence rate increases abruptly in male teenagers. Gender, age, and socioeconomic status are independent risk factors that should be considered.

Neurosurgical Focus, 2013

Object This study aimed to determine the age- and sex-specific incidence of cervical spondylotic ... more Object This study aimed to determine the age- and sex-specific incidence of cervical spondylotic myelopathy (CSM) and its associated risk of causing subsequent spinal cord injury (SCI). Methods Using the National Health Insurance Research Database (NHIRD), a 12-year nationwide database in Taiwan, this retrospective cohort study analyzed the incidence of hospitalization caused by CSM. All patients diagnosed with and admitted for CSM were identified during the study period. The CSM patients were divided into 2 groups, a control group and an operated group. An incidence density method was used to estimate age- and sex-specific incidence rates of CSM. The Kaplan-Meier method and Cox regression analyses were performed to compare the risk of SCI between the 2 groups. Results From 1998 to 2009, covering 349.5 million person-years, 14,140 patients were hospitalized for CSM. The overall incidence of CSM-related hospitalization was 4.04 per 100,000 person-years. Specifically, males and older ...

Neuro-Oncology, 2008

We tested the herbal extract 2,3,5,6-tetramethylpyrazine (TMP) for possible therapeutic efficacy ... more We tested the herbal extract 2,3,5,6-tetramethylpyrazine (TMP) for possible therapeutic efficacy against a glioma cell line and against gliomas transplanted into rat brains. In the cultured glioma cells, 50 mM TMP significantly inhibited glutamate-induced increase in intracellular calcium. Significant cell damage (30%) and proliferation suppression (10%), however, occurred only at higher concentrations (200-400 mM). Gliomaneuronal co-culturing resulted in significant neuronal damage and higher proliferation of the glioma cells (140%) compared with single cultures. Low concentrations of TMP (<200 mM) attenuated the neuronal damage, suppressed glioma migration, and decreased glioma proliferation in the neuronal-glioma co-culture. Gliomas

Journal of Biomedical Science, Jul 17, 2014

Background: Acute spinal cord injury (SCI) leads to a series of reactive changes and causes sever... more Background: Acute spinal cord injury (SCI) leads to a series of reactive changes and causes severe neurological deficits. A pronounced inflammation contributes to secondary pathology after SCI. Astroglia respond to SCI by proliferating, migrating, and altering phenotype. The impact of reactive gliosis on the pathogenesis of SCI is not fully understood. Our previous study has identified an inflammatory modulating protein, proliferation related acidic leucine-rich protein (PAL31) which is upregulated in the microglia/macrophage of injured cords. Because PAL31 participates in cell cycle progression and reactive astroglia often appears in the injured cord, we aim to examine whether PAL31 is involved in glial modulation after injury. Results: Enhanced PAL31 expression was shown not only in microglia/macrophages but also in spinal astroglia after SCI. Cell culture study reveal that overexpression of PAL31 in mixed glial cells or in C6 astroglia significantly reduced LPS/IFNγ stimulation. Further, enhanced PAL31 expression in C6 astroglia protected cells from H 2 O 2 toxicity; however, this did not affect its proliferative activity. The inhibiting effect of PAL31 on LPS/IFNγ stimulation was observed in glia or C6 after co-culture with neuronal cells. The results demonstrated that the overexpressed PAL31 in glial cells protected neuronal damages through inhibiting NF-kB signaling and iNOS. Conclusions: Our data suggest that PAL31upregulation might be beneficial after spinal cord injury. Reactive gliosis might become a good target for future therapeutic interventions.

Journal of Spinal Cord Medicine, Oct 9, 2014

Objective: To assess whether functional activity, perceived health, and depressive symptoms diffe... more Objective: To assess whether functional activity, perceived health, and depressive symptoms differ between individuals with traumatic paraplegia with and without shoulder pain. Design: Cross sectional and comparative investigation using the unified questionnaire. Setting: Neural Regeneration and Repair Division unit of Taipei Veterans General Hospital in Taiwan. Participants: Seventy-six patients with paraplegia (23 with and 53 without shoulder pain) who had experienced spinal cord injury at American Spinal Injury Association Impairment Scale T2 to T12 neurologic level (at least 6 months previously). Outcome measures: Spinal Cord Independence Measure (SCIM), a single item from the Medical Outcomes Study 36-Item Short-Form Health Survey, and Patient Health Questionnaire-9 (PHQ-9) depression scale. Results: Shoulder pain was prevalent in 30% patients. Patients with shoulder pain had significantly worse perceived health and greater depressive symptoms than those without. No significant difference was found in functional ability between groups. Greater shoulder pain intensity was related to higher depressive scores (r = 0.278, P = 0.017) and lower self-perceived health scores (r = −0.433, P < 0.001) but not SCIM scores (P = 0.342). Conclusion: Although shoulder pain was unrelated to functional limitation, it was associated with lower perceived health and higher depressive mood levels.

Neurospine, Sep 30, 2018

The Dynesys-Transition-Optima (DTO) hybrid system was designed to achieve arthrodesis and stabili... more The Dynesys-Transition-Optima (DTO) hybrid system was designed to achieve arthrodesis and stabilization in patients with lumbar degeneration. Satisfactory outcomes were demonstrated previously. However, no study has evaluated the effects of using the DTO system in patients with lumbar spondylolisthesis or stenosis. Methods: This retrospective study included 35 consecutive patients with multilevel lumbar degeneration with or without spondylolisthesis who underwent surgery using the DTO system. Imaging studies included pre-and postoperative radiography, magnetic resonance imaging, and computed tomography. The clinical outcomes were measured by Japanese Orthopedic Association (JOA) scores, Oswestry Disability Index (ODI) scores, and a visual analogue scale (VAS) for back and leg pain. Results: Thirty patients (85.7%) with a mean age of 61.9 years completed the follow-up, with a mean duration of 35.1 months. There were 21 patients in the spondylolisthesis group and 9 in the stenosis group. The spondylolisthesis group had worse functional scores than the stenosis group preoperatively. After DTO surgery, all patients showed significant improvements in clinical outcomes, including VAS for back and leg pain, ODI, and JOA scores (p < 0.05). There were no significant differences in clinical outcomes between the 2 groups. At a 2-year follow-up, lumbar alignment was well maintained in both groups (p = 0.116). There were no significant differences in lumbar alignment between the 2 groups. Conclusion: During a follow-up period of over 2 years, both patients with spondylolisthesis and those with stenosis showed improvements and similar disability and pain scores after surgery using the DTO system. Lumbar alignment was also well maintained.

Biomedicines

Background: The ossification of the posterior longitudinal ligament (OPLL) is one of the contribu... more Background: The ossification of the posterior longitudinal ligament (OPLL) is one of the contributing factors leading to severe cervical spondylotic myelopathy (CSM). The mechanism causing ossification is still unclear. The current study was designed to analyze the specimens of patients with or without OPLL. Methods: The study collected 51 patients with cervical spondylosis. There were six serum samples in both the non-OPLL (NOPLL) and OPLL groups. For tissue analysis, there were seven samples in the NOPLL group and five samples in the OPLL group. The specimens of serum and tissue were analyzed by using Human Cytokine Antibody Arrays to differentiate biomarkers between the OPLL and NOPLL groups, as well as between serum and OPLL tissue. Immunohistochemical staining of the ligament tissue was undertaken for both groups. Results: For OPLL vs. NOPLL, the serum leptin levels are higher in the OPLL group, corroborating others’ observations that it may serve as a disease marker. In the ti...

Brain Sciences

This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY

Journal of Neurosurgery: Case Lessons

BACKGROUND The natural history of ossification of the posterior longitudinal ligament (OPLL) rema... more BACKGROUND The natural history of ossification of the posterior longitudinal ligament (OPLL) remains poorly understood and multiple etiologies have been reported. However, most have focused on the characteristics of the patient rather than alternation of mechanical stress after spinal fusion. OBSERVATIONS This report describes, for the first time, a de novo OPLL found at the subaxial cervical spine 7 years after an atlantoaxial fusion surgery. A 57-year-old female initially required atlantoaxial arthrodesis for os odontoideum and stenosis that caused myelopathy. The posterior fusion surgery went smoothly without complications and the patient had good recovery of neurological functions. There was no associated instability, trauma, or reoperations during the follow-up. Seven years later, the patient presented with slight neck pain and a newly developed OPLL at C3–4 caudal to the C1–2 fusion construct. LESSONS Conflicting with the conventional concept that OPLL is common in elderly men...

BMC Musculoskeletal Disorders, 2020

Background The conventional pedicle-screw-based dynamic stabilization process involves dissection... more Background The conventional pedicle-screw-based dynamic stabilization process involves dissection of the Wiltse plane to cannulate the pedicles, which cannot be undertaken with minimal surgical invasion. Despite some reports having demonstrated satisfactory outcomes of dynamic stabilization in the management of low-grade spondylolisthesis, the extensive soft tissue dissection involved during pedicle screw insertion substantially compromises the designed rationale of motion (muscular) preservation. The authors report on a novel method for minimally invasive insertion of dynamic screws and a mini case series. Methods The authors describe innovations for inserting dynamic screws via the cortical bone trajectory (CBT) under spinal navigation. All the detailed surgical procedures and clinical data are demonstrated. Results A total of four (2 females) patients (mean age 64.75 years) with spinal stenosis at L4–5 were included. By a combination of microscopic decompression and image-guided ...

Journal of Neurosurgery: Spine, 2020

OBJECTIVECigarette smoking has been known to increase the risk of pseudarthrosis in spinal fusion... more OBJECTIVECigarette smoking has been known to increase the risk of pseudarthrosis in spinal fusion. However, there is a paucity of data on the effects of smoking in dynamic stabilization following lumbar spine surgery. This study aimed to investigate the clinical outcomes and the incidence of screw loosening among patients who smoked.METHODSConsecutive patients who had lumbar spondylosis, recurrent disc herniations, or low-grade spondylolisthesis that was treated with 1- or 2-level surgical decompression and pedicle screw–based Dynesys dynamic stabilization (DDS) were retrospectively reviewed. Patients who did not complete the minimum 2 years of radiological and clinical evaluations were excluded. All screw loosening was determined by both radiographs and CT scans. Patient-reported outcomes, including visual analog scale (VAS) scores of back and leg pain, Japanese Orthopaedic Association (JOA) scores, and Oswestry Disability Index (ODI), were analyzed. Patients were grouped by smokin...

Journal of Neurosurgery: Spine, 2019

OBJECTIVECigarette smoking can adversely affect bone fusion in patients who undergo anterior cerv... more OBJECTIVECigarette smoking can adversely affect bone fusion in patients who undergo anterior cervical discectomy and fusion. However, there is a paucity of data on smoking among patients who have undergone cervical disc arthroplasty (CDA). The present study aimed to compare the clinical and radiological outcomes of smokers to those of nonsmokers following CDA.METHODSThe authors retrospectively reviewed the records of consecutive patients who had undergone 1- or 2-level CDA for cervical disc herniation or spondylosis and had a minimum 2-year follow-up. All patients were grouped into a smoking group, which consisted of those who had consumed cigarettes within 6 months prior to the CDA surgery, or a nonsmoking group, which consisted of those who had not consumed cigarettes at all or within 6 months of the CDA. Clinical outcomes were evaluated according to the visual analog scale for neck and arm pain, Neck Disability Index, Japanese Orthopaedic Association Scale, and Nurick Scale at ea...

Neurospine, 2018

As spine surgery flourished in Taiwan and neurosurgeons became more involved towards the end of t... more As spine surgery flourished in Taiwan and neurosurgeons became more involved towards the end of the 20 th century, the Taiwan Neurosurgical Spine Society (TNSS), earlier named the Taiwan Neurospinal Society, was established on March 11, 2001. As the main founder, Dr. Chun-I Huang was elected as the first president of the TNSS. The goals of the TNSS were set to promote research, hold academic seminars, participate in international conferences, and to exchange clinical experiences. The mission of the TNSS has been successful and the profession of spine surgery in Taiwan has been elevated during the first decade of the 21 st century, by the time the TNSS joined ASIA SPINE in 2010. Since its establishment, the TNSS has always been supportive of collaboration and communication with the Korean Spinal Neurosurgery Society (KSNS) and the Neurospinal Society of Japan (NSJ). Through periodical meetings, supported by the TNSS, surgeons worldwide have enjoyed a platform of sharing and mutual learning. To further promote academics, the TNSS has officially supported the journal Neurospine since 2018. With all the efforts from local and international surgeons, the TNSS will continue to hold its mission and advance the profession of spine surgery.

International journal of molecular sciences, 2017

Accumulated evidence indicates that autophagy is a response of cancer cells to various anti-cance... more Accumulated evidence indicates that autophagy is a response of cancer cells to various anti-cancer therapies. Autophagy is designated as programmed cell death type II, and is characterized by the formation of autophagic vacuoles in the cytoplasm. Numerous herbs, including Chinese herbs, have been applied to cancer treatments as complementary and alternative medicines, supplements, or nutraceuticals to dampen the side or adverse effects of chemotherapy drugs. Moreover, the tumor suppressive actions of herbs and natural products induced autophagy that may lead to cell senescence, increase apoptosis-independent cell death or complement apoptotic processes. Hereby, the underlying mechanisms of natural autophagy inducers are cautiously reviewed in this article. Additionally, three natural compounds-curcumin, 16-hydroxycleroda-3,13-dien-15,16-olide, and prodigiosin-are presented as candidates for autophagy inducers that can trigger cell death in a supplement or alternative medicine for ca...

Journal of Neurosurgery: Spine, 2017

OBJECTIVECervical disc arthroplasty (CDA) has been demonstrated to be as safe and effective as an... more OBJECTIVECervical disc arthroplasty (CDA) has been demonstrated to be as safe and effective as anterior cervical discectomy and fusion (ACDF) in the management of 1- and 2-level degenerative disc disease (DDD). However, there has been a lack of data to address the fundamental discrepancy between the two surgeries (CDA vs ACDF), and preservation versus elimination of motion, in the management of cervical myelopathy associated with congenital cervical stenosis (CCS). Although younger patients tend to benefit more from motion preservation, it is uncertain if CCS caused by multilevel DDD can be treated safely with CDA.METHODSConsecutive patients who underwent 3-level anterior cervical discectomy were retrospectively reviewed. Inclusion criteria were age less than 50 years, CCS (Pavlov ratio ≤ 0.82), symptomatic myelopathy correlated with DDD, and stenosis limited to 3 levels of the subaxial cervical (C3–7) spine. Exclusion criteria were ossification of the posterior longitudinal ligamen...

Neurosurgical focus, 2016

OBJECTIVE This study aimed to estimate the risk of spinal cord injury (SCI) in patients with cerv... more OBJECTIVE This study aimed to estimate the risk of spinal cord injury (SCI) in patients with cervical spondylotic myelopathy (CSM) with and without ossification of posterior longitudinal ligament (OPLL). Also, the study compared the incidence rates of SCI in patients who were managed surgically and conservatively. METHODS This retrospective cohort study covering 15 years analyzed the incidence of SCI in patients with CSM. All patients, identified from the National Health Insurance Research Database, were hospitalized with the diagnosis of CSM and followed up during the study period. These patients with CSM were categorized into 4 groups according to whether they had OPLL or not and whether they received surgery or not: 1) surgically managed CSM without OPLL; 2) conservatively managed CSM without OPLL; 3) surgically managed CSM with OPLL; and 4) conservatively managed CSM with OPLL. The incidence rates of subsequent SCI in each group during follow-up were then compared. Kaplan-Meier ...

BMC musculoskeletal disorders, Jan 28, 2015

The efficacy and safety of using cervical arthroplasty for degenerative disc disease have been de... more The efficacy and safety of using cervical arthroplasty for degenerative disc disease have been demonstrated by prospective, randomized and controlled clinical trials. However, there are scant data on using cervical arthroplasty for traumatic disc herniation. Therefore, this study aimed to investigate the outcomes of patients who underwent cervical arthroplasty for traumatic disc herniation. This cohort included patients who were admitted through the emergency department for trauma. Only patients who had newly-onset, one- or two-level cervical disc disease causing radiculopathy or myelopathy were identified. None of these patients had previously sought for medical attention for such problems. Those patients who had severe spinal cord injury (i.e. American Spinal Injury Association scale A, B or C) or severe myelopathy (i.e. Nurick scale 4 or 5), bony fracture, dislocation, perched facet, kyphotic deformity, or instability were also excluded. An age- and sex-matched one-to-one compari...

Advances in orthopedics, 2013

Objective. To compare the clinical and radiographic outcomes in patients of different ages who un... more Objective. To compare the clinical and radiographic outcomes in patients of different ages who underwent the Dynesys stabilization. Methods. This retrospective study included 72 patients (mean age 61.4 years) with one- or two-level lumbar spinal stenosis who underwent laminectomy and the Dynesys (Zimmer Spine, Minneapolis) dynamic stabilization system. Thirty-seven patients were younger than 65-year old while the other 35 were older. Mean followup was 46.7 months. Pre- and postoperative radiographic and clinical evaluations were analyzed. Results. The mean calibrated disc signal (CDS) at the index level was significantly improved from 60.2 ± 25.2 preoperatively to 66.9 ± 26.0 postoperatively (P > 0.001). Screw loosening occurred in 22.2% of patients and 5.1% of screws. The improvement in CDS at index level was seen to be significant in younger patients but not in older patients. Overall, the mean visual analogue scale (VAS) of back pain, VAS of leg pain, and the Oswestry disabili...

The journal of spinal cord medicine, Jan 9, 2014

Objective To assess whether functional activity, perceived health, and depressive symptoms differ... more Objective To assess whether functional activity, perceived health, and depressive symptoms differ between individuals with traumatic paraplegia with and without shoulder pain. Design Cross sectional and comparative investigation using the unified questionnaire. Setting Neural Regeneration and Repair Division unit of Taipei Veterans General Hospital in Taiwan. Participants Seventy-six patients with paraplegia (23 with and 53 without shoulder pain) who had experienced spinal cord injury at American Spinal Injury Association Impairment Scale T2 to T12 neurologic level (at least 6 months previously). Outcome measures Spinal Cord Independence Measure (SCIM), a single item from the Medical Outcomes Study 36-Item Short-Form Health Survey, and Patient Health Questionnaire-9 (PHQ-9) depression scale. Results Shoulder pain was prevalent in 30% patients. Patients with shoulder pain had significantly worse perceived health and greater depressive symptoms than those without. No significant diffe...

PLoS ONE, 2012

Purpose: To investigate the incidence and risk of stroke after percutaneous vertebroplasty in pat... more Purpose: To investigate the incidence and risk of stroke after percutaneous vertebroplasty in patients with osteoporosis. Methods: A group of 334 patients with osteoporosis, and who underwent percutaneous vertebroplasty during the study period, was compared to 1,655 age-, sex-and propensity score-matched patients who did not undergo vertebroplasty. All demographic covariates and co-morbidities were deliberately matched between the two groups to avoid selection bias. Every subject was followed-up for up to five years for stroke. Adjustments using a Cox regression model and Kaplan-Meier analyses were conducted. Results: A total of 1,989 osteoporotic patients were followed up for 3,760.13 person-years. Overall, the incidence rates of any stroke, hemorrhagic stroke and ischemic stroke were 22.6, 4.2 and 19.6 per 1,000 person-years, respectively. Patients who underwent vertebroplasty were not more likely to have any stroke (crude hazard ratio = 1.13, p = 0.693), hemorrhagic stroke (HR = 2.21, p = 0.170), or ischemic stroke (HR = 0.96, p = 0.90). After adjusting for demographics, co-morbidities and medications, the vertebroplasty group had no significant difference with the comparison group in terms of any, hemorrhagic and ischemic strokes (adjusted HR = 1.22, 3.17, and 0.96, p = 0.518, 0.055, and 0.91, respectively). Conclusions: Osteoporotic patients who undergo percutaneous vertebroplasty are not at higher risk of any stroke in the next five years after the procedure.

PLoS ONE, 2012

Background: Few studies focus on pediatric spinal cord injury (SCI) and there is little informati... more Background: Few studies focus on pediatric spinal cord injury (SCI) and there is little information regarding the cause, anatomic level, and high risk population of SCI in children. This study aims to investigate the incidence and risk factors of pediatric SCI. Methods: A nationwide cohort of 8.7 million children aged,18 years in an 11-year period was analyzed for causes, age at injury, anatomic sites, disability, and familial socioeconomic factors. Incidence rates and Cox regression analysis were conducted. Results: A total of 4949 SCI patients were analyzed. The incidence rates of cervical, thoracic, lumbar, and other SCI were 4.06, 0.34, 0.75, and 0.85 per 100,000 person-years, respectively. The proportional composition of gender, age, and socioeconomic status of SCI patients were significantly different than those of non-SCI patients (all p,0.001). Male children were significantly more likely to have SCI than females in both the cervical and the other SCI groups [Incidence rate ratio (IRR) = 2.03 and 1.52; both p,0.001]. Young adults and teenagers were also significantly more likely to have SCI than preschool age children in the cervical SCI (IRR = 28.55 and 10.50, both p,0.001) and other SCI groups (IRR = 18.8 and 7.47, both p,0.001). Children in families of lower socioeconomic status were also significantly more likely to have SCI (p,0.05). Conclusions: In the pediatric population, the overall SCI incidence rate is 5.99 per 100,000 person-years, with traumatic cervical SCI accounting for the majority. The incidence rate increases abruptly in male teenagers. Gender, age, and socioeconomic status are independent risk factors that should be considered.

Neurosurgical Focus, 2013

Object This study aimed to determine the age- and sex-specific incidence of cervical spondylotic ... more Object This study aimed to determine the age- and sex-specific incidence of cervical spondylotic myelopathy (CSM) and its associated risk of causing subsequent spinal cord injury (SCI). Methods Using the National Health Insurance Research Database (NHIRD), a 12-year nationwide database in Taiwan, this retrospective cohort study analyzed the incidence of hospitalization caused by CSM. All patients diagnosed with and admitted for CSM were identified during the study period. The CSM patients were divided into 2 groups, a control group and an operated group. An incidence density method was used to estimate age- and sex-specific incidence rates of CSM. The Kaplan-Meier method and Cox regression analyses were performed to compare the risk of SCI between the 2 groups. Results From 1998 to 2009, covering 349.5 million person-years, 14,140 patients were hospitalized for CSM. The overall incidence of CSM-related hospitalization was 4.04 per 100,000 person-years. Specifically, males and older ...

Neuro-Oncology, 2008

We tested the herbal extract 2,3,5,6-tetramethylpyrazine (TMP) for possible therapeutic efficacy ... more We tested the herbal extract 2,3,5,6-tetramethylpyrazine (TMP) for possible therapeutic efficacy against a glioma cell line and against gliomas transplanted into rat brains. In the cultured glioma cells, 50 mM TMP significantly inhibited glutamate-induced increase in intracellular calcium. Significant cell damage (30%) and proliferation suppression (10%), however, occurred only at higher concentrations (200-400 mM). Gliomaneuronal co-culturing resulted in significant neuronal damage and higher proliferation of the glioma cells (140%) compared with single cultures. Low concentrations of TMP (<200 mM) attenuated the neuronal damage, suppressed glioma migration, and decreased glioma proliferation in the neuronal-glioma co-culture. Gliomas