Publications by authors named "Jau-Ching Wu"

142 Publications

Cranio-Vertebral Junction Triangular Area: Quantification of Brain Stem Compression by Magnetic Resonance Images.

Brain Sci 2021 Jan 6;11(1). Epub 2021 Jan 6.

Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei 11217, Taiwan.

(1) Background: Most of the currently used radiological criteria for craniovertebral junction (CVJ) were developed prior to the popularity of magnetic resonance images (MRIs). This study aimed to evaluate the efficacy of a novel triangular area (TA) calculated on MRIs for pathologies at the CVJ. (2) Methods: A total of 702 consecutive patients were enrolled, grouped into three: (a) Those with pathologies at the CVJ ( = 129); (b) those with underlying rheumatoid arthritis (RA) but no CVJ abnormalities ( = 279); and (3) normal (control; = 294). TA was defined on T2-weighted MRIs by three points: The lowest point of the clivus, the posterior-inferior point of C2, and the most dorsal indentation point at the ventral brain stem. Receiver operating characteristic (ROC) analysis was used to correlate the prognostic value of the TA with myelopathy. Pre- and post-operative TA values were compared for validation. (c) Results: The CVJ-pathology group had the largest mean TA (1.58 ± 0.47 cm), compared to the RA and control groups (0.96 ± 0.31 and 1.05 ± 0.26, respectively). The ROC analysis calculated the cutoff-point for myelopathy as 1.36 cm with the area under the curve at 0.93. Of the 81 surgical patients, the TA was reduced (1.21 ± 0.37 cm) at two-years post-operation compared to that at pre-operation (1.67 ± 0.51 cm). Moreover, intra-operative complete reduction of the abnormalities could further decrease the TA to 1.03 ± 0.39 cm. (4) Conclusions: The TA, a valid measurement to quantify compression at the CVJ and evaluate the efficacy of surgery, averaged 1.05 cm in normal patients, and 1.36 cm could be a cutoff-point for myelopathy and of clinical significance.
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http://dx.doi.org/10.3390/brainsci11010064DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7825444PMC
January 2021

Minimally invasive dynamic screw stabilization using cortical bone trajectory.

BMC Musculoskelet Disord 2020 Sep 10;21(1):605. Epub 2020 Sep 10.

Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Room 525, 17F, No. 201, Shih-Pai Road, Sec. 2, Beitou, Taipei, 11217, Taiwan.

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 CBT screw insertion, laminectomy and dynamic screw stabilization were achieved via one small skin incision (less than 3 cm). These patients' back and leg pain improved significantly after the surgery.

Conclusion: This innovative dynamic screw stabilization via the CBT involved no discectomy (or removal of sequestrated fragment only), no interbody fusion, and little muscle dissection (not even of the Wiltse plane). As a minimally invasive surgery, CBT appeared to be a viable alternative to the conventional pedicle-screw-based dynamic stabilization approach.
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http://dx.doi.org/10.1186/s12891-020-03629-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7488542PMC
September 2020

The Effect of T1-Slope in Spinal Parameters After Cervical Disc Arthroplasty.

Neurosurgery 2020 Jul 10. Epub 2020 Jul 10.

Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.

Background: Although patients with cervical kyphosis are not ideal candidates for cervical disc arthroplasty (CDA), there is a paucity of data on patients with a straight or slightly lordotic neck.

Objective: To correlate cervical lordosis, T1-slope, and clinical outcomes of CDA.

Methods: The study retrospectively analyzed 95 patients who underwent 1-level CDA and had 2-yr follow-up. They were divided into a high T1-slope (≥28°) group (HTSG, n = 45) and a low T1-slope (<28°) group (LTSG, n = 50). Cervical spinal alignment parameters, including T1-slope, cervical lordosis (C2-7 Cobb angle), and segmental mobility (range of motion [ROM]) at the indexed level, were compared. The clinical outcomes were also assessed.

Results: The mean T1-slope was 28.1 ± 7.0°. After CDA, the pre- and postoperative segmental motility remained similar and cervical lordosis was preserved. All the clinical outcomes improved after CDA. The HTSG were similar to the LTSG in age, sex, segmental mobility, and clinical outcomes. However, the HTSG had higher cervical lordosis than the LTSG. Furthermore, the LTSG had increased cervical lordosis (ΔC2-7 Cobb angle), whereas the HTSG had decreased lordosis after CDA. Patients of the LTSG, who had more improvement in cervical lordosis, had a trend toward increasing segmental mobility at the index level (ΔROM) than the HTSG.

Conclusion: In this series, T1-slope correlated well with global cervical lordosis but did not affect the segmental mobility. After CDA, the changes in cervical lordosis correlated with changes in segmental mobility. Therefore, segmental lordosis should be cautiously preserved during CDA as it could determine the mobility of the disc.
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http://dx.doi.org/10.1093/neuros/nyaa271DOI Listing
July 2020

Commentary: Low-Grade Infection and Implant Failure Following Spinal Instrumentation: A Prospective Comparative Study.

Neurosurgery 2020 10;87(5):E541-E542

Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.

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http://dx.doi.org/10.1093/neuros/nyaa160DOI Listing
October 2020

Effects of smoking on pedicle screw-based dynamic stabilization: radiological and clinical evaluations of screw loosening in 306 patients.

J Neurosurg Spine 2020 May 1:1-8. Epub 2020 May 1.

1Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital.

Objective: Cigarette 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.

Methods: Consecutive 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 smoking versus nonsmoking, and loosening versus intact screws, respectively. All radiological and clinical outcomes were compared between the groups.

Results: A total of 306 patients (140 women), with a mean age of 60.2 ± 12.5 years, were analyzed during an average follow-up of 44 months. There were 34 smokers (9 women) and 272 nonsmokers (131 women, 48.2% more than the 26.5% of smokers, p = 0.017). Postoperatively, all the clinical outcomes improved (e.g., VAS back and leg pain, JOA scores, and ODI, all p < 0.001). The overall rate of screw loosening was 23.2% (71 patients), and patients who had loosened screws were older (61.7 ± 9.6 years vs 59.8 ± 13.2 years, p = 0.003) and had higher rates of diabetes mellitus (33.8% vs 21.7%, p = 0.038) than those who had intact DDS screws. Although the patients who smoked had similar clinical improvement (even better VAS scores in their legs, p = 0.038) and a nonsignificantly lower rate of screw loosening (17.7% and 23.9%, p = 0.416), the chances of secondary surgery for adjacent segment disease (ASD) were higher than for the nonsmokers (11.8% vs 1.5%, p < 0.001).

Conclusions: Smoking had no adverse effects on the improvements of clinical outcomes in the pedicle screw-based DDS surgery. For smokers, the rate of screw loosening trended lower (without significance), but the chances of secondary surgery for ASD were higher than for the nonsmoking patients. However, the optimal surgical strategy to stabilize the lumbar spine of smoking patients requires future investigation.
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http://dx.doi.org/10.3171/2020.2.SPINE191380DOI Listing
May 2020

Comparison of Radiation Exposure Between O-Arm Navigated and C-Arm Guided Screw Placement in Minimally Invasive Transforaminal Lumbar Interbody Fusion.

World Neurosurg 2020 07 18;139:e489-e495. Epub 2020 Apr 18.

Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan. Electronic address:

Background: Instrumentation in minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) is highly dependent on image guidance. Guidance with fluoroscopy (C-arm) and cone-beam computed tomography (O-arm) with navigation are common options. The intraoperative radiation exposure to patients with the different image modalities has not been compared, however. The present study aimed to compare the radiation exposure of the C-arm guidance and O-arm navigation techniques during MIS-TLIF surgery.

Methods: Ninety consecutive patients who underwent MIS-TLIF for degenerative lumbar pathologies were retrospectively reviewed. The patients were divided into the C-arm guided (CG) and the O-arm navigated (ON) groups (45 patients in each group), and the radiation dosage reports were analyzed for comparison of radiation exposure.

Results: The ON group had a higher average effective radiation dose (1.99 ± 0.4 mSv vs. 0.91 ± 0.3 mSv). For patients with more than 2 interbody fusion levels (≥6 pedicle screws), the effective dose per screw was similar in the CG and ON groups (0.22 ± 0.08 mSv vs. 0.23 ± 0.05 mSv). As the body mass index increased, the per-screw effective dose of the CG group showed a significant positive trend, compared with a nonsignificant negative trend in the ON group.

Conclusions: For level 1 MIS-TLIF (4 percutaneous screws), patients in the ON group had almost double the radiation exposure as those in the CG group. For level ≥2 (≥6 screws) or obese patients, the O-arm with navigation has the advantage of similar radiation exposure to the patient and less (almost no) radiation to the operating room staff.
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http://dx.doi.org/10.1016/j.wneu.2020.04.052DOI Listing
July 2020

Less Opioid Consumption With Enhanced Recovery After Surgery Transforaminal Lumbar Interbody Fusion (TLIF): A Comparison to Standard Minimally-Invasive TLIF.

Neurospine 2020 Mar 31;17(1):228-236. Epub 2020 Mar 31.

Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL, USA.

Objective: The concept of enhanced recovery after surgery (ERAS) is relatively new to the neurosurgical field. The introduction of an ERAS protocol in lumbar fusion surgery has aimed to accelerate patient recovery from surgery by reducing in-hospital opioid consumption.

Methods: Patients with 1- or 2-level degenerative lumbar spine disease and who underwent ERAS transforaminal lumbar interbody fusion (TLIF) were retrospectively reviewed. Patients' general demographic data, in-hospital opioid dosage (converted to morphine equivalents), and hospital stay were compared to those who underwent standard minimally-invasive (MIS)-TLIF.

Results: Twenty-four patients who received ERAS TLIF (the ERAS group) were compared to a series of 24 patients who received standard MIS-TLIF (the MIS group). The demographic data were similar. The operation time and blood loss significantly favored ERAS TLIF. The average daily opioid consumption was remarkably lower in the ERAS group than the MIS group. Average opioid dosage throughout the entire in-hospital period was also significantly reduced in the ERAS group compared to the MIS group. The average length of hospital stay was substantially shorter in the ERAS group (1.4 ± 1.13 days vs. 4.0±1.98 days, p<0.001).

Conclusion: The present study demonstrated a significant decline in the consumption of opioids and in the hospital length of stay for patients undergoing ERAS TLIF for 1- or 2-level degenerative lumbar spine disease.
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http://dx.doi.org/10.14245/ns.1938422.211DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7136122PMC
March 2020

Early Discharged Lumbar Spine Fusion Reduced Postoperative Readmissions: A Retrospective Cohort Study.

Int J Environ Res Public Health 2020 02 19;17(4). Epub 2020 Feb 19.

Department of Family Medicine, School of Medicine, National Yang-Ming University, Taipei 11221, Taiwan.

Early discharge (ED) has emerged and gained popularity in spine surgery. However, the benefits of ED in lumbar fusion have not yet been validated by large cohort studies. To evaluate the effects of ED on readmissions and reoperations in lumbar fusion, this study utilized a national database to enroll patients who had undergone lumbar fusion surgery at age 50-70 years, and grouped them into an ED group or a comparison group. In the comprehensive follow-up of 180 days post-operation, the two groups were compared. There were 18,008 patients in the cohort, including 2172 in the ED group and 15,836 in the comparison group. The ED group was slightly younger (59.9 vs. 60.7 years, < 0.001), more male predominant (44.9% vs. 36.9%, < 0.001), and had fewer medical comorbidities. The ED group had less incidences of readmission than the comparison group. (Crude hazard ratio = 0.73, and adjusted HR = 0.75, both < 0.001). Overall, the cumulative incidences of readmission in the ED group (9.5%) were lower than those in the comparison group (12.8%, < 0.001), whereas reoperations were insignificantly different (1.5% vs. 1.2%, = 0.189). For patients aged 50-70 years and who require lumbar fusion surgery, ED could yield a 25% reduced risk of readmission for any cause within 180 days post-operation. Since the reoperation rates remained similar, our results suggest that ED may be a promising option for elderly patients undergoing lumbar spinal fusion surgery.
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http://dx.doi.org/10.3390/ijerph17041335DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7068397PMC
February 2020

Assess the Performance and Cost-Effectiveness of LACE and HOSPITAL Re-Admission Prediction Models as a Risk Management Tool for Home Care Patients: An Evaluation Study of a Medical Center Affiliated Home Care Unit in Taiwan.

Int J Environ Res Public Health 2020 02 2;17(3). Epub 2020 Feb 2.

Institute of Hospital and Health Care Administration, National Yang-Ming University, Taipei 11221, Taiwan.

The LACE index and HOSPITAL score models are the two most commonly used prediction models identifying patients at high risk of readmission with limited information for home care patients. This study compares the effectiveness of these two models in predicting 30-day readmission following acute hospitalization of such patients in Taiwan. A cohort of 57 home care patients were enrolled and followed-up for one year. We compared calibration, discrimination (area under the receiver operating curve, AUC), and net reclassification improvement (NRI) to identify patients at risk of 30-day readmission for both models. Moreover, the cost-effectiveness of the models was evaluated using microsimulation analysis. A total of 22 readmissions occurred after 87 acute hospitalizations during the study period (readmission rate = 25.2%). While the LACE score had poor discrimination (AUC = 0.598, 95% confidence interval (CI) = 0.488-0.702), the HOSPITAL score achieved helpful discrimination (AUC = 0.691, 95% CI = 0.582-0.785). Moreover, the HOSPITAL score had improved the risk prediction in 38.3% of the patients, compared with the LACE index (NRI = 0.383, 95% CI = 0.068-0.697, = 0.017). Both prediction models effectively reduced readmission rates compared to an attending physician's model (readmission rate reduction: LACE, 39.2%; HOSPITAL, 43.4%; physician, 10.1%; < 0.001). The HOSPITAL score provides a better prediction of readmission and has potential as a risk management tool for home care patients.
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http://dx.doi.org/10.3390/ijerph17030927DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7037289PMC
February 2020

Bilateral Cavernous Sinus Dural Arteriovenous Fistulae : The Strategies for Endovascular Treatment.

Clin Neuroradiol 2021 Mar 18;31(1):165-172. Epub 2019 Dec 18.

School of Medicine, National Yang Ming University, Taipei, Taiwan.

Purpose: Most cavernous sinus dural arteriovenous fistulas (CSDAVF) are unilateral; however, simultaneous bilateral CSDAVFs occasionally may be found. This article reports on 141 patients and compares the angioarchitecture and outcomes of embolization of bilateral CSDAVFs with those of unilateral CSDAVFs, with reference to limited demographics (sex and age) of the patients.

Method: From January 2010 to February 2018 a total of 141 consecutive patients with CSDAVFs were referred for transvenous embolization. Bilateral CSDAVFs were found in 20 patients (14.2%, with a mean age of 62.2 years). The angioarchitecture of the 141 patients with CSDAVFs were evaluated by conventional cerebral angiography. We compared the angioarchitecture and treatment outcomes of 20 bilateral and 121 unilateral CSDAVFs, and in relation to the patients' sex and age.

Results: Female patients significantly dominated the bilateral CSDAVFs (90%, p = 0.043). Bilateral eye symptoms were significantly more common in bilateral CSDAVFs (p = 0.011), with dominant orbital and cavernous symptoms, and showed statistical significance (p = 0.049 and 0.011, respectively). Occlusion of one CSDAVF may significantly decrease the fistula flow of the other untreated side (n = 13, 65%), leading to less coil utilization for embolization in bilateral CSDAVFs (p < 0.001). There was no statistical significance in the occurrence of occlusion of the inferior petrous sinus(s), in pial vein reflux, and treatment outcomes in the unilateral and bilateral CSDAVFs.

Conclusion: Bilateral CSDAVFs were more dominant in female patients and frequently presented with orbital and cavernous symptoms. Fewer coils were used per lesion in the bilateral CSDAVFs. There was no statistical significance in bilateral and unilateral CSDAVFs in terms of impact of venous drainage, pial vein reflux and treatment outcomes.
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http://dx.doi.org/10.1007/s00062-019-00868-zDOI Listing
March 2021

Natural History of Acromegaly: Incidences, Re-operations, Cancers, and Mortality Rates in a National Cohort.

Neuroendocrinology 2020 11;110(11-12):977-987. Epub 2019 Dec 11.

School of Medicine, National Yang-Ming University, Taipei, Taiwan,

Background: Acromegaly is so rare that its natural history, including incidence, risk of cancers, and mortality rates, remains elusive. This natural study utilized a nationwide database to provide a better understanding of acromegaly's disease course.

Methods: A cohort of 1,195 acromegaly patients were identified and followed-up from 1997 to 2013. Incidence, operation, and re-operation rates were calculated. Excessive mortality and cancer risk related to acromegaly were estimated by standardized mortality ratio (SMR) and standardized incidence ratio (SIR).

Results: The incidence was 2.78 per million-person-years, with little gender predominance (female vs. male, 49.5 vs. 50.5%, respectively). There was female predominance only among 50 and 60 year-olds (incidence rate ratio: 1.37 and 1.43, p < 0.001 and p = 0.002). Among them, 673 (56.3%) had hypophysectomy surgery, and the young-onset (<40 years) patients had more re-operations (15.5%, p = 0.01). The overall mortality rate was 22.3 per 1,000 person-years, with a median survival of 4.67 years (with no gender differences, p = 0.38). The overall SMR of acromegaly patients was 1.41, and the onset-age-specific SMRs of the early- and middle-onset patients were higher than for those with late-onset. There were 87 newly diagnosed cancers in the cohort, with an incidence rate of 10.6 per 1,000 person-years (median 5.4 years). The overall SIR of cancers was 1.91, and there were no differences among gender, onset-age, and disease duration (all SIR >1, approximately 2).

Conclusion: Acromegaly is associated with an excessive risk of mortality and two-fold higher risk of cancers. Patients with acromegaly should be managed appropriately after the diagnosis.
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http://dx.doi.org/10.1159/000505332DOI Listing
December 2019

Radiological and clinical outcomes of 3-level cervical disc arthroplasty.

J Neurosurg Spine 2019 Nov;32(2):174-181

3Department of Biomedical Imaging and Radiological Sciences, and.

Objective: One- and two-level cervical disc arthroplasty (CDA) has been compared to anterior cervical discectomy and fusion (ACDF) in several large-scale, prospective, randomized trials that have demonstrated similar clinical outcomes. However, whether these results would be similar when treating 3-level disc herniation and/or spondylosis has remained unanswered. This study aimed to investigate the differences between 3-level CDA and ACDF.

Methods: A series of 50 patients who underwent 3-level CDA at C3-7 was retrospectively reviewed and compared with another series of 50 patients (age- and sex-matched controls) who underwent ACDF at C3-7. Clinical outcomes were measured using the visual analog scale (VAS) for neck and arm pain, the modified Japanese Orthopaedic Association (mJOA) scale, and the Neck Disability Index (NDI). Radiological outcomes included range of motion (ROM) at the index levels. Every patient was evaluated by CT for the presence of fusion in the ACDF group. Also, complication profiles were investigated.

Results: The demographics and levels of distribution in both groups were very similar. During the follow-up period of 24 months, clinical outcomes improved (overall and respectively in each group) for both the CDA and ACDF patients when compared with the patients' preoperative condition. There were essentially few differences between the two groups in terms of neck and arm pain VAS scores, mJOA scores, and NDI scores preoperatively and at 3, 6, 12, and 24 months postoperatively. After the 3-level surgery, the CDA group had an increased mean ROM of approximately 3.4°, at 25.2° ± 8.84°, compared to their preoperative ROM (21.8° ± 7.20°) (p = 0.001), whereas the ACDF group had little mobility (22.8° ± 5.90° before and 1.0° ± 1.28° after surgery; p < 0.001). The mean operative time, estimated blood loss, and complication profiles were similar for both groups.

Conclusions: In this selectively matched retrospective study, clinical outcomes after 3-level CDA and ACDF were similar during the 2-year follow-up period. CDA not only successfully preserved but slightly increased the mobility at the 3 index levels. However, the safety and efficacy of 3-level CDA requires more long-term data for validatation.
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http://dx.doi.org/10.3171/2019.8.SPINE19545DOI Listing
November 2019

Preservation Versus Elimination of Segmental Motion in Anterior Cervical Spine Surgery.

Neurospine 2019 Sep 30;16(3):576-578. Epub 2019 Sep 30.

Department of Neurosurgery, Taipei Veterans General Hospital, School of Medicine, National Yang-Ming University, Taiwan.

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http://dx.doi.org/10.14245/ns.19edi.016DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6790725PMC
September 2019

Recent advances in the management of cervical spondylotic myelopathy: bibliometric analysis and surgical perspectives.

J Neurosurg Spine 2019 09;31(3):299-309

1School of Medicine, National Yang-Ming University, Taipei.

Objective: Cervical spondylotic myelopathy (CSM) has become a prevalent cause of spinal cord dysfunction among the aging population worldwide. Although great strides have been made in spine surgery in past decades, the optimal timing and surgical strategy to treat CSM have remained controversial. In this article the authors aimed to analyze the current trends in studies of CSM and to summarize the recent advances of surgical techniques in its treatment.

Methods: The PubMed database was searched using the keywords pertaining to CSM in human studies that were published between 1975 and 2018. Analyses of both the bibliometrics and contents, including the types of papers, authors, affiliations and countries, number of patients, and the surgical approaches were conducted. A systematic review of the literature was also performed with emphasis on the diagnosis and treatment of mild CSM.

Results: A total of 1008 papers published during the span of 44 years were analyzed. These CSM studies mainly focused on the natural history, diagnosis, and treatment, and only a few prospective randomized trials were reported. For the authors and affiliations, there was a shift of clustering of papers toward Asian countries in the past decades. Regarding the treatment for CSM, there was an exponential growth of surgical series published, and there was a trend toward slightly more anterior than posterior approaches through the past decade. Patients with CSM had increased risks of neurological deterioration or spinal cord injury with nonoperative management. Because surgery might reduce the risks, and early surgery was likely to be correlated with better outcomes, there was a trend toward attention to mildly symptomatic CSM.

Conclusions: There is emerging enthusiasm for research on CSM worldwide, with more publications originating in Asian countries over the past few decades. The surgical management of CSM is evolving continuously toward early and anterior approaches. More prospective investigations on the optimal timing and choices of surgery are therefore needed.
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http://dx.doi.org/10.3171/2019.5.SPINE18769DOI Listing
September 2019

Suture Repair in Endoscopic Surgery for Craniovertebral Junction.

Neurospine 2019 Jun 30;16(2):257-266. Epub 2019 Jun 30.

Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.

Objective: Endoscopic approaches to the craniovertebral junction (CVJ) have been established as viable and effective surgical treatments in the past decade. One of the major complications is leakage of the cerebrospinal fluid (CSF). This study aimed to investigate the efficacy and feasibility of suture closure at the nasopharyngeal mucosa upon durotomy.

Methods: A series of consecutive patients who underwent different endoscopic approaches to the CVJ were retrospectively reviewed. The pathologies, surgical corridors, neurological and functional outcomes, radiological evaluations, and complications were analyzed. Different strategies of repair for the intraoperative CSF leakage were described and compared.

Results: A total of 22 patients covering 13 years were analyzed. There were 12, 2, and 8 patients who underwent transnasal, transoral, and combined approaches, respectively. There were 8 patients (36.4%) who experienced intraoperative CSF leakage, and were grouped into 2: 4 in the nonsuture (NS) group and 4 in the suture-repaired (SR) group. The NS group had 3 (75%) persistent CSF leakages postoperation that caused 1 mortality, whereas patients of the SR group had only 1 minor CSF rhinorrhea that healed spontaneously within days.

Conclusion: In this series of 22 patients who required anterior endoscopic resection of pathologies at the CVJ, there was 1 (4.5%) serious complication related to CSF leakage. For patients who had no durotomy, the mucosal incision at the nasopharynx usually healed rapidly and there were few procedure-related complications. For patients with intraoperative CSF leakage, suture closure was technically challenging but could significantly lower the risks of postoperative complications.
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http://dx.doi.org/10.14245/ns.1938174.087DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6603818PMC
June 2019

Risk factors of second surgery for adjacent segment disease following anterior cervical discectomy and fusion: A 16-year cohort study.

Int J Surg 2019 Aug 15;68:48-55. Epub 2019 Jun 15.

Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan; Institute of Hospital and Health Care Administration, National Yang-Ming University School of Medicine, Taipei, Taiwan. Electronic address:

Background: Although the incidence of second surgery for adjacent segment disease (ASD) after anterior cervical discectomy and fusion (ACDF) has been reported, its risk factors remain elusive. Few studies have had a sufficiently large number of patients, long follow-up time, and high follow-up rate for investigation. To identify non-surgical risk factors of second surgery for ASD following ACDF, the study used a national cohort with comprehensive follow-up.

Materials And Methods: All second ACDF surgery after one year from the first ACDF were identified as a consequence of ASD that required another surgery. A multivariate competing risk survival model, Kaplan-Meier survivorship, and average time to events were calculated.

Results: Among 38,149 patients who had the first ACDF, 1,092 (2.9%) later (mean 4.66 years) received a second ACDF surgery, during the nearly-perfect follow-up of 16 years. Young age and psychiatric disorders were independent risk factors. Patients who were aged under 40, 50, 60 and 70 years were, respectively, 4.56, 4.09, 3.09 and 2.17 times more likely than those older than 70 years. Also, patients with depression or psychoses were, respectively, 1.42 and 1.45 times more likely to have second surgery for ASD. (all p < 0.05).

Conclusion: Young age and psychiatric disorders are independent risk factors of second ACDF surgery for ASD. Personalized strategies to ameliorate or postpone the development of ASD are therefore warranted for patients who need ACDF surgery.
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http://dx.doi.org/10.1016/j.ijsu.2019.06.002DOI Listing
August 2019

Characteristics of Non-Emergent Visits in Emergency Departments: Profiles and Longitudinal Pattern Changes in Taiwan, 2000-2010.

Int J Environ Res Public Health 2019 06 5;16(11). Epub 2019 Jun 5.

School of Medicine, National Yang-Ming University, Taipei 11221, Taiwan.

An increasing number of emergency department (ED) visits have posed a challenge to health systems in many countries, but an understanding of non-emergent ED visits has remained limited and contentious. This retrospective study analyzed ED visits using three representative cohorts from routine data to explore the profiles and longitudinal pattern changes of non-emergent ED visits in Taiwan. Systematic-, personal-, and ED visit-level data were analyzed using a logistic regression model. Average marginal effects were calculated to compare the effects of each factor. The annual ED visit rate increased up to 261.3 per 1000 population in 2010, and a significant one-third of visits were considered as non-emergent. The rapidly growing utilization of ED visits underwent a watershed change after cost-sharing payments between patients and medical institutions were increased in 2005. In addition to cohort effects resulting from cost-sharing payment changes, all factors were significantly associated with non-emergent ED visits with different levels of impact. We concluded that non-emergent ED visits were associated with multifaceted factors, but the change to cost-sharing payment, being female, younger age, and geographical residence were the most predictive factors. This information would enhance the implementation of evidence-based strategies to optimize ED use.
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http://dx.doi.org/10.3390/ijerph16111999DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6603954PMC
June 2019

Monkey Recovery from Spinal Cord Hemisection: Nerve Repair Strategies for Rhesus Macaques.

World Neurosurg 2019 Sep 25;129:e343-e351. Epub 2019 May 25.

Institute of Pharmacology, National Yang-Ming University, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.

Objective: Repair of spinal cord injury (SCI) using peripheral nerve graft (PNG) and acidic fibroblast growth factor (aFGF) has shown promising results in rats and a few human patients, but not in nonhuman primates. The aim of this study was to verify the effective use of PNG and aFGF for repairing incomplete SCI in nonhuman primates.

Methods: Six adult rhesus macaques received spinal cord hemisection at T8 level and were grouped into repair and control groups (n = 3 in each). Animals in the repair group underwent nerve repair with autologous PNG plus aFGF immediately after lesioning. The control group received exactly the same operation for lesioning but no treatment. Postoperative behavioral evaluations, electrophysiologic tests (including motor and somatosensory evoked potentials), and magnetic resonance imaging were performed and compared between the 2 groups as well as histologic examination of the spinal cord cephalic to, at, and caudal to the lesion site after sacrifice.

Results: Animals in the repair group had better motor function in the lower limbs at every observed time point and demonstrated more improvement on electrophysiologic examinations than the control group. The repair group had smaller areas of myelomalacia on magnetic resonance imaging around the lesion compared with the control group, suggesting diminished inflammatory responses with the repair strategy.

Conclusions: PNG plus aFGF for SCI in nonhuman primates yielded improvements in clinical behavior, electrophysiologic tests, and magnetic resonance imaging. This study suggests that the repair strategy is feasible and effective for nonhuman primate SCI. Further investigations are warranted to corroborate its effectiveness for clinical application.
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http://dx.doi.org/10.1016/j.wneu.2019.05.145DOI Listing
September 2019

Cervical disc arthroplasty for less-mobile discs.

J Neurosurg Spine 2019 May;31(3):310-316

1Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital.

Objective: The published clinical trials of cervical disc arthroplasty (CDA) have unanimously demonstrated the success of preservation of motion (average 7°-9°) at the index level for up to 10 years postoperatively. The inclusion criteria in these trials usually required patients to have evident mobility at the level to be treated (≥ 2° on lateral flexion-extension radiographs) prior to the surgery. Although the mean range of motion (ROM) remained similar after CDA, it was unclear in these trials if patients with less preoperative ROM would have different outcomes than patients with more ROM.

Methods: A series of consecutive patients who underwent CDA at the level of C5-6 were followed up and retrospectively reviewed. The indications for surgery were medically refractory cervical radiculopathy, myelopathy, or both, caused by cervical disc herniation or spondylosis. All patients were assigned to 1 of 2 groups: a less-mobile group, which consisted of those patients who had an ROM of ≤ 5° at C5-6 preoperatively, or a more-mobile group, which consisted of patients whose ROM at C5-6 was > 5° preoperatively. Clinical outcomes, including visual analog scale, Neck Disability Index, and Japanese Orthopaedic Association Scale scores, were evaluated at each time point. Radiological outcomes were also assessed.

Results: A total of 60 patients who had follow-up for more than 2 years were analyzed. There were 27 patients in the less-mobile group (mean preoperative ROM 3.0°) and 33 in the more-mobile group (mean ROM 11.7°). The 2 groups were similar in demographics, including age, sex, diabetes, and cigarette smoking. Both groups had significant improvements in clinical outcomes, with no significant differences between the 2 groups. However, the radiological evaluations demonstrated remarkable differences. The less-mobile group had a greater increase in ΔROM than the more-mobile group (ΔROM 5.5° vs 0.1°, p = 0.001), though the less-mobile group still had less segmental mobility (ROM 8.5° vs 11.7°, p = 0.04). The rates of complications were similar in both groups.

Conclusions: Preoperative segmental mobility did not alter the clinical outcomes of CDA. The preoperatively less-mobile (ROM ≤ 5°) discs had similar clinical improvements and greater increase of segmental mobility (ΔROM), but remained less mobile, than the preoperatively more-mobile (ROM > 5°) discs at 2 years postoperatively.
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http://dx.doi.org/10.3171/2019.2.SPINE181472DOI Listing
May 2019

Effects of smoking on cervical disc arthroplasty

J Neurosurg Spine 2019 02;30(2):168-174

1Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital.

Objective: Cigarette 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.

Methods: The 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 each time point of evaluation. Radiological outcomes were assessed using radiographs and CT for multiple parameters, including segmental range of motion (ROM), neutral lordotic curve, and presence of heterotopic ossification (HO).

Results: A total of 109 patients completed at least 2 years of follow-up and were analyzed (mean follow-up 42.3 months). There were 89 patients in the nonsmoking group and 20 in the smoking group. The latter group was younger and predominantly male (both p < 0.05) compared to the nonsmoking group. The two groups had similar improvements in all clinical outcomes after CDA compared to preoperatively. Radiological evaluations were also very similar between the two groups, except for two factors. The smoking group had well-preserved segmental ROM after CDA at an average of 8.1° (both pre- and postoperation). However, while the nonsmoking group remained mobile, segmental ROM decreased significantly (8.2° to 6.9°, p < 0.05) after CDA. There was a trend toward more HO development in the nonsmoking group than in the smoking group, but the difference was without significance (59.6% vs 50.0%, p = 0.43).

Conclusions: During an average 3.5 years of follow-up after 1- and 2-level CDA, cigarette smokers and nonsmokers had similar improvements in clinical outcomes. Moreover, segmental mobility was slightly better preserved in smokers. Since smoking status did not negatively impact outcomes, CDA may be a reasonable option for selected patients who have smoked.

Abbreviations: ACDF = anterior cervical discectomy and fusion; ASD = adjacent-segment degeneration; CDA = cervical disc arthroplasty; FDA = Food and Drug Administration; HO = heterotopic ossification; JOA = Japanese Orthopaedic Association; NDI = Neck Disability Index; ROM = range of motion; VAS = visual analog scale.
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http://dx.doi.org/10.3171/2018.7.SPINE18634DOI Listing
February 2019

Long Term Outcomes and Effects of Surgery on Degenerative Spinal Deformity: A 14-Year National Cohort Study.

J Clin Med 2019 Apr 10;8(4). Epub 2019 Apr 10.

School of Medicine, National Yang-Ming University, Taipei 11221, Taiwan.

Degenerative spinal deformity (DSD) has become a prevalent cause of disability and pain among the aging population worldwide. Though surgery has emerged as a promising option for DSD, the natural course, outcomes, and effects of surgery on DSD have remained elusive. This cohort study used a national database to comprehensively follow up patients of DSD for all-cause mortality, respiratory problems, and hip fracture-related hospitalizations. All patients were grouped into an operation or a non-operation group for comparison. An adjustment of demographics, comorbidities, and propensity-score matching was conducted to ameliorate confounders. A Cox regression hazard ratio (HR) model and Kaplan-Meier analysis were also applied. The study comprised 21,810 DSD patients, including 12,544 of the operation group and 9266 of the non-operation group. During the 14 years (total 109,591.2 person-years) of follow-up, the operation group had lower mortality (crude hazard ratio = 0.40), lower respiratory problems (cHR = 0.45), and lower hip fractures (cHR = 0.63) than the non-operation group (all < 0.001). After adjustment, the risks for mortality and respiratory problems remained lower (adjusted HR = 0.60 and 0.65, both < 0.001) in the operation than the non-operation group, while hip fractures were indifferent (aHR = 1.08, > 0.05). Therefore, surgery for DSD is invaluable since it could reduce the risks of mortality and of hospitalization for respiratory problems.
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http://dx.doi.org/10.3390/jcm8040483DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6518357PMC
April 2019

Radiological and clinical outcomes of cervical disc arthroplasty for the elderly: a comparison with young patients.

BMC Musculoskelet Disord 2019 Mar 18;20(1):115. Epub 2019 Mar 18.

Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Room 525, 17F, #201, Shih-Pai Road, Sec. 2, Beitou District, Taipei, 11217, Taiwan.

Background: This study aimed to investigate whether cervical disc arthroplasty (CDA) would be equally effective in elderly patients as in the young. The inclusion criteria of published clinical trials for CDA-enrolled patients covered the ages from 18 to 78 years. However, there was a paucity of data addressing the differences of outcomes between older and the younger patients.

Methods: A series of consecutive patients who underwent one- or two-level CDA were retrospectively reviewed. Patients at the two extreme ends of the age distribution (≥65 and ≤ 40 years) were selected for comparison. Clinical outcome parameters included visual analog scale (VAS) of neck and arm pain, neck disability index (NDI), and Japanese Orthopaedic Association (JOA) scores. Radiographic outcomes included range of motion (ROM) at the indexed level and evaluation of heterotopic ossification (HO) by computed tomography (CT). Complication profiles were also investigated.

Results: There were 24 patients in the elderly group (≥65 years old) and 47 patients in the young group (≤40 years old) with an overall mean follow-up of 28.0 ± 21.97 months. The elderly group had more two-level CDA, and thus the mean operative time was longer (239 vs. 179 min, p < 0.05) than the young group. Both groups had similarly significant improvement in clinical outcomes at the final follow-up. All the replaced disc segments remained mobile on post-operative lateral flexion and extension radiographs. However, the elderly group had a slight decrease in mean ROM (- 0.32° ± 3.93°) at the index level after CDA when compared to that of pre-operation. In contrast, the young group had an increase in mean ROM (+ 0.68° ± 3.60°). The complication profiles were not different, though a trend toward dysphagia was noted in the elderly group (p = 0.073). The incidence or severity (grading) of HO was similar between the two groups.

Conclusions: During the follow-up of two years, CDA was equally effective for patients over 65 years old and those under 40 years in clinical improvement. Although the elderly group demonstrated a small reduction of mean ROM after CDA, in contrast to the young group which had a small increase, the segmental mobility was well preserved at every indexed level for each group.
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http://dx.doi.org/10.1186/s12891-019-2509-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6421705PMC
March 2019

Radiological and clinical outcomes of cervical disc arthroplasty for the elderly: a comparison with young patients.

BMC Musculoskelet Disord 2019 Mar 18;20(1):115. Epub 2019 Mar 18.

Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Room 525, 17F, #201, Shih-Pai Road, Sec. 2, Beitou District, Taipei, 11217, Taiwan.

Background: This study aimed to investigate whether cervical disc arthroplasty (CDA) would be equally effective in elderly patients as in the young. The inclusion criteria of published clinical trials for CDA-enrolled patients covered the ages from 18 to 78 years. However, there was a paucity of data addressing the differences of outcomes between older and the younger patients.

Methods: A series of consecutive patients who underwent one- or two-level CDA were retrospectively reviewed. Patients at the two extreme ends of the age distribution (≥65 and ≤ 40 years) were selected for comparison. Clinical outcome parameters included visual analog scale (VAS) of neck and arm pain, neck disability index (NDI), and Japanese Orthopaedic Association (JOA) scores. Radiographic outcomes included range of motion (ROM) at the indexed level and evaluation of heterotopic ossification (HO) by computed tomography (CT). Complication profiles were also investigated.

Results: There were 24 patients in the elderly group (≥65 years old) and 47 patients in the young group (≤40 years old) with an overall mean follow-up of 28.0 ± 21.97 months. The elderly group had more two-level CDA, and thus the mean operative time was longer (239 vs. 179 min, p < 0.05) than the young group. Both groups had similarly significant improvement in clinical outcomes at the final follow-up. All the replaced disc segments remained mobile on post-operative lateral flexion and extension radiographs. However, the elderly group had a slight decrease in mean ROM (- 0.32° ± 3.93°) at the index level after CDA when compared to that of pre-operation. In contrast, the young group had an increase in mean ROM (+ 0.68° ± 3.60°). The complication profiles were not different, though a trend toward dysphagia was noted in the elderly group (p = 0.073). The incidence or severity (grading) of HO was similar between the two groups.

Conclusions: During the follow-up of two years, CDA was equally effective for patients over 65 years old and those under 40 years in clinical improvement. Although the elderly group demonstrated a small reduction of mean ROM after CDA, in contrast to the young group which had a small increase, the segmental mobility was well preserved at every indexed level for each group.
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http://dx.doi.org/10.1186/s12891-019-2509-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6421705PMC
March 2019

Early Discharge for Anterior Cervical Fusion Surgery: Prediction of Readmission and Special Considerations for Older Adults.

Int J Environ Res Public Health 2019 02 21;16(4). Epub 2019 Feb 21.

Department of Neurosurgery, School of Medicine, National Yang-Ming University, Taipei 11221, Taiwan.

Anterior cervical discectomy and fusion (ACDF) is the standard surgical management for disc herniation and spondylosis worldwide and reportedly performed with short hospitalization and early discharge (ED). However, it is unknown if ED improves the outcomes of ACDF including among older adults. This cohort study included patients who underwent ACDF surgery in Taiwan over two years analyzed in two groups: the ED group (discharged within 48 hours), and the comparison group (hospitalized for more than 48 h). Both groups were followed-up for at least 180 days. Pre- and post-operative comorbidities, re-admissions and re-operations were analyzed using a multivariate cox-regression model, with bootstrapping, and Kaplan⁻Meier analysis. Among 5565 ACDF patients, the ED group ( = 405) had a higher chance (crude and adjusted hazard ratio = 2.33 and 2.39, both < 0.001) of re-admission than the comparison group ( = 5160). The ED group had an insignificant trend toward more re-admissions for spinal problems and re-operations within 180 days. In the ED group, older age (≥60) and hypertension were predictive of re-admission. For ACDF surgery, the ED group had higher rates of re-admission within 180 days of post-op, suggesting that the current approach to ED requires modification or more cautious selection criteria be adopted, particularly for older adults.
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http://dx.doi.org/10.3390/ijerph16040641DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6406524PMC
February 2019

Artificial intelligence-based decision-making for age-related macular degeneration.

Theranostics 2019 1;9(1):232-245. Epub 2019 Jan 1.

Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan.

Artificial intelligence (AI) based on convolutional neural networks (CNNs) has a great potential to enhance medical workflow and improve health care quality. Of particular interest is practical implementation of such AI-based software as a cloud-based tool aimed for telemedicine, the practice of providing medical care from a distance using electronic interfaces. In this study, we used a dataset of labeled 35,900 optical coherence tomography (OCT) images obtained from age-related macular degeneration (AMD) patients and used them to train three types of CNNs to perform AMD diagnosis. Here, we present an AI- and cloud-based telemedicine interaction tool for diagnosis and proposed treatment of AMD. Through deep learning process based on the analysis of preprocessed optical coherence tomography (OCT) imaging data, our AI-based system achieved the same image discrimination rate as that of retinal specialists in our hospital. The AI platform's detection accuracy was generally higher than 90% and was significantly superior (p < 0.001) to that of medical students (69.4% and 68.9%) and equal (p = 0.99) to that of retinal specialists (92.73% and 91.90%). Furthermore, it provided appropriate treatment recommendations comparable to those of retinal specialists. We therefore developed a website for realistic cloud computing based on this AI platform, available at https://www.ym.edu.tw/~AI-OCT/. Patients can upload their OCT images to the website to verify whether they have AMD and require treatment. Using an AI-based cloud service represents a real solution for medical imaging diagnostics and telemedicine.
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http://dx.doi.org/10.7150/thno.28447DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6332801PMC
December 2019

Anterior Cervical Discectomy and Fusion for Hirayama Disease: A Case Report and Literature Review.

Neurospine 2019 Sep 4;16(3):626-630. Epub 2019 Jan 4.

Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.

Hirayama disease, a juvenile muscular atrophy of the distal upper extremity, is a rare form of cervical flexion myelopathy characterized by insidiously progressive weakness of the hands and forearm muscles (i.e., painless amyotrophy). The pathognomonic finding is a markedly forward-shifted spinal cord during neck flexion, demonstrated by dynamic magnetic resonance imaging (MRI), as in a young man with muscle atrophy in the bilateral distal upper extremities. In this report, the authors describe a 31-year-old man who had the classic radiological and clinical presentations of Hirayama disease. Since prior medical treatment had been ineffective for years, he underwent multilevel instrumented anterior cervical discectomy and fusion (ACDF) to keep his subaxial cervical spine slightly-lordotic (nonflexion). His motor evoked potential amplitude improved immediately during the operation, and there were improvements of myelopathy and a modest reversal of muscle wasting at 1 year postoperatively. Postoperative dynamic cervical spine MRI also demonstrated minimal cord compression and elimination of the venous plexus engorgement dorsal to the thecal sac. Although Hirayama disease is benign in nature and frequently self-limiting, multilevel instrumented ACDF could be a reasonable management option.
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http://dx.doi.org/10.14245/ns.1836178.089DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6790718PMC
September 2019

Acidic Fibroblast Growth Factor in Spinal Cord Injury.

Neurospine 2019 Dec 15;16(4):728-738. Epub 2019 Jan 15.

Institute of Pharmacology, National Yang-Ming University, Taipei, Taiwan.

Spinal cord injury (SCI), with an incidence rate of 246 per million person-years among adults in Taiwan, remains a devastating disease in the modern day. Elderly men with lower socioeconomic status have an even higher risk for SCI. Despite advances made in medicine and technology to date, there are few effective treatments for SCI due to limitations in the regenerative capacity of the adult central nervous system. Experiments and clinical trials have explored neuro-regeneration in human SCI, encompassing cell- and molecule-based therapies. Furthermore, strategies have aimed at restoring connections, including autologous peripheral nerve grafts and biomaterial scaffolds that theoretically promote axonal growth. Most molecule-based therapies target the modulation of inhibitory molecules to promote axonal growth, degrade glial scarring obstacles, and stimulate intrinsic regenerative capacity. Among them, acidic fibroblast growth factor (aFGF) has been investigated for nerve repair; it is mitogenic and pluripotent in nature and could enhance axonal growth and mitigate glial scarring. For more than 2 decades, the authors have conducted multiple trials, including human and animal experiments, using aFGF to repair nerve injuries, including central and peripheral nerves. In these trials, aFGF has shown promise for neural regeneration, and in the future, more trials and applications should investigate aFGF as a neurotrophic factor. Focusing on aFGF, the current review aimed to summarize the historical evolution of the utilization of aFGF in SCI and nerve injuries, to present applications and trials, to summarize briefly its possible mechanisms, and to provide future perspectives.
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http://dx.doi.org/10.14245/ns.1836216.108DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6944993PMC
December 2019

Surgical Treatment for a Giant Solitary Plasmacytoma with Skull Erosion.

Cureus 2018 Nov 1;10(11):e3535. Epub 2018 Nov 1.

Neurosurgery, Taipei Veterans General Hospital, Taipei, TWN.

Solitary plasmacytoma of the skull, a single malignant monoclonal plasma cell proliferation without systemic involvement, is rare and often misdiagnosed by radiological examinations only. In this article, the authors presented a 40-year-old man who had a painless protruding mass over the midline of the posterior head region. A brain magnetic resonance imaging (MRI) revealed an enhanced mass lesion over the midline of the parieto-occipital region with skull erosion. Under the tentative diagnosis of meningioma, craniectomy was performed with en bloc tumor resection, and the skull defect was replaced by cranioplasty with bone cement. The final histopathological report revealed plasmacytoma without evidence of multiple myeloma. No further adjuvant radiotherapy was arranged for the patient. The postoperative course was uneventful within a one-year follow-up period. For the skull solitary plasmacytoma, there was no strong evidence that adjuvant radiotherapy was necessary after the primary surgery. Surgical intervention with total tumor resection is an effective option for the patient with solitary plasmacytoma of the skull.
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http://dx.doi.org/10.7759/cureus.3535DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6319599PMC
November 2018

Taiwan Neurosurgical Spine Society: The New Shining Star.

Neurospine 2018 Dec 19;15(4):285-295. Epub 2018 Nov 19.

Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.

As spine surgery flourished in Taiwan and neurosurgeons became more involved in spine surgery towards the end of the 20th century, the Taiwan Neurosurgical Spine Society (TNSS), earlier named the Taiwan Neurospinal Society, was established on March 11, 2001. As its main founder, Dr. Chun-I Huang was elected as the first president of the TNSS. The goals of the TNSS were to promote research, to hold academic seminars, to participate in international conferences, and to exchange clinical experiences. The mission of the TNSS was successful, and the profession of spine surgery in Taiwan advanced during the first decade of the 21st century, culminating in the TNSS joining ASIA SPINE in 2010. Since its establishment, the TNSS has always been supportive of collaboration and communication with the Korean Spinal Neurosurgery Society and the Neurospinal Society of Japan. Through periodical meetings, supported by the TNSS, surgeons worldwide have enjoyed a platform of sharing and mutual learning. To further promote academic research, the TNSS has officially supported the journal Neurospine since 2018. With extensive efforts from local and international surgeons, the TNSS will continue to adhere to its mission and to advance the profession of spine surgery.
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http://dx.doi.org/10.14245/ns.1836194.097DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6347352PMC
December 2018
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