Browsing by Author "Wang, Michael"

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    ItemOpen Access
    Assessment of CD37 B-cell antigen and cell of origin significantly improves risk prediction in diffuse large B-cell lymphoma
    (BLOOD, 2016-12-29) Xu-Monette, Zijun Y; Li, Ling; Byrd, John C; Jabbar, Kausar J; Manyam, Ganiraju C; de Winde, Charlotte Maria; van den Brand, Michiel; Tzankov, Alexandar; Visco, Carlo; Wang, Jing; Dybkaer, Karen; Chiu, April; Orazi, Attilio; Zu, Youli; Bhagat, Govind; Richards, Kristy L; Hsi, Eric D; Choi, William WL; Huh, Jooryung; Ponzoni, Maurilio; Ferreri, Andres JM; Moller, Michael B; Parsons, Ben M; Winter, Jane N; Wang, Michael; Hagemeister, Frederick B; Piris, Miguel A; van Krieken, J Han; Medeiros, L Jeffrey; Li, Yong; van Spriel, Annemiek B; Young, Ken H
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    Do obese patients undergoing surgery for grade 1 spondylolisthesis have worse outcomes at 5 years' follow-up? A QOD study.
    (Journal of neurosurgery. Spine, 2024-09) Zammar, Samer G; Ambati, Vardhaan S; Yee, Timothy J; Patel, Arati; Le, Vivian P; Alan, Nima; Coric, Domagoj; Potts, Eric A; Bisson, Erica F; Knightly, Jack J; Fu, Kai-Ming; Foley, Kevin T; Shaffrey, Mark E; Bydon, Mohamad; Chou, Dean; Chan, Andrew K; Meyer, Scott; Asher, Anthony L; Shaffrey, Christopher I; Slotkin, Jonathan R; Wang, Michael; Haid, Regis; Glassman, Steven D; Park, Paul; Virk, Michael; Mummaneni, Praveen V

    Objective

    The long-term effects of increased body mass index (BMI) on surgical outcomes are unknown for patients who undergo surgery for low-grade lumbar spondylolisthesis. The goal of this study was to assess long-term outcomes in obese versus nonobese patients after surgery for grade 1 spondylolisthesis.

    Methods

    Patients who underwent surgery for grade 1 spondylolisthesis at the Quality Outcomes Database's 12 highest enrolling sites (SpineCORe group) were identified. Long-term (5-year) outcomes were compared for patients with BMI ≥ 35 versus BMI < 35.

    Results

    In total, 608 patients (57.6% female) were included. Follow-up was 81% (excluding patients who had died) at 5 years. The BMI ≥ 35 cohort (130 patients, 21.4%) was compared to the BMI < 35 cohort (478 patients, 78.6%). At baseline, patients with BMI ≥ 35 were more likely to be younger (58.5 ± 11.4 vs 63.2 ± 12.0 years old, p < 0.001), to present with both back and leg pain (53.8% vs 37.0%, p = 0.002), and to require ambulation assistance (20.8% vs 9.2%, p < 0.001). Furthermore, the cohort with BMI ≥ 35 had worse baseline patient-reported outcomes including visual analog scale (VAS) back (7.6 ± 2.3 vs 6.5 ± 2.8, p < 0.001) and leg (7.1 ± 2.6 vs 6.4 ± 2.9, p = 0.031) pain, disability measured by the Oswestry Disability Index (ODI) (53.7 ± 15.7 vs 44.8 ± 17.0, p < 0.001), and quality of life on EuroQol-5D (EQ-5D) questionnaire (0.47 ± 0.22 vs 0.56 ± 0.22, p < 0.001). Patients with BMI ≥ 35 were more likely to undergo fusion (85.4% vs 74.7%, p = 0.01). There were no significant differences in 30- and 90-day readmission rates (p > 0.05). Five years postoperatively, there were no differences in reoperation rates or the development of adjacent-segment disease for patients in either BMI < 35 or ≥ 35 cohorts who underwent fusion (p > 0.05). On multivariate analysis, BMI ≥ 35 was a significant risk factor for not achieving minimal clinically important differences (MCIDs) for VAS leg pain (OR 0.429, 95% CI 0.209-0.876, p = 0.020), but BMI ≥ 35 was not a predictor for achieving MCID for VAS back pain, ODI, or EQ-5D at 5 years postoperatively.

    Conclusions

    Both obese and nonobese patients benefit from surgery for grade 1 spondylolisthesis. At the 5-year time point, patients with BMI ≥ 35 have similarly low reoperation rates and achieve rates of satisfaction and MCID for back pain (but not leg pain), disability (ODI), and quality of life (EQ-5D) that are similar to those in patients with a BMI < 35.
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    ItemOpen Access
    How closely are outcome questionnaires correlated to patient satisfaction after cervical spine surgery for myelopathy?
    (Journal of neurosurgery. Spine, 2023-05) Zaki, Mark M; Joshi, Rushikesh S; Ibrahim, Sufyan; Michalopoulos, Giorgos D; Linzey, Joseph R; Saadeh, Yamaan S; Upadhyaya, Cheerag; Coric, Domagoj; Potts, Eric A; Bisson, Erica F; Turner, Jay D; Knightly, John J; Fu, Kai-Ming; Foley, Kevin T; Tumialan, Luis; Shaffrey, Mark E; Bydon, Mohamad; Mummaneni, Praveen V; Chou, Dean; Chan, Andrew K; Meyer, Scott; Asher, Anthony L; Shaffrey, Christopher I; Gottfried, Oren N; Than, Khoi D; Wang, Michael; Haid, Regis; Slotkin, Jonathan R; Glassman, Steven D; Park, Paul

    Objective

    Patient-reported outcomes (PROs) have become the standard means to measure surgical outcomes. Insurers and policy makers are also increasingly utilizing PROs to assess the value of care and measure different aspects of a patient's condition. For cervical myelopathy, it is currently unclear which outcome measure best reflects patient satisfaction. In this investigation, the authors evaluated patients treated for cervical myelopathy to determine which outcome questionnaires best correlate with patient satisfaction.

    Methods

    The Quality Outcomes Database (QOD), a prospectively collected multi-institutional database, was used to retrospectively analyze patients undergoing surgery for cervical myelopathy. The North American Spine Society (NASS) satisfaction index, Neck Disability Index (NDI), numeric rating scales for neck pain (NP-NRS) and arm pain (AP-NRS), EQ-5D, and modified Japanese Orthopaedic Association (mJOA) scale were evaluated.

    Results

    The analysis included 1141 patients diagnosed with myelopathy, of whom 1099 had an NASS satisfaction index recorded at any of the follow-up time points. Concomitant radiculopathy was an indication for surgery in 368 (33.5%) patients, and severe neck pain (NP-NRS ≥ 7) was present in 471 (42.8%) patients. At the 3-month follow-up, NASS patient satisfaction index scores were positively correlated with scores for the NP-NRS (r = 0.30), AP-NRS (r = 0.32), and NDI (r = 0.36) and negatively correlated with EQ-5D (r = -0.38) and mJOA (r = -0.29) scores (all p < 0.001). At the 12-month follow-up, scores for the NASS index were positively correlated with scores for the NP-NRS (r = 0.44), AP-NRS (r = 0.38), and NDI (r = 0.46) and negatively correlated with scores for the EQ-5D (r = -0.40) and mJOA (r = -0.36) (all p < 0.001). At the 24-month follow-up, NASS index scores were positively correlated with NP-NRS (r = 0.49), AP-NRS (r = 0.36), and NDI (r = 0.49) scores and negatively correlated with EQ-5D (r = -0.44) and mJOA (r = -0.38) scores (all p < 0.001).

    Conclusions

    Neck pain was highly prevalent in patients with myelopathy. Notably, improvement in neck pain-associated disability rather than improvement in myelopathy was the most prominent PRO factor for patients. This finding may reflect greater patient concern for active pain symptoms than for neurological symptoms caused by myelopathy. As commercial payers begin to examine novel remuneration strategies for surgical interventions, thoughtful analysis of PRO measurements will have increasing relevance.
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    ItemOpen Access
    Investigation of UV and Visible Light Effects on Kinetic and Thermodynamic Properties of Metal-Binding Aroylhydrazone Photoswitches
    (2017-05-04) Wang, Michael
    The use of light as a controlled stimulus for chemical reactions has many advantages over stimuli, such as physical or chemical stimuli, that include its high specificity, resolution, and non-invasiveness. HAPI and its 16 easily synthesized derivatives studied here have the unique ability of shifting between ground and excited state equilibria in response to different wavelengths of light. They also possess E isomer-specific metal binding abilities, furthering its ability for application. UVC, UVA, and Blue Light centered on 254, 371, and 395 nm, respectively, were used as the different light sources for sample stimulation. Different derivatives possess a wide range of isomer compositions in the ground and excited state equilibria depending on which wavelength is used for stimulation. Each derivative had a unique response to any of the three wavelengths used. Once these compounds were stimulated long enough, they reach a photostationary state (PSS) where any more stimulation with light does not produce a change in equilibrium monitored by UV-visible spectroscopy. From this state, the compounds thermally relax back to the ground state equilibrium at different rates, allowing for calculations of half-lives for the PSS of each compound. These half-lives range from 26 min to 216 min. A competitive binding assay is used to assess relative Fe3+ affinity for each compound in its ground and excited states. It was observed that altering certain functional groups on HAPI could dramatically inhibit or enhance iron chelating ability. These data suggest a wide range of effects that simple molecular changes can produce. Thus, further study into this class of compounds may yield optimizations for various potential applications.
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    Is There a Patient Profile That Characterizes a Patient With Adult Spinal Deformity as a Candidate for Minimally Invasive Surgery?
    (Global spine journal, 2017-10) Eastlack, Robert K; Mundis, Gregory M; Wang, Michael; Mummaneni, Praveen V; Uribe, Juan; Okonkwo, David; Akbarnia, Behrooz A; Anand, Neel; Kanter, Adam; Park, Paul; Lafage, Virginie; Shaffrey, Christopher; Fessler, Richard; Deviren, Vedat; International Spine Study Group
    Retrospective review.The goal of this study was to evaluate the baseline characteristics of patients chosen to undergo traditional open versus minimally invasive surgery (MIS) for adult spinal deformity (ASD).A multicenter review of 2 databases including ASD patients treated with surgery. Inclusion criteria were age >45 years, Cobb angle minimum of 20°, and minimum 2-year follow-up. Preoperative radiographic parameters and disability outcome measures were reviewed.A total of 350 patients were identified: 173 OPEN patients and 177 MIS. OPEN patients were significantly younger than MIS patients (61.5 years vs 63.74 years, P = .013). The OPEN group had significantly more females (87% vs 76%, P = .006), but both groups had similar body mass index. Preoperative lumbar Cobb was significantly higher for the OPEN group (34.2°) than for the MIS group (26.0°, P < .001). The mean preoperative Oswestry Disability Index was significantly higher in the MIS group (44.8 in OPEN patients and 49.8 in MIS patients, P < .011). The preoperative Numerical Rating Scale value for back pain was 7.2 in the OPEN group and 6.8 in the MIS group preoperatively, P = .100.Patients chosen for MIS for ASD are slightly older and have smaller coronal deformities than those chosen for open techniques, but they did not have a substantially lesser degree of sagittal malalignment. MIS surgery was most frequently utilized for patients with an sagittal vertical axis under 6 cm and a baseline pelvic incidence and lumbar lordosis mismatch under 30°.
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    ItemOpen Access
    Minimally Invasive Surgery for Mild-to-Moderate Adult Spinal Deformities: Impact on Intensive Care Unit and Hospital Stay.
    (World neurosurgery, 2019-07) Chou, Dean; Mundis, Gregory; Wang, Michael; Fu, Kai-Ming; Shaffrey, Christopher; Okonkwo, David; Kanter, Adam; Eastlack, Robert; Nguyen, Stacie; Deviren, Vedat; Uribe, Juan; Fessler, Richard; Nunley, Pierce; Anand, Neel; Park, Paul; Mummaneni, Praveen; International Spine Study Group

    Objective

    To compare circumferential minimally invasive (cMIS) versus open surgeries for mild-to-moderate adult spinal deformity (ASD) with regard to intensive care unit (ICU) and hospital lengths of stay (LOS).

    Methods

    A retrospective review of 2 multicenter ASD databases with 426 ASD (sagittal vertical axis <6 cm) surgery patients with 4 or more fusion levels and 2-year follow-up was conducted. ICU stay, LOS, and estimated blood loss (EBL) were compared between open and cMIS surgeries.

    Results

    Propensity matching resulted in 88 patients (44 cMIS, 44 open). cMIS were older (61 vs. 53 years, P = 0.005). Mean levels fused were 6.5 in cMIS and 7.1 in open (P = 0.368). Preoperative lordosis was higher in open than in cMIS (42.7° vs. 40.9°, P = 0.016), and preoperative visual analog score back pain was greater in open than in cMIS (7 vs. 6.2, P = 0.033). Preoperative and postoperative spinopelvic parameters and coronal Cobb angles were not different. EBL was 534 cc in cMIS and 1211 cc in open (P < 0.001). Transfusions were less in cMIS (27.3% vs. 70.5%, P < 0.001). ICU stay was 0.6 days for cMIS and 1.2 days for open (P = 0.009). Hospital LOS was 7.9 days for cMIS versus 9.6 for open (P = 0.804).

    Conclusions

    For patients with mild-to-moderate ASD, cMIS surgery had a significantly lower EBL and shorter ICU stay. Major and minor complication rates were lower in cMIS patients than open patients. Overall LOS was shorter in cMIS patients, but did not reach statistical significance.
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    Outcomes and Complications With Age in Spondylolisthesis: An Evaluation of the Elderly From the Quality Outcomes Database.
    (Spine, 2020-07) Karsy, Michael; Chan, Andrew K; Mummaneni, Praveen V; Virk, Michael S; Bydon, Mohamad; Glassman, Steven D; Foley, Kevin T; Potts, Eric A; Shaffrey, Christopher I; Shaffrey, Mark E; Coric, Domagoj; Asher, Anthony L; Knightly, John J; Park, Paul; Fu, Kai-Ming; Slotkin, Jonathan R; Haid, Regis W; Wang, Michael; Bisson, Erica F

    Study design

    Prospective database analysis.

    Objective

    To assess the effect of age on patient-reported outcomes (PROs) and complication rates after surgical treatment for spondylolisthesis SUMMARY OF BACKGROUND DATA.: Degenerative lumbar spondylolisthesis affects 3% to 20% of the population and up to 30% of the elderly. There is not yet consensus on whether age is a contraindication for surgical treatment of elderly patients.

    Methods

    The Quality Outcomes Database lumbar registry was used to evaluate patients from 12 US academic and private centers who underwent surgical treatment for grade 1 lumbar spondylolisthesis between July 2014 and June 2016.

    Results

    A total of 608 patients who fit the inclusion criteria were categorized by age into the following groups: less than 60 (n = 239), 60 to 70 (n = 209), 71 to 80 (n = 128), and more than 80 (n = 32) years. Older patients showed lower mean body mass index (P < 0.001) and higher rates of diabetes (P = 0.007), coronary artery disease (P = 0.0001), and osteoporosis (P = 0.005). A lower likelihood for home disposition was seen with higher age (89.1% in <60-year-old vs. 75% in >80-year-old patients; P = 0.002). There were no baseline differences in PROs (Oswestry Disability Index, EuroQol health survey [EQ-5D], Numeric Rating Scale for leg pain and back pain) among age categories. A significant improvement for all PROs was seen regardless of age (P < 0.05), and most patients met minimal clinically important differences (MCIDs) for improvement in postoperative PROs. No differences in hospital readmissions or reoperations were seen among age groups (P < 0.05). Multivariate analysis demonstrated that, after controlling other variables, a higher age did not decrease the odds of achieving MCID at 12 months for the PROs.

    Conclusion

    Our results indicate that well-selected elderly patients undergoing surgical treatment of grade 1 spondylolisthesis can achieve meaningful outcomes. This modern, multicenter US study reflects the current use and limitations of spondylolisthesis treatment in the elderly, which may be informative to patients and providers.

    Level of evidence

    4.