Jay Wang · University of Southern California · PhdFit
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Jay Wang
· CPD Director; Associate ProfessorVerified
University of Southern California · Public Diplomacy
Jay Wang is the Director of the USC Center on Public Diplomacy and an Associate Professor at the USC Annenberg School for Communication and Journalism. He previously worked for the international consulting firm McKinsey & Company, where he advised clients on communication strategy and implementation across various industries and sectors. Dr. Wang has written extensively on the role of communication in the contemporary process of globalization. He is a co-editor of the book Debating Public Diplomacy: Now and Next and the author of Shaping China’s Global Imagination: Nation Branding at the World Expo, among other publications. He serves on the editorial board of the International Journal of Communication.
Background: Endoscopic decompression (ED) and microscopic decompression (MD) are newer minimally invasive approaches for surgical treatment of lumbar spinal stenosis (LSS). However, the absence of large, high-quality randomized controlled trials raises concerns for the potential of bias, or spin, in studies evaluating these techniques. This study aims to analyze the prevalence of spin in abstracts of systematic reviews and meta-analyses comparing ED and MD as treatments for LSS. Methods: Studies were identified using the Preferred Reporting Items for Systematic Reviews and Meta Analysis guidelines searching PubMed, Web of Science (WOS), and Scopus. Articles included were: (I) a systematic review with or without a meta-analysis; (II) degenerative etiology; (III) human subjects; (IV) available in English. Abstracts were graded for incidence of the 15 most common types of spin, and full texts were reviewed using AMSTAR 2 classification. General demographics were identified, including study title, author, journal of publication, year of publication, level of evidence (LOE), study design, and funding. Fisher's exact test was used to compare study metrics. Results: Ten studies were included, all of which contained at least one type of spin. Spin type 12 ("Conclusion claims equivalence or comparable effectiveness for non-statistically significant results with a wide confidence interval") and type 3 (Selective reporting of or overemphasis on efficacy outcomes or analysis favoring the beneficial effect of the experimental intervention) were the most common forms of spin, found in 5/10 (50%) of the included studies. All 10 studies received a confidence rating of "critically low" according to the AMSTAR 2 domain. There were no significant associations between incidence of spin type and year of publication, journal of publication, number of citations, LOE, funding, Clarivate impact factor, or ScopusCiteScore. Conclusions: Spin is highly prevalent in abstracts of systematic reviews and meta-analyses investigating ED versus MD. All ten manuscripts evaluated received a low quality rating according to the AMSTAR 2 domain.
Introduction: Double crush syndrome (DCS) refers to compressive neuropathy at multiple sites along a peripheral nerve (PN), yet its relevance in the lower extremity remains poorly defined. This study aimed to (1) determine the prevalence of PN lesions in patients undergoing surgery for lumbosacral radiculopathy (LR), (2) identify commonly affected nerves, (3) assess associated risk factors, and (4) evaluate the DCS hypothesis by comparing the incidence of PN lesions in patients undergoing surgery for LR versus matched controls. Methods: A retrospective cohort study was conducted using the PearlDiver database (2010-2022) to identify adult patients who underwent lumbar decompression and/or fusion for LR. PN lesions diagnosed within two years before or after surgery were categorized by nerve. Univariate logistic regression was used to identify risk factors. A matched control cohort without LR was created using propensity score matching to evaluate the DCS hypothesis. Results: Of 650,562 patients undergoing surgery for LR, 32,909 (5.1%) were diagnosed with a PN lesion, with 60.6% occurring before and 38.4% after surgery. The most commonly affected nerves were the sciatic (31.7%), plantar (16.1%), and peroneal (11.2%). Risk factors for PN lesions included female gender (odds ratio [OR]: 1.22), age 50-59 years (OR: 1.23) and 60-69 years (OR: 1.17), and higher comorbidity burden with Elixhauser Comorbidity Index ≥5 (OR: 1.50). Comorbid conditions associated with increased risk included complex regional pain syndrome (OR: 3.33), fibromyalgia (OR: 1.73), and osteoarthritis (OR: 1.61). Compared to matched controls, patients with LR were significantly more likely to develop a PN lesion (OR: 3.10). Conclusions: PN lesions affect over 5% of patients undergoing surgery for LR and are significantly more common than in controls, supporting the DCS hypothesis in the lower extremity. Clinicians should maintain a broad differential diagnosis when evaluating radicular symptoms, especially in patients with high comorbidity burden or recurrent postoperative pain.
OBJECTIVE: To explore global practice patterns and surgeon preferences in the surgical management of recurrent lumbar disc herniation (rLDH), and to identify factors influencing the choice of technique. METHODS: A survey was distributed to the AOSpine members globally to ascertain rLDH surgical management preferences. Preference of surgeons for management options such as sequestrectomy, partial discectomy (PD), radical discectomy (RD) and fusion was ascertained for early (< 3 months) and late (> 3 months) rLDH scenarios following initial recovery for 6 months. RESULTS: 714 surgeons responded to the survey. In early rLDH, PD was predominantly preferred (48.0%, n = 343) followed by RD (18.3%, n = 131), fusion (17.9%, n = 128) and sequestrectomy (14.4%, n = 103). In late rLDH, 40.2%(n = 287) of the surgeons preferred interbody fusion followed by sequestrectomy (31.7%, n = 226) and RD (21.6%, n = 154). Surgeons predominantly preferred to utilize the same approach as that of index surgery. Fusion was considered when there was a concomitant or incipient degenerative disease. Fusion in the early rLDH is significantly influenced by region, training, and volume of cases handled by the surgeons. CONCLUSION: Partial discectomy and interbody fusion are the predominant management of choice in both the early and late rLDH. The choice of fusion predominantly depends on the state of the index and adjacent segment, instability and degeneration respectively. Fusion in the early rLDH is significantly influenced by region, surgical training, and volume of cases handled by the surgeons.
Background/Objectives: The purpose of this review was to determine the impact of osteoporosis on outcomes after surgery for cervical deformity. Cervical deformity involves abnormal curvature or misalignment of the cervical spine, often resulting in a significant loss of quality of life and requiring surgical correction. While osteoporosis has been associated with hardware failure including screw loosening and cage migration in spine surgery, its role in cervical deformity remains unclear. Existing studies report mixed findings with regard to postoperative sequelae in patients with osteoporosis undergoing surgical correction of cervical deformity. Methods: A systematic review using PRISMA guidelines and MeSH terms involving spine surgery for cervical deformity and osteoporosis was performed. The Medline (PubMed) database was searched from 1990 to August 2022 using the following terms: “osteoporosis” AND “cervical” AND (“outcomes” OR “revision” OR “reoperation” OR “complication”). This review focused on radiographic outcomes, as well as post-operative complications. Results: Eight studies were included in the final analysis. Three papers assessed risk factors for the development of post-operative distal junctional kyphosis (DJK), but only one found osteoporosis as a predictor for DJK. Although three studies found that osteoporosis was not significantly associated with the incidence of surgical complications, one highlights osteoporosis as a predictor of complications at 90 days postoperatively (p < 0.001) and another associates osteoporosis with overall poor outcomes (p = 0.021). Furthermore, one study assessing the relationship between osteoporosis and reoperation found no association. Conclusions: Overall, our systematic review suggests that in patients undergoing surgery for cervical deformity, osteoporosis is not predictive of the need for reoperation or the development of postoperative complications, such as DJK, dysphagia, superficial infection, and others. These findings highlight the need for further study regarding the role of osteoporosis in surgical correction of cervical deformity.
Spine Surgery and Related Research · 2025-06-10 · 1 citations
articleOpen access
Introduction: The prone transpsoas (PTP) approach is a novel, single-position lumbar fusion technique that enables lateral lumbar interbody fusion (LLIF) entirely in the prone position, allowing simultaneous access to both the anterior and posterior spinal columns. While it offers advantages such as achieving circumferential fusion without repositioning the patient, it also presents challenges, including hemodynamic shifts, pressure-related complications, and technical difficulties in navigating complex anatomical structures. This study describes anatomical shifts relative to the lumbar spine when transitioning from the supine to the prone position. Methods: This retrospective review included patients who underwent posterior lumbar fusion between 2018 and 2024 and had both preoperative magnetic resonance imaging (MRI) and intraoperative prone computed tomography-guided imaging. Patients with deformity, infection, trauma, prior fusion, or malignancy were excluded. Anteroposterior (AP) and mediolateral (ML) distances (in mm) were measured on axial slices using reference lines aligned to vertebral endplates at each lumbar level. Measurements included AP and ML distances to the abdominal great vessels, psoas major, and intervertebral discs. Dependent samples t-tests and analysis of variance were used to assess anatomical shifts from supine to prone and to compare segmental differences. Results: . Significant AP translation was observed at L2-L3 and L3-L4 for the inferior vena cava (p<0.001) and aorta (p<0.01), and at L4-L5 for the common iliac arteries (p<0.001) and right iliac vein (p<0.05). Symmetric AP excursion of the psoas major muscle was noted at L2-L3 and L4-L5 in the prone position (p<0.05). No significant differences in mean translation were found across lumbar levels. Conclusions: Prone positioning induces measurable anterior translation of both the psoas major muscle and great vessels, potentially altering the operative corridor utilized in the PTP approach. These discrepancies between supine MRI and prone intraoperative anatomy emphasize the need to account for positional anatomical changes to minimize neurovascular risk during PTP LLIF.
