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Marc Asher

Publications and source records attributed to Marc Asher.

At least 19 recordsLinked to original sources
PubMed2006

Estimating SRS-22 quality of life measures with SF-36: application in idiopathic scoliosis.

STUDY DESIGN: Comparison of a generic- with a disorder-specific health-related quality of life (HRQL) questionnaire. OBJECTIVES: To determine the association between generic- and disorder-specific questionnaire domains of similar construct. SUMMARY OF BACKGROUND DATA: Short Form-36 (SF-36), a general HRQL questionnaire, has been widely used to evaluate patients with scoliosis and related spine deformity. How it relates to the disorder-specific Scoliosis Research Society-22 (SRS-22) questionnaire is currently unknown. METHODS: Seventy-eight patients, operated at a mean age 14.5 years for idiopathic scoliosis with a mean largest Cobb of 60 degrees , completed both questionnaires at a mean of 9.25 years after surgery. RESULTS: The predictability of the SRS-22 Mental Health domain is excellent using the SF-36 Mental Health domain, from which it was adapted (R2 = 0.81). The SRS-22 Pain domain predictability using the SF-36 Bodily Pain domain is also excellent (R2 = 0.79). The SRS-22 Function domain predictability using the SF-36 Physical Component Summary domain is good (R2 = 0.64). The SRS-22 Self-Image and Management Satisfaction/Dissatisfaction domains are poorly predicted by the SF-36 General Health and Physical Component Summary domains, respectively, R2 = 0.52 and 0.54. CONCLUSION: SRS-22 Mental Health and Pain domain scores can be accurately calculated from correlating SF-36 domain scores. SRS-22 Function scores can be fairly well predicted from correlated SF-36 domain scores. Self-Image and Management Satisfaction/Dissatisfaction domain scores cannot be approximated from SF-36 domain scores.

Adolescent↗
PubMed2006

Trunk rotational strength training for the management of adolescent idiopathic scoliosis (AIS).

Quantified trunk rotational strength training has shown promise as a non-operative management option for individuals with AIS. The purposes of our study are to test whether a quantified trunk rotational strength training protocol can increase trunk strength and stabilize or decrease curve size. Seven adolescents with AIS (5 female 2 male; mean 14 yrs +/- 2.6 yrs; mean Cobb 28 degrees +/- 6 degrees range 20 degrees -37 degrees) underwent four months of supervised trunk rotational strength training, and repeat strength test. Trunk strength in both directions increased significantly after training (p<0.05). Average Cobb angle decreased to 23 degrees +/- 11 degrees (range 6 degrees -35 degrees). Four individuals showed reduction (>5 degrees) in their original curve, and 3 remained the same (+/-5 degrees). The strength training protocol significantly increased isometric rotational strength and scoliosis was stabilized short term.

Adolescent↗
PubMed2006

Correction of the angle of trunk inclination utilizing apical wiring techniques and concave rib osteotomy in adolescent idiopathic thoracic scoliosis.

Improving the angle of trunk inclination (ATI) is important for achieving optimum clinical deformity correction in adolescent idiopathic scoliosis. Three concave apical implant techniques were reviewed in combination with the use of concave rib osteotomies. Rib osteotomy improved the ATI correction significantly when using apical wiring techniques.

Adolescent↗
PubMed2006

Comparison of isometric trunk rotational strength of adolescents with idiopathic scoliosis to healthy adolescents.

Trunk rotational strength asymmetry has been suggested in adolescents with idiopathic scoliosis (IS), but is unconfirmed. The sitting isometric trunk rotational strength, at neutral and 18 degrees or 36 degrees of right or left pre-rotation, of a group of healthy adolescent females (CG), n=12, is compared with a group of female adolescents with IS (ISG), n= 14. Torque values were normalized to lean body weight. There is a significant weakness when rotating towards the concavity found in patients with AIS at the 36 lo (p 0.07 marginal), 18 lo (p<0.03) and neutral positions (p<0.02), with no side strength asymmetry found in a cohort of healthy adolescents without AIS.

Adolescent↗
PubMed2005

Estimation of transverse plane pelvic rotation using a posterior-anterior radiograph.

STUDY DESIGN: Experimental and analytical study of transverse plane pelvic rotation. OBJECTIVES: To determine how pelvic rotation projected onto the transverse plane relates to coronal plane anatomic landmark location. SUMMARY OF BACKGROUND DATA: Current spine deformity instrumentation may be used to apply transverse plane loads to the spine that may be transmitted to regions not included in the instrumentation, including the pelvis. METHODS: An anatomically correct, sawbones model of an adult female pelvis was marked with lead shot at prominent radiographic landmarks, rotated at different angles in the sagittal, transverse, and coronal planes, and left/right (L/R) ratios of the medial-lateral distances between similar landmarks determined. An analytical equation was also derived to determine the degree of rotation in the transverse plane, using medial-lateral and anterior-posterior distances between same landmarks. RESULTS: The L/R ratio for the coronal plane distance between the inferior ilium at the sacro iliac joint (SI) and anterior superior iliac spine (ASIS), the SI-ASIS measurement, proved the most reliable of the four ratios studied to determine the extent of pelvic rotation in the transverse plane. Assuming the pelvis is symmetric, the most important factor is location of the compared landmarks. A long distance between the landmarks in both the coronal and transverse plane and a large angle between the line joining the two landmarks and the coronal plane of the pelvis, as viewed in the transverse plane, are best. Transverse plane pelvic rotation up to 20 degrees is accurately reflected nearly linearly by L/R SI-ASIS ratios. CONCLUSIONS: Bony pelvis landmarks visible on coronal plane radiographs can be used to estimate transverse plane pelvic rotation, but precise conversion to degrees rotation requires additional information on specific patient pelvic morphology.

Adult↗
PubMed2004

Safety and efficacy of Isola instrumentation and arthrodesis for adolescent idiopathic scoliosis: two- to 12-year follow-up.

STUDY DESIGN: Retrospective case series including patient outcome assessment. OBJECTIVE: To study the safety and efficacy of Isola instrumentation in comparison with similar series. SUMMARY OF BACKGROUND DATA: Both the technique and technology used in the surgical treatment of adolescent idiopathic scoliosis continue to evolve, the common theme since the 1980s being provision of instrumentation stable and strong enough to eliminate the need for postoperative immobilization. The purpose of this study is to determine the safety and efficacy of a system deliberately integrating hook, wire, and screw anchors to deliver torsional and countertorsional corrective loads. METHODS: A total of 185 consecutive patients, index patient included, were treated by posterior instrumentation and arthrodesis from January 1989 through December 2000. Safety was studied by complications, and reoperation type and occurrence. Effectiveness was studied by deformity correction and health-related quality of life questionnaire response. Variables affecting effectiveness were sought. A total of 179 patients (97%) had outcome assessment at an average of 6 years postoperative, and 176 had radiographic evaluation at an average of 5 years postoperative. RESULTS: There were no deaths, spinal cord or nerve root problems, or acute posterior wound infections. Proven pseudarthrosis occurred in 4 patients (2.2%) and delayed deep wound infection in 2 patients (1.1%). The implant-related reoperation rate was 8% and was necessary more often in the first quarter of the series (17% vs. 4.6%, P = 0.0062). The largest Cobb angle averaged 62 degrees preoperative and 23 degrees at latest follow-up, 63% correction. The largest angle of trunk inclination averaged 16.7 degrees before surgery and 9.9 degrees at latest follow-up, a 39% correction (P < 0.0001). Eighty-eight percent of patients were satisfied or very satisfied with the outcome. The principal problems identified were the need for a stronger transverse connector, stable end-instrumented vertebrae foundations, and convex thoracic anchorage. CONCLUSIONS: Isola instrumentation seems to be at least as safe and effective as other instrumentations being used for the surgical treatment of adolescent idiopathic scoliosis.

Adolescent↗
PubMed2004

Maintenance of trunk deformity correction following posterior instrumentation and arthrodesis for idiopathic scoliosis.

STUDY DESIGN: This is a retrospective observational case series. OBJECTIVES: To determine whether or not trunk deformity correction is achieved and maintained using the surgical techniques described. SUMMARY OF BACKGROUND DATA: Transverse plane trunk deformity correction and correction maintenance have been questioned. METHODS: The study group of 44 patients (40 female, 4 male) had a mean age of 16.1 years (range 10-38 years). Thirty-three had thoracic and 11 had a double curve pattern with a mean largest preoperative curve of 65 degrees. All had preoperative and follow-up at a median of 25 months (range 20-69 months); surface topography exposures quantified for both the coronal plane, as determined by the Posterior Trunk Symmetry Index, and transverse plane, as determined by the Suzuki Hump Sum, asymmetry. Thirty-four also had early postoperative studies. Change following surgery was determined by the signed rank test, with P < 0.01 being significant. RESULTS: Preoperative to latest follow-up largest Cobb angles had improved from a mean of 65 degrees to 23 degrees (65%, P < 0.0001), Posterior Trunk Symmetry Index from 55 to 20 (64%) (P < 0.0001), and Suzuki Hump Sum from 20 to 12 (40%) (P < 0.0001). Posterior Trunk Symmetry Index improved during the follow-up from 26 to 20 (23%) (P = 0.007). Neither Cobb nor Suzuki Hump Sum further improved or deteriorated during follow-up. CONCLUSION: These findings validate the concepts of torsional posterior spinal instrumentation and wide-thick arthrodesis to provide significant and lasting coronal and transverse plane trunk deformity correction.

Adolescent↗
PubMed2004

The influence of spine and trunk deformity on preoperative idiopathic scoliosis patients' health-related quality of life questionnaire responses.

STUDY DESIGN: Retrospective case series. OBJECTIVES: To determine the influence of spine and trunk deformity on preoperative idiopathic scoliosis patients' health-related quality of life questionnaire responses. SUMMARY OF BACKGROUND DATA: Management recommendations for patients with idiopathic scoliosis during adolescence are based heavily on spine deformity and to some extent trunk deformity magnitude. However, the manner in which these objective measures influence the patients' perception of their condition is unclear. METHODS: Of 67 consecutive preoperative patients, 61 (91%) had completed the Scoliosis Research Society-22 health-related quality of life questionnaire and had been studied with posterior exposure surface topography. Their average age was 15 years, 6 months (range 10 years, 10 months-20 years, 10 months), and the average maximum Cobb was 63 degrees (range 40-137 degrees). Correlations between spine and trunk deformity measures and Scoliosis Research Society-22 scores were determined by the Pearson correlation coefficient, with P < 0.01 considered significant. RESULTS: For the study group, spine deformity (Cobb) correlated significantly only with Scoliosis Research Society-22 function (r = -0.39, P = 0.0022) domain. Neither coronal nor transverse plane trunk deformity composite scores correlated with any Scoliosis Research Society-22 scores. The Hump Index component of the transverse plane Suzuki Hump Sum composite score was the only trunk measurement to correlate significantly (function r = -0.45, P = 0.003; self image, r = -0.36, P = 0.0040). The strongest correlations occurred when the single thoracic curves, King classifications III and IV, were combined: Cobb versus function r = -0.53, P = 0.0027; Cobb versus self-image r = -0.46, P = 0.0099; and Hump Index versus function r = -0.60, P = 0.0005. There were no significant correlations between either spine deformity or any trunk deformity measure with Scoliosis Research Society-22 responses for either the double or thoracolumbar curve pattern groups. CONCLUSION: Both spine and upper thoracic transverse plane trunk deformity significantly influenced preoperative idiopathic scoliosis patients' perception of function and self-image, but not pain or mental health. However, in spite of a fairly rigorous standard of proof, P < or = 0.01, the significant r values ranged from -0.33 to -0.68, suggesting that there are factors other than spine and trunk deformity influencing the idiopathic scoliosis patients' health-related quality of life questionnaire responses. Future studies are necessary to define these factors.

Abdomen↗
PubMed2003

The reliability and concurrent validity of the scoliosis research society-22 patient questionnaire for idiopathic scoliosis.

STUDY DESIGN: Outcome study to determine response distribution, internal consistency, reproducibility, and concurrent validity of the Scoliosis Research Society-22 (SRS-22) health-related quality-of-life (HRQL) questionnaire. OBJECTIVES: Further refinement of an HRQL questionnaire specific for idiopathic scoliosis. SUMMARY OF BACKGROUND DATA: Previous experience with the original and modified SRS HRQL questionnaires suggested a need for further refinement and more complete validation. METHODS: The SRS-22 and Short Form 36 (SF-36) HRQL questionnaires were mailed to 83 previously surveyed postoperative idiopathic scoliosis patients. RESULTS: Fifty-eight (70%) patients returned the first set of questionnaires. Their average age at surgery was 14.6 years, and their average follow-up interval since surgery was 10.8 years. Fifty-one (88%) of the 58 returned the second set of questionnaires an average of 28 days later. The psychometric attributes of the instruments were comparable: score distribution, SRS-22 56.9% ceiling and 1.7% floor, SF-36 79.3% ceiling and 1.7% floor; internal consistency (Cronbach alpha), SRS-22 0.92 to 0.75, SF-36 0.91 to 0.36; and reproducibility (intraclass correlation coefficient), SRS-22 0.96 to 0.85, SF-36 0.92 to 0.61. Concurrent validity, determined by Pearson Correlation Coefficients between SRS-22 and SF-36 domains, was 0.70 or greater ( < 0.0001) for 17 relevant comparisons. CONCLUSION: The SRS-22 HRQL questionnaire is reliable with internal consistency and reproducibility comparable to SF-36. In addition, it demonstrated concurrent validity when compared to SF-36. It is shorter and more focused on the health issues related to idiopathic scoliosis than SF-36.

Adolescent↗
PubMed2003

Scoliosis research society-22 patient questionnaire: responsiveness to change associated with surgical treatment.

STUDY DESIGN: Prospective observational consecutive case series. OBJECTIVES: To determine the responsiveness to change of the Scoliosis Research Society-22 (SRS-22) patient questionnaire after surgical treatment. SUMMARY OF BACKGROUND DATA: The SRS-22 outcomes questionnaire is the outgrowth of prior research that led to modifications and improvements of the original SRS questionnaire. METHODS: Fifty-eight patients with an average age of 16 years and an average Cobb size of 63 degrees enrolled. They were tested preoperatively and at 3- (within 4 months), 6- (5-8 months), 12- (9-16 months), and 24-month (22-36 months) intervals postoperatively using the SRS-22 outcomes questionnaire. The paired Student test with multiple comparison adjustment was used to test significance of change score over time. Only patients with data on both time points of interest were included in the analysis. RESULTS: Self-image was significantly improved at 3 months ( < 0.0001) and maintained improvement through 24 months. Function was significantly decreased at 3 months ( < 0.0001), but returned to baseline by 6 months. Pain was significantly worse at 3 months ( = 0.0099), but was significantly less at 6 ( = 0.0011), 12 ( < 0.0001), and 24 ( = 0.0037) months when compared to 3 months. CONCLUSION: The SRS-22 questionnaire is responsive to changes in the postsurgical period.

Activities of Daily Living↗
PubMed2003

Discrimination validity of the scoliosis research society-22 patient questionnaire: relationship to idiopathic scoliosis curve pattern and curve size.

STUDY DESIGN: Prospective observational study. OBJECTIVE: To determine the discriminant validity of the Scoliosis Research Society-22 (SRS-22) health-related quality-of-life (HRQL) questionnaire for idiopathic scoliosis patients based on curve pattern and curve size. SUMMARY OF BACKGROUND DATA: An important psychometric attribute of the HRQL questionnaire is the capacity to discriminate between and among patients with differing condition severity. METHOD: Three study groups, with subjects ranging in age from 10 to 16 years, were set up: a control group (C) of 19 persons with scoliosis suspected but unproven with an average age of 13 years; a nonsurgical group (NS) of 68 patients with an average age of 14 years and an average scoliosis (Cobb) of 30 degrees; and a presurgical group (PS) of 32 patients with an average age of 14 years and an average scoliosis of 61 degrees. The NS group was subdivided into untreated (NSU) (n = 54) and braced (NSB) patients (n = 14). Also created were subgroups of the NS and PS groups having similar curve sizes: nonsurgical similar (NSS) and presurgery similar (PSS). Statistical significance of the SRS-22 domain scores by comparison groups was tested by ANOVA. Relationships between the SRS-22 questionnaire and scoliosis deformity measurements were calculated using the Pearson Correlation Coefficients. RESULTS: There were no significant differences between the control (C) and nonsurgical (NS) groups. The presurgical group (PS) scored significantly lower in the pain and self-image domains than the C or NS groups and lower than group C in the mental health domain. A subgroup of the nonsurgical group (NSS) with curves comparable to the presurgical subgroup (PSS) had significantly better self-image scores. There were no significant correlations between SRS-22 scores and curve pattern. For persons with scoliosis, curve size (Cobb) correlated with pain, self-image, and function; trunk asymmetry correlated with self-image. CONCLUSION: The SRS-22 HRQL questionnaire successfully discriminated among persons with no scoliosis or moderate scoliosis and large scoliosis. It did not discriminate among patients with single, double, or triple curves. Self-image and, to a lesser extent, pain and function domain scores correlated with radiographic and trunk asymmetry severity. The SRS-22 HRQL questionnaire may be useful in choosing nonsurgical versus surgical treatment in borderline cases.

Adolescent↗
PubMed2002

Transverse plane pelvic rotation measurement.

AIM: To determine how pelvic rotation in the transverse plane relates to coronal plane anatomical landmark location. The problem this addresses is the observation that iliac crest medial lateral width as seen in the coronal plane Cobb is often asymmetrical in patients with idiopathic scoliosis before treatment, and sometimes after treatment. MATERIALS AND METHODS: A pelvis was marked with radiographically opaque markers at symmetrical sites in the ilium, sacrum and acetabulum; mounted in a jig; and radiographed at varying degrees of transverse and sagittal plane angulation. The medial lateral distance from two similar landmarks on opposite sides of the pelvis was then determined and a left/right ratio correlated with the degrees of transverse plane angulation. In addition, a theoretically derived equation was developed to describe the effect of pelvic shape on the degree of transverse plane rotation. RESULTS: The left/right ratio for the distance from the sacro iliac joint to the anterior superior iliac spine proved to be the most reliable for determining the degree of pelvic rotation in the transverse plane. The relationship is nearly linear up to 25 rotation and is little influenced by the degree of sagittal plane angulation. Based on theoretical considerations, the importance of the anterior to posterior angular relationship of the two coronal plane landmarks measured influences the degree of rotation but not the linear relationship. CONCLUSION: Within limits the transverse plane rotation of the pelvis can be determined by a left/right ratio of the distances between two similar landmarks on each side of the pelvis.

Acetabulum↗
PubMed2002

Spine deformity correlates better than trunk deformity with idiopathic scoliosis patients' quality of life questionnaire responses.

AIM: To determine whether either spine or trunk deformity measurements correlate with patients quality of life questionnaire responses. MATERIALS AND METHODS: Forty five pre operative patients (5M, 40F), average age 15 years, 9 months (range, 10-20) met the inclusion criteria of age (< or = 20 years), Posterior Trunk Symmetry Index (POTSI) and Suzuki Hump Sum (SHS) determination from surface topography, and Scoliosis Research Society-22 (SRS-22)patient questionnaire completion. Average measurement and measurement ranges were largest Cobb 62 degrees (range, 40-137 degrees), POTSI 49 (range, 17-149), SHS 16 (5-32), and SRS-22 subtotal score 3.86 (range, 4.7-2.35). The individual SRS-22 domain scores were function 4.13 (4.80-2.20), pain 4.01 (5-1.60), self image 3.34 (4.4-1.80) and mental health 4.01 (5-1.80). (Scale 5 Best-1 Worst). Correlations between deformity and questionnaire measurements were determined, p<0.01 considered significant. RESULTS: Spine deformity (Cobb) correlated with the SRS-22 subtotal scores (cc-04207, p<0.005) and with the function and self image SRS-22 domain scores: cc0.5182, p<0.001) and cc-0.3981, p<0.01 respectively. Neither trunk deformity score correlated with the SRS-22 Score: POTSI versus SRS-22 (cc 0.0449, ns) and SHS versus SRS-22 (cc-0.0311, ns) CONCLUSION: Spine deformity correlates well with quality of life questionnaire responses whereas trunk deformity magnitude does not. This is somewhat surprising as it is the trunk deformity that the patient can they themselves see. These findings illustrate the pitfalls of assuming what is important to the patient based on clinical measurements.

Adolescent↗
PubMed2002

Trunk deformity correction stability following posterior instrumentation and arthrodesis for idiopathic scoliosis.

AIM: To determine whether trunk deformity correction is stable over time. MATERIALS AND METHODS: Thirty-seven patients (5M, 32 F) average age 16 years, 3 months (range, 10 to 38) met inclusion crieteria of primary posterios instrumentation (ISOLA) and arthrodesis with x-ray and surface topography measurements [Posterior Trunk Symmetry Index (POTSI)] and [Suzuki Hump Sum (SHS)] pre-operatively and at 2 years follow up. For 30 patients measurements were also available post-operatively. Patient's average pre, post, and two-year measurements were: Largst Cobb 65 degrees (+/- 12), 21 degrees (+/- 8), and 21 degrees (+/- 17); POTSI 53 (+/- 29), 28 (+/- 12); and 22 degrees (+/- 10); and SHS 18 (+/- 11), 12 (+/- 7), and 12 (+/- 7), and 12 (+/- 6). Statistical analysis was done with the sign test, comparing only patients with data at the intervals studied. Surface topography measurements were considered to be unchanged/tied unless they increased or decreased by more than 8 for POTSI and 3.5 for SHS, Significance was set at p<0.05. RESULTS: POTSI changes were pre-to post operative: 20 improved (I), 3 worsened (W), and 7 tied (T) (p<0.01): pre to two years: 30 (I), 4 (W), and 3 (T) (p<0.01): and from post to two years: 14 (I), 3 (W) and 13 (T) (p<0.01). SHS changes were pre to post to two years: 18 (I), 2 (W), and 11 (T) (p<0.01); pre to two years: 23 (I), 2 (W), and 11 (T) (p<0.01); ad post to two years: 4(I), 6 (W), and 20 T (ns). CONCLUSION: Trunk deformity improvement following surgery is stable or improved over time with surgical techniques utilized.

Adolescent↗