Andrew Haig

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Fazlollah Ghofranipour

Tarbiat Modares University

Gary Goldberg

Virginia Commonwealth University

Paulo Azevedo

Universidade Federal de São Paulo (UNIFESP)

Pavel Uspenskij

National Research University Higher School of Economics

Canan Coşkan

Université libre de Bruxelles

Alessandro Silvestri

Università degli Studi di Salerno

rudolph bauer

Washington Center for Consciousness Studies

Antonio Salvatore Romano

Pontificia Facoltà Teologica dell'Italia Meridionale

Antonio Alvarez-Ossorio Alvariño

Universidad Autónoma de Madrid

Joyce Mothabeng

University of Pretoria

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Papers by Andrew Haig

Poster 153 Inter-Rater Reliability of Physiatrists in Diagnosing Neurogenic Claudication Under an Unconstrained Clinical Situation

by Anne Hartigan and Andrew Haig

PM&R, 2012

Spinal Cord Injury Management and Rehabilitation: Highlights and Shortcomings From the 2005 Earthquake in Pakistan

by Andrew Haig, Peter New, and Farooq A Rathore

Archives of Physical Medicine and Rehabilitation, 2008

Rathore FA, Farooq F, Muzammil S, New PW, Ahmad N, Haig AJ. Spinal cord injury management and reh... more

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Relationship between ambulation and obesity in older persons with and without low back pain

International journal of obesity and related metabolic disorders : journal of the International Association for the Study of Obesity, 2004

For obese older persons, ambulation is both functionally important and a means of weight control.... more For obese older persons, ambulation is both functionally important and a means of weight control. The relationship between weight and ambulation is not known in this population. Also, the extent to which pain interferes with ambulation is not studied. To examine the relationship between obesity and ambulation, and to determine the effect of pain and body mass index (BMI) on ambulation in older persons. Retrospective study of 82 older persons, ages 55-79 y, some with no back pain recruited from the community, others with back pain or spinal stenosis recruited from a magnetic resonance imaging (MRI) scanner as part of a larger university study of spinal stenosis. Age, Visual Analog Scales for pain, BMI, patient diagnosis (no pain, mechanical back pain, and spinal stenosis), walking velocity and stride length on a 15-min laboratory ambulation test, and 1-week community ambulation measured with a pedometer (steps, distance, and energy expenditure). BMI had a significant inverse relation...

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The effect of order of testing in functional performance in persons with and without chronic back pain

Journal of occupational rehabilitation, 2003

Batteries of individually standardized physical and functional tests are commonly used to assess ... more Batteries of individually standardized physical and functional tests are commonly used to assess persons with chronic back pain disability. The order of testing may affect performance on later tests. One hundred and fifty patients with > 3 months of back pain disability underwent a multidisciplinary Spine Team Assessment involving Physical Therapy, Occupational Therapy, Pain Psychology, and Vocational Rehabilitation Counselor assessments at a university spine clinic. Seventeen back healthy volunteers performed the physical component of the assessment. For the volunteers the order of testing was randomized to OT tests first or PT test first, with 0.5 h rest between the tests. For patients the order of testing was arbitrarily set by an alternating schedule, with 1 h psychological testing between the two components. For both the patients and volunteers, among the 14 test components, there was no significant difference (p > 0.05) in performance with order of testing. This held tru...

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Lumbosacral radiculopathies: conservative approaches to management

Physical medicine and rehabilitation clinics of North America, 2002

The prevalence of sciatica in Western society and its economic and functional impact make it an i... more The prevalence of sciatica in Western society and its economic and functional impact make it an important problem to understand for treatment. Such understanding will impact greatly both medical management and decisions regarding activity, which could affect the perceived disability and financial dependence of a patient. This knowledge could be used to direct primary prevention, patient education, and future research efforts in back pain. The article also discusses that such strategies could improve health, decrease disability, and rein in costs.

Prospective Evidence for Change in Paraspinal Muscle Activity after Herniated Nucleus Pulposus

Spine, 1993

ABSTRACT

A case study of unusual benign osseous lesion of the L5 lamina

Journal of back and musculoskeletal rehabilitation, 2014

The differential diagnosis of benign-appearing posterior element lesions is complex. To explore t... more The differential diagnosis of benign-appearing posterior element lesions is complex. To explore the etiology of an unusual benign lesion found on the lamina of L5 described in a case report. Case report. The patient's medical, surgical and imaging histories as well as medical literature were reviewed. A 35-year old male complained of low back pain radiating to both legs for 5 months. Abdominal CT scan 1 year prior as well as post symptom-onset CT and MRI showed a well-corticated lesion lateral to the spinous process of L5. After failed rehabilitation and injection, operation revealed normal cortical bone. Pain was not markedly relieved post-operatively. The pre-surgical differential diagnosis of this lesion included osteosarcoma and osteoid osteoma, however benign pathological results suggest the possibility of atypical spina bifida occulta, Baastrup changes, atypical sacralization of L5, or a resolved fracture with heterotopic ossification.

Musculoskeletal, Neurologic, and Cardiopulmonary Aspects of Physical Rehabilitation in Patients with Chronic Graft-versus-Host Disease

Biology of Blood and Marrow Transplantation, 2014

Chronic graft-versus-host disease (cGVHD) has the potential to cause significant morbidity and mo... more Chronic graft-versus-host disease (cGVHD) has the potential to cause significant morbidity and mortality in people who undergo allogeneic hematopoietic stem cell transplantation. Management of complications due to cGVHD can be challenging because of multiorgan involvement and variable presentation of the disease. This paper outlines the diagnosis and management of musculoskeletal, neurologic, and cardiopulmonary manifestations of cGVHD that have the potential to cause profound functional impairment and that may significantly impact quality of life and lifespan. Expert evaluation by a physical medicine and rehabilitation physician and multidisciplinary team may be beneficial in the treatment of the disease sequelae, and examples of specific rehabilitation interventions are described.

Endurance Training of Trunk Extensor Muscles

Background and purpose. The purpose of this study was to assess the effects of an endurance exerc... more Background and purpose. The purpose of this study was to assess the effects of an endurance exercise protocol on the isometric holding time of the trunk exten- sor muscles (mechanical fatigue measure) and on the recorded median frequency (MF) measurements from the suqace electromyogram @hysiological fatigue mea- sure). SuMects. Twenty-eight healthy female volunteers were selected to partici- pate in the

Predicting outcomes of transforaminal epidural injections for sciatica*1

The Spine Journal, 2003

Previous studies on epidural injections have focused on efficacy and have not evaluated factors p... more Previous studies on epidural injections have focused on efficacy and have not evaluated factors predicting outcomes of epidural injections. To determine which patient factors are associated with transforaminal epidural injection outcomes for sciatica. Cross-sectional study design at a university spine center. Consecutive patients with sciatica who have had an electromyography study and a transforaminal epidural injection between January 1999 and July 2001. The outcome variable was a composite score of the patients&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; pain severity and medication use compared with their initial visit. Independent variables included demographics, previous back surgery, pain severity at initial presentation, pain medication use at initial presentation, litigation, having Social Security Disability Insurance (SSDI) or workers&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; compensation, electromyography results. Medical information was gathered on the variables listed above. Seventy-six patients, mean age 50.4 years and 49% female, participated. At a mean follow-up of 122 days (SD 146.3), 35 (47%) were improved, 21 (28% were unchanged) and 12 (16%) were worse. Initial correlation analysis showed some relationship between outcomes and having SSDI or workers&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; compensation (R=.43, p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;.001), lifting requirements at work (R=.44, p=.002), working status (R=-.31, p=.02), and electromyogram evidence of radiculopathy (R=-.25, p=.04). Regression analysis showed that having SSDI or workers&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; compensation was the primary factor associated with worse outcomes. When controlled for SSDI/workers&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; compensation, lifting requirements at work, but not working status and radiculopathy, also were associated with outcomes but the association was not as strong. This paper brings into question the utility of offering epidural injections to patients who are on SSDI/workers&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; compensation and require heavy lifting at work.

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The bent spine syndrome: myopathy + biomechanics = symptoms

The Spine Journal, 2006

The bent spine syndrome, which mimics spinal stenosis, is thought to be a focal paraspinal myopat... more The bent spine syndrome, which mimics spinal stenosis, is thought to be a focal paraspinal myopathy, but because paraspinal fatigue with ambulation is not a feature of more severe myopathies, the cause of symptoms is not clear. To evaluate electromyographic and biomechanical aspects of the bent spine syndrome. University spine clinic. A patient with severe disability from the bent spine syndrome was compared with a fortuitously discovered asymptomatic research subject with the syndrome, in terms of physical examination, magnetic resonance imaging, and electrodiagnostic testing. Both subjects had fatty paraspinal replacement on magnetic resonance imaging and electromyography. More detailed electromyography of the patient showed abnormalities medially and caudally, but changes including apparent myopathic motor units up to the high thoracic region. The research subject had no hip flexion contracture, whereas the patient had severe contracture. Correction of contracture increased ambulation from 20 to 300 meters. Bent spine syndrome is likely a paraspinal myopathy, but symptoms do not occur unless there is also a hip flexion contracture.

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Re: Fazal A, Yoo A, Bendo JA. Does the presence of the nerve root sedimentation sign on MRI correlate with the operative level in patients undergoing posterior lumbar decompression for lumbar stenosis? Spine J 2013;13:837–42

The Spine Journal, 2014

The Relation Among Spinal Geometry on MRI, Paraspinal Electromyographic Abnormalities, and Age in Persons Referred for Electrodiagnostic Testing of Low Back Symptoms

Spine, 2002

A retrospective EMG study with blinded radiologic measurement was conducted. To determine the rel... more A retrospective EMG study with blinded radiologic measurement was conducted. To determine the relation among spinal measurements on MRI, paraspinal denervation, and age in patients referred for electrodiagnostic and radiologic evaluation of low back pain. Spinal pathology, including disc herniation and spinal stenosis, can cause denervation of the paraspinal muscles. Various mechanisms including direct compression, inflammation, vascular compromise, and mechanical stretch of the posterior primary ramus may play a role in denervation. The relation between the amount of denervation and the size of the spinal canal can assist in understanding the pathophysiology of back pain. Since paraspinal denervation may increase with age in asymptomatic persons, age is an important covariable. At a university hospital, 44 patients referred to undergo both electrodiagnostic evaluation and MRI for low back pain were studied. The study investigated the relation among the following: 1) axial MRI spinal measurements (canal transverse diameter, anteroposterior diameter, and area; thecal sac anteroposterior diameter and area; and the radiologist&amp;amp;amp;amp;#39;s overall impression at each level) and denervation measurements in terms of scores on the MiniPM, a quantified needle electromyographic measure of paraspinal denervation; 2) various models of multilevel spinal compression (smallest, smallest two, and average spinal levels for each measurement) and MiniPM scores; and 3) MRI spinal canal measurements and age. Although individual MRI measurements and combinations of measurements did not relate to MiniPM scores, the radiologist&amp;amp;amp;amp;#39;s impression was significantly related. The &amp;amp;amp;amp;quot;smallest two&amp;amp;amp;amp;quot; levels measurement had the strongest relation (r = 0.400; P &amp;amp;amp;amp;lt; 0.007). Age related to the MiniPM scores (P = 0.004) and radiologic impression (P = 0.031). A regression suggested that MiniPM was an independent predictor of age. The radiologist&amp;amp;amp;amp;#39;s overall impression is more accurate than axial image measurements in predicting paraspinal denervation. A combination score of the smallest two levels is the most accurate, perhaps relating to the vascular pathophysiology of stenosis. There is more denervation with increasing age in this symptomatic population.

Predictors of Pain and Function in Persons With Spinal Stenosis, Low Back Pain, and No Back Pain

by Andrew Haig and Jennifer Miner

Spine, 2006

Longitudinal masked, double-controlled cohort study. To determine prognosis and predictors of fun... more Longitudinal masked, double-controlled cohort study. To determine prognosis and predictors of function and pain in persons with spinal stenosis. The clinical syndrome of spinal stenosis is common and disabling, but not clearly related to anatomic measures. Prognosis not well studied. Persons 55 to 80 years of age with and without stenosis on preliminary review of magnetic resonance imaging (MRI), and asymptomatic volunteers underwent screening, questionnaires, physical examination, ambulation testing, masked electromyogram (EMG), and masked MRI scans; these were repeated at &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;18 months. Twenty-three asymptomatic, 28 back pain, and 32 clinically diagnosed stenosis subjects underwent follow-up. Although initial and follow-up diagnosis tended to agree (kappa = 0.394, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 001), there were substantial shifts between the three groups. Among persons with clinically diagnosed stenosis, every measure trended for improvement, including significant changes in pain, ambulation, and EMG. Ambulation velocity and Pain Disability Index at follow-up were predicted by initial disability measures. Pain was predicted by initial sleep difficulty but not initial pain. EMG and MRI did not predict function or pain. Clinically recognized spinal stenosis is fluctuating and largely improving, and in continuum with back pain and no symptoms. Since anatomic and neurologic deficits do not predict future function, they should not be weighed heavily in surgical risk-benefit discussions.

The Sensitivity and Specificity of Electrodiagnostic Testing for the Clinical Syndrome of Lumbar Spinal Stenosis

by Andrew Haig and Jennifer Miner

Spine, 2005

Prospective, masked, double controlled diagnostic trial. To determine the sensitivity and specifi... more Prospective, masked, double controlled diagnostic trial. To determine the sensitivity and specificity of electrodiagnostic consultation (EDX) for the clinical syndrome of lumbar spinal stenosis. EDX has been used for more than 50 years to diagnose spinal disorders but has not met the new standards of evidence-based medicine. A total of 150 subjects (asymptomatic volunteers and patients with MRIs suggesting back pain or spinal stenosis; 55-80 years of age) underwent physiatrist history and physical examination, MRI, and review of this data by a neurosurgeon, with each clinician masked to any outside information, leading to a unanimous consensus on diagnosis in 55. After masked EDX testing, 7 subjects with undiagnosed neuromuscular disease were discovered. EDX findings were related to &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;clinical gold standard&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; diagnoses in 48 persons. Paraspinal mapping EMG score of &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;4 had 100% specificity and 30% sensitivity for stenosis compared with either the back pain or asymptomatic groups (each, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.04). A composite limb and paraspinal fibrillation score had a sensitivity of 47.8% and specificity of 87.5% (P = 0.008), and H-wave sensitivity was 36.4, specificity 91.3 (P = 0.026) for stenosis versus all controls. This first masked study in the 60-year history of needle electromyography also introduces anatomically validated needle placement, quantified and reproducible examination of the paraspinal muscles, and dual control populations to EDX research in spinal disorders. EDX has statistically significant, clinically meaningful specificity for spinal stenosis and detects neuromuscular diseases that may masquerade as stenosis.

Epidemiology of spinal cord injuries in the 2005 Pakistan earthquake

Spinal Cord, 2007

Study design: Prospective observational study. Objectives: To identify the epidemiological featur... more Study design: Prospective observational study. Objectives: To identify the epidemiological features specific to spinal injuries as a result of an earthquake. Settings: Rawalpindi, Pakistan in the months after the 8 October 2005 earthquake. Methods: In the month after the earthquake, the one established rehabilitation center was augmented with two makeshift spinal cord centers. Information on mechanism of injury, mode of evacuation, associated injuries was gathered, and a detailed clinical and radiological assessment was performed. Neurological status and functional outcome was determined after 10 weeks. Results: Of an estimated 650-750 spinal cord injuries, 187 were admitted to these centers, including 80 men and 107 women with a mean age of 28.3712.4 years. Injuries occurred while standing in 57.8% of patients. Most (83.4%) who reached the spinal cord center were airlifted. A urinary catheter had been placed before admission in 91.5%. Most of the patients were paraplegic 89.3, with 50.8% incomplete injuries. Fracture or fracture dislocation was present in 70, and 75% underwent spinal fixation. Although pressure ulcers (28.9%) and urinary tract infections (39%) were common, deep venous thromboses (4.8%) and depression (5.8%) were seldom detected. At 10 weeks, 75% were continent or performing intermittent catheterization. There were no deaths and two births. Conclusion: After a disaster, evacuation of persons with a spinal cord injury to a specialized center results in low mortality. Response planning for disasters should include early aggressive medical rehabilitation. Sponsorship: None.

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A technique for needle localization in paraspinal muscles with cadaveric confirmation

Muscle & Nerve, 1991

lnvasive electromyography (EMG) of the paraspinal muscles is useful in clinical and research sett... more lnvasive electromyography (EMG) of the paraspinal muscles is useful in clinical and research settings. No technique for localization of the needle in specific fascicles has been validated. Recent descriptions of the segmented innervation of the multifidus imply that such a technique would add greatly to the EMG determination of root level of a radiculopathy. We have developed a technique for localization which relies on palpation of bony structures and needle insertion at certain angles and depths. The technique was evaluated by injecting latex dye in 199 locations in 13 cadavers. Dissection demonstrated that the technique was accurate in 91 of 11 2 injections into specific fascicles of the multifidus (originating from different spinous processes), 39 of 43 injections into the longissimus, and 35 of 44 injections into the iliocostalis. Certain types of errors would not have occurred with the aid of EMG in vivo. When these are added to the correct injections, accuracy improves 97%, 93'30, and 82%, respectively. The technique described here should be useful for kinesiological studies, biopsies and injections, as well as for the EMG confirmation of a radiculopathy.

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Paraspinal mapping: Quantified needle electromyography in lumbar radiculopathy

Muscle & Nerve, 1993

In the diagnosis of low back pain, the presence of a high percentage of false positive findings o... more In the diagnosis of low back pain, the presence of a high percentage of false positive findings on radiologic imaging studies has lead to a more definitive role for electrodiagnosis as a confirmatory test. The paraspinal muscles are a crucial part of the electrodiagnostic examination for radiculopathy. To date, no technique for paraspinal evaluation has been validated. Based on previously documented anatomical techniques, we have designed a method of paraspinal examination termed "paraspinal mapping" (PM). Electromyographic (EMG) needles are placed in five carefully chosen locations and inserted in multiple directions. Individual scores for these insertions are added to determine a total PM sensitivity score. The first 50 studies using PM were compared to peripheral EMG, imaging studies, and pain drawings. Results indicate that the technique is easy to perform. Sensitivity scores relate well with these tests. In this limited and uncontrolled population, PM had higher sensitivity for abnormalities than either peripheral EMG or imaging studies. Because of the anatomical validity of PM, future studies may show it to be useful in localizing the level of radiculopathy independently from peripheral EMG, and to support clinical findings and imaging studies. 0

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Technology review: The Neurometer� current perception threshold (CPT)

Muscle & Nerve, 1999

CPT is a device for evaluating and quantifying sensory function which has been available in the m... more CPT is a device for evaluating and quantifying sensory function which has been available in the medical market place for some years. The AAEM is currently undertaking a review of the general topic of quantitative sensory testing (QST), and technology reviews of other specific methodologies and instruments are anticipated in the future. The Neurometer ® CPT is a transcutaneous electrical

Cross-cultural adaption of the manniche questionnaire for german-speaking low back pain patients

by Michael Quittan and Andrew Haig

Journal of Rehabilitation Medicine, 2004

Objective: To develop and validate a cross-cultural version of the Manniche Low Back Pain Rating ... more Objective: To develop and validate a cross-cultural version of the Manniche Low Back Pain Rating Scale (MRS) for use in German-speaking low back pain patients. Background: Clinical intervention research in back pain would be enormously facilitated if a small number of relevant, patient-centred questionnaires became internationally used. MRS seems to be particularly suitable for crosscultural adaptation due to its coverage of multidimensional back pain-specific health domains. Methods: MRS was translated and back-translated, pretested and reviewed by a committee. The German version was tested in 126 patients with low back pain from all countries of German-speaking Europe. Reliability (subsample n = 20), dimensionality and construct validity was assessed. Single-dimensionality, higher correlations of MRS with the physical scales compared with the mental scales of the MOS SF-36, a moderate to good correlation with the Roland Morris Questionnaire and a low correlation with the Finger Floor Distance were hypothesized. Results: Spearman's Rho for test-retest reliability was 0.98 (p < 0.001); Cronbach's alpha 0.95. Factor analysis revealed only 1 factor with an Eigenvalue >1 [3.25]. MRS was strongly correlated with the Roland Morris Questionnaire (r = 0.91), and slightly correlated with the Finger Floor Distance (r = 0.23).

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Poster 153 Inter-Rater Reliability of Physiatrists in Diagnosing Neurogenic Claudication Under an Unconstrained Clinical Situation

by Anne Hartigan and Andrew Haig

PM&R, 2012

Spinal Cord Injury Management and Rehabilitation: Highlights and Shortcomings From the 2005 Earthquake in Pakistan

by Andrew Haig, Peter New, and Farooq A Rathore

Archives of Physical Medicine and Rehabilitation, 2008

Rathore FA, Farooq F, Muzammil S, New PW, Ahmad N, Haig AJ. Spinal cord injury management and reh... more

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Relationship between ambulation and obesity in older persons with and without low back pain

International journal of obesity and related metabolic disorders : journal of the International Association for the Study of Obesity, 2004

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