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Xiao Y, Zhu C, Xiu P, Wang L, Zhang Z, Deng Z, Song Y, Yang X. Postoperative Sclerotic Modic Changes After Transforaminal Lumbar Interbody Fusion: The Prevalence, Risk Factors, and Impact on Fusion. Spine (Phila Pa 1976) 2024; 49:E135-E141. [PMID: 38031447 DOI: 10.1097/brs.0000000000004890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 11/21/2023] [Indexed: 12/01/2023]
Abstract
STUDY DESIGN A retrospective cohort study. OBJECTIVE This study aimed to assess postoperative sclerotic modic changes (MCs) following transforaminal lumbar interbody fusion for lumbar degenerative disc disease, investigating their prevalence, risk factors, and association with clinical outcomes. SUMMARY OF BACKGROUND DATA Sclerotic MCs may occur in patients with lumbar degenerative disc disease after lumbar interbody fusion. The incidence and characteristics of postoperative sclerotic MCs, as well as their clinical impact, are unknown. MATERIALS AND METHODS The study included 467 patients (510 levels) who underwent single or two-level transforaminal lumbar interbody fusion surgery, divided into a postoperative sclerotic MC group (60 patients, 66 levels) and a non-MC group (407 patients, 444 levels). The time of development and location of postoperative sclerotic MCs, fusion rate, cage subsidence, bilateral process decompression, and cross-link usage were recorded. Preoperative, postoperative, and follow-up visual analogue scale and Oswestry disability index scores were collected. Multivariable logistic regression was used to evaluate factors associated with the development of postoperative sclerotic MCs. RESULTS The prevalence of postoperative sclerotic MCs was 12.8%. The postoperative sclerotic MC group had a higher body mass index (BMI). The postoperative sclerotic MC group demonstrated a fusion rate of 47%, significantly lower than that of the non-MC group (71%) at six months post-operation. At final follow-up, the fusion rate in the postoperative sclerotic MC group was 62%, significantly lower than that of the non-MC group (86%). Postoperative visual analogue scale and Oswestry disability index scores were significantly higher in the group with postoperative sclerotic MCs. BMI and osteoporosis were significantly associated with the development of postoperative sclerotic MCs. CONCLUSION Postoperative sclerotic MCs generally appear within the first year after surgery, with a prevalence of 12.8%. The presence of postoperative sclerotic MCs can adversely impact postoperative outcomes. To prevent postoperative sclerotic MCs, the authors postulate extending the immobilization period with external bracing and improving the management of BMI and osteoporosis in the perioperative time window.
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Affiliation(s)
- Yang Xiao
- Department of Orthopaedic, Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
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Gruneisen E, Kremer R, Duque G. Fat as a Friend or Foe of the Bone. Curr Osteoporos Rep 2024; 22:245-256. [PMID: 38416274 DOI: 10.1007/s11914-024-00864-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/12/2024] [Indexed: 02/29/2024]
Abstract
PURPOSE OF REVIEW The objective of this review is to summarize the literature on the prevalence and diagnosis of obesity and its metabolic profile, including bone metabolism, focusing on the main inflammatory and turnover bone mediators that better characterize metabolically healthy obesity phenotype, and to summarize the therapeutic interventions for obesity with their effects on bone health. RECENT FINDINGS Osteoporosis and fracture risk not only increase with age and menopause but also with metabolic diseases, such as diabetes mellitus. Thus, patients with high BMI may have a higher bone fragility and fracture risk. However, some obese individuals with healthy metabolic profiles seem to be less at risk of bone fracture. Obesity has become an alarming disease with growing prevalence and multiple metabolic comorbidities, resulting in a significant burden on healthcare and increased mortality. The imbalance between increased food ingestion and decreased energy expenditure leads to pathological adipose tissue distribution and function, with increased secretion of proinflammatory markers and harmful consequences for body tissues, including bone tissue. However, some obese individuals seem to have a healthy metabolic profile and may not develop cardiometabolic disease during their lives. This healthy metabolic profile also benefits bone turnover and is associated with lower fracture risk.
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Affiliation(s)
- Elodie Gruneisen
- Division of Endocrinology & Metabolism, Department of Medicine, McGill University Health Centre, Montréal, QC, Canada
| | - Richard Kremer
- Division of Endocrinology & Metabolism, Department of Medicine, McGill University Health Centre, Montréal, QC, Canada
- Bone, Muscle & Geroscience Group, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Gustavo Duque
- Bone, Muscle & Geroscience Group, Research Institute of the McGill University Health Centre, Montreal, QC, Canada.
- Dr. Joseph Kaufmann Chair in Geriatric Medicine, Department of Medicine, McGill University, Montreal, QC, Canada.
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Ghezelbash F, Hossein Eskandari A, Robert-Lachaine X, Cao S, Pesteie M, Qiao Z, Shirazi-Adl A, Larivière C. Machine learning applications in spine biomechanics. J Biomech 2024; 166:111967. [PMID: 38388222 DOI: 10.1016/j.jbiomech.2024.111967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 01/21/2024] [Accepted: 01/28/2024] [Indexed: 02/24/2024]
Abstract
Spine biomechanics is at a transformation with the advent and integration of machine learning and computer vision technologies. These novel techniques facilitate the estimation of 3D body shapes, anthropometrics, and kinematics from as simple as a single-camera image, making them more accessible and practical for a diverse range of applications. This study introduces a framework that merges these methodologies with traditional musculoskeletal modeling, enabling comprehensive analysis of spinal biomechanics during complex activities from a single camera. Additionally, we aim to evaluate their performance and limitations in spine biomechanics applications. The real-world applications explored in this study include assessment in workplace lifting, evaluation of whiplash injuries in car accidents, and biomechanical analysis in professional sports. Our results demonstrate potential and limitations of various algorithms in estimating body shape, kinematics, and conducting in-field biomechanical analyses. In industrial settings, the potential to utilize these new technologies for biomechanical risk assessments offers a pathway for preventive measures against back injuries. In sports activities, the proposed framework provides new opportunities for performance optimization, injury prevention, and rehabilitation. The application in forensic domain further underscores the wide-reaching implications of this technology. While certain limitations were identified, particularly in accuracy of predictions, complex interactions, and external load estimation, this study demonstrates their potential for advancement in spine biomechanics, heralding an optimistic future in both research and practical applications.
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Affiliation(s)
- Farshid Ghezelbash
- Division of Applied Mechanics, Department of Mechanical Engineering, Polytechnique Montréal, Canada.
| | - Amir Hossein Eskandari
- Division of Applied Mechanics, Department of Mechanical Engineering, Polytechnique Montréal, Canada; Institut de Recherche Robert Sauvé en Santé et en Sécurité du Travail, Montréal, Canada
| | | | - Shufan Cao
- Department of Mechanical Engineering and Material Science, Duke University, USA
| | - Mehran Pesteie
- Department of Electrical and Computer Engineering, University of British Columbia, Canada
| | - Zhuohua Qiao
- Department of Mechanical Engineering, McGill University, Canada
| | - Aboulfazl Shirazi-Adl
- Division of Applied Mechanics, Department of Mechanical Engineering, Polytechnique Montréal, Canada
| | - Christian Larivière
- Institut de Recherche Robert Sauvé en Santé et en Sécurité du Travail, Montréal, Canada
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Jamnik AA, Datcu AM, Lachmann E, Patibandla SD, Thornberg D, Jo CH, Morris WZ, Ramo B, Johnson M. Repeat surgical interventions following "definitive" instrumentation and fusion for idiopathic scoliosis: a 30-year update. Spine Deform 2024; 12:99-107. [PMID: 37572225 DOI: 10.1007/s43390-023-00742-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 07/22/2023] [Indexed: 08/14/2023]
Abstract
PURPOSE Although spinal fusion (SF) is considered "definitive" treatment in juvenile/adolescent idiopathic scoliosis (JIS/AIS), complications requiring reoperation continue to occur. The purpose of this study was to characterize the evolving rates of reoperation following SF in JIS/AIS. METHODS Single-center retrospective review of patients who underwent SF for JIS/AIS as their index surgical treatment between 2013 and 2019. Patient data were collected to identify complications requiring reoperation and factors associated with reoperation. Complication rates from 2013 to 2019 were compared to patients from 1988 to 2012 at the same institution. RESULTS This study analyzed 934 patients (81.7% female, mean age at surgery 14.5 ± 2.1). Thirty-eight patients (4.1%) required a total of 47 reoperations, a > 50% decrease in overall complication rate from the 2008-2012 population (4.1% vs 9.6%, respectively, p < 0.001). The decrease stemmed mainly from decreases in rates of infection (1.1% vs 4.1%, p < 0.001) and symptomatic implants (0.4% vs 2.1%, p = 0.004). There were, however, non-significant increases in implant failures (0.6% vs 0.2%, p = 0.4367) and pseudoarthrosis (1.0% vs 0.4%, p = 0.5202). Both of these complications were associated with patients with a higher mean weight (implant failure: 70.4 kg ± 21.1 vs 56.1 kg ± 14.9, p = 0.002; pseudoarthrosis: 85.8 kg ± 27.9 vs 55.9 ± 14.5, p = 0.001). CONCLUSIONS Reoperation following SF for JIS/AIS has decreased over the past 7 years when compared to 25 years of historical controls. The changing landscape of reoperation demands further research into the risk factors for those reoperations that have become more common.
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Mohseni M, Zargarzadeh S, Arjmand N. Multi-task artificial neural networks and their extrapolation capabilities to predict full-body 3D human posture during one- and two-handed load-handling activities. J Biomech 2024; 162:111884. [PMID: 38043495 DOI: 10.1016/j.jbiomech.2023.111884] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 11/20/2023] [Accepted: 11/23/2023] [Indexed: 12/05/2023]
Abstract
Machine-learning based human posture-prediction tools can potentially be robust alternatives to motion capture measurements. Existing posture-prediction approaches are confined to two-handed load-handling activities performed at heights below 120 cm from the floor and to predicting a limited number of body-joint coordinates/angles. Moreover, the extrapolating power of these tools beyond the range of the input dataset they were trained for (e.g., for underweight, overweight, or left-handed individuals) has not been investigated. In this study, we trained/validated/tested two posture-prediction (for full-body joint coordinates and angles) artificial neural networks (ANNs) using both 70%/15%/15% random-hold-out and leave-one-subject-out methods, based on a comprehensive kinematic dataset of forty-one full-body skin markers collected from twenty right-handed normal-weight (BMI = 18-26 kg/m2) subjects. Subjects performed 204 one- and two-handed unloaded activities at different vertical (0 to 180 cm from the floor) and horizontal (up to 60 cm lateral and/or anterior) destinations. Subsequently, the extrapolation capability of the trained/validated/tested ANNs was evaluated using data collected from fifteen additional subjects (unseen by the ANNs); three individuals in five groups: underweight, overweight, obese, left-handed individuals, and subjects with a hand-load. Results indicated that the ANNs predicted body joint coordinates and angles during various activities with errors of ∼ 25 mm and ∼ 10°, respectively; considerable improvements when compared to previous posture-prediction ANNs. Extrapolation errors of our ANNs generally remained within the error range of existing ANNs with obesity and being left-handed having, respectively, the most and least compromising effects on their accuracy. These easy-to-use ANNs appear, therefore, to be robust alternatives to common posture-measurement approaches.
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Affiliation(s)
- Mahdi Mohseni
- Department of Mechanical Engineering, Sharif University of Technology, Tehran, Iran
| | - Sadra Zargarzadeh
- Department of Mechanical Engineering, Sharif University of Technology, Tehran, Iran
| | - Navid Arjmand
- Department of Mechanical Engineering, Sharif University of Technology, Tehran, Iran.
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Ren G, Liu L, Zhang P, Xie Z, Wang P, Zhang W, Wang H, Shen M, Deng L, Tao Y, Li X, Wang J, Wang Y, Wu X. Machine Learning Predicts Recurrent Lumbar Disc Herniation Following Percutaneous Endoscopic Lumbar Discectomy. Global Spine J 2024; 14:146-152. [PMID: 35499394 PMCID: PMC10676175 DOI: 10.1177/21925682221097650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
STUDY DESIGN Retrospective study. OBJECTIVES To develop machine learning (ML) models to predict recurrent lumbar disc herniation (rLDH) following percutaneous endoscopic lumbar discectomy (PELD). METHODS We retrospectively analyzed 1159 patients who had undergone single-level PELD for lumbar disc herniation (LDH) between July 2014 to December 2019 at our institution. Various preoperative imaging variables and demographic metrics were brought in analysis. Student's t test and Chi-squared test were applied for univariate analysis, which were feature selection for ML models. We established ML models to predict rLDH: Artificial neural networks (ANN), Extreme Gradient Boost classifier (XGBoost), KNeighborsClassifier (KNN), Decision tree classifier (Decision Tree), Random forest classifier (Random Forest), and support vector classifier (SVC). RESULTS A total 130 patients (11.22%) were diagnosed as rLDH in 1159 patients. Recurrence occurred within 10.25 ± 11.05 months. Body mass index (BMI) (P = .027), facet orientation (FO) (P < .001), herniation type (P = .012), Modic changes (P = .004), and disc calcification (P = .013) are significant factors in univariate analysis (P < .05). Extreme Gradient Boost classifier, Random Forest, ANN showed fine area under the curve, .9315, .9220, and .8814 respectively. CONCLUSION We developed a deep learning and 2 ensemble models with fine performance in prediction of rLDH following PELD. Predicting re-herniation before surgery has the potential to optimize decision-making and meaningfully decrease the rates of rLDH following PELD. Our ML model identified higher BMI, lower FO, Modic changes, disc calcification in a non-protrusive region, and herniation type (noncontained herniation) as significant features for predicting rLDH.
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Affiliation(s)
- GuanRui Ren
- Department of Spine Surgery, Zhongda Hospital, Medical College, Southeast University, Nanjing, China
| | - Lei Liu
- Department of Spine Surgery, Zhongda Hospital, Medical College, Southeast University, Nanjing, China
| | - Po Zhang
- Nanjing Integrated Traditional Chinese And Western Medicine Hospital, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
| | - ZhiYang Xie
- Department of Spine Surgery, Zhongda Hospital, Medical College, Southeast University, Nanjing, China
| | - PeiYang Wang
- Department of Spine Surgery, Zhongda Hospital, Medical College, Southeast University, Nanjing, China
| | - Wei Zhang
- Department of Spine Surgery, Zhongda Hospital, Medical College, Southeast University, Nanjing, China
| | - Hui Wang
- Department of Spine Surgery, Zhongda Hospital, Medical College, Southeast University, Nanjing, China
| | - MeiJi Shen
- Department of Spine Surgery, Zhongda Hospital, Medical College, Southeast University, Nanjing, China
| | - LiTing Deng
- Department of Spine Surgery, Zhongda Hospital, Medical College, Southeast University, Nanjing, China
| | - YuAo Tao
- Department of Spine Surgery, Zhongda Hospital, Medical College, Southeast University, Nanjing, China
| | - Xi Li
- Department of Spine Surgery, Zhongda Hospital, Medical College, Southeast University, Nanjing, China
| | - JiaoDong Wang
- Department of Spine Surgery, Zhongda Hospital, Medical College, Southeast University, Nanjing, China
| | - YunTao Wang
- Department of Spine Surgery, Zhongda Hospital, Medical College, Southeast University, Nanjing, China
| | - XiaoTao Wu
- Department of Spine Surgery, Zhongda Hospital, Medical College, Southeast University, Nanjing, China
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Anwar FN, Roca AM, Medakkar SS, Loya AC, Singh K. Response to the letter to the editor entitled: "Letter: impact of body mass index on PROMIS outcomes following lumbar decompression". Acta Neurochir (Wien) 2023; 165:3961-3962. [PMID: 37843606 DOI: 10.1007/s00701-023-05805-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 09/08/2023] [Indexed: 10/17/2023]
Affiliation(s)
- Fatima N Anwar
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL, 60612, USA
| | - Andrea M Roca
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL, 60612, USA
| | - Srinath S Medakkar
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL, 60612, USA
| | - Alexandra C Loya
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL, 60612, USA
| | - Kern Singh
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL, 60612, USA.
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Bahramian M, Arjmand N, El-Rich M, Parnianpour M. Effect of obesity on spinal loads during load-reaching activities: A subject- and kinematics-specific musculoskeletal modeling approach. J Biomech 2023; 161:111770. [PMID: 37633816 DOI: 10.1016/j.jbiomech.2023.111770] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Revised: 07/24/2023] [Accepted: 08/17/2023] [Indexed: 08/28/2023]
Abstract
Obesity has been associated to increase the risk of low back disorders. Previous musculoskeletal models simulating the effect of body weight on intervertebral joint loads have assumed identical body postures for obese and normal-weight individuals during a given physical activity. Our recent kinematic-measurement studies, however, indicate that obese individuals adapt different body postures (segmental orientations) than normal-weight ones when performing load-reaching activities. The present study, therefore, used a subject- and kinematics-specific musculoskeletal modeling approach to compare spinal loads of nine normal-weight and nine obese individuals each performing twelve static two-handed load-reaching activities at different hand heights, anterior distances, and asymmetry angles (total of 12 tasks × 18 subjects = 216 model simulations). Each model incorporated personalized muscle architectures, body mass distributions, and full-body kinematics for each subject and task. Results indicated that even when accounting for subject-specific body kinematics obese individuals experienced significantly larger (by ∼38% in average) L5-S1 compression (2305 ± 468 N versus 1674 ± 337 N) and shear (508 ± 111 N versus 705 ± 150 N) loads during all reaching activities (p < 0.05 for all hand positions). This average difference of ∼38% was similar to the results obtained from previous modeling investigations that neglected kinematics differences between the two weight groups. Moreover, there was no significant interaction effect between body weight and hand position on the spinal loads; indicating that the effect of body weight on L5-S1 loads was not dependent on the position of hands. Postural differences alone appear, hence, ineffective in compensating the greater spinal loads that obese people experience during reaching activities.
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Affiliation(s)
- M Bahramian
- Department of Mechanical Engineering, Sharif University of Technology, Tehran, Iran
| | - N Arjmand
- Department of Mechanical Engineering, Sharif University of Technology, Tehran, Iran.
| | - M El-Rich
- Healthcare Engineering Innovation Center, Department of Mechanical Engineering, Khalifa University, Abu Dhabi, United Arab Emirates
| | - M Parnianpour
- Department of Mechanical Engineering, Sharif University of Technology, Tehran, Iran
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Zhang N, Wang G. From Metabolically Healthy Obesity to Metabolically Unhealthy Obesity Populations: Decreased Bone Turnover Bioactivity. Diabetes Metab Syndr Obes 2023; 16:3657-3667. [PMID: 38028998 PMCID: PMC10659145 DOI: 10.2147/dmso.s431194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Accepted: 11/10/2023] [Indexed: 12/01/2023] Open
Abstract
Purpose A bone turnover marker reflects bone bioactivity. The effects of metabolically healthy compared with metabolically unhealthy obesity phenotypes on bone metabolism are not well understood. The aim of the study was to evaluate differences of bone transformation indexes in these two obesity phenotypes. Patients and Methods A total of 419 obese subjects were recruited, 64 with metabolically healthy obesity (MHO) and 351 with metabolically unhealthy obesity (MuHO). BTMs and clinical parameters were measured. Results Bone metabolism indexes, including tartrate resistant acid phosphatase (TRACP, p < 0.05), β carboxyl terminal peptide of collagen (β-CTX, p < 0.01), and bone alkaline phosphatase (BAP, p < 0.01), were higher in subjects with MHO than MuHO, but parathyroid hormone (PTH) was lower (p < 0.05). The between-group difference in serum calcium was not significant. Low bone turnover activity was associated with significant hyperglycemia, insulin resistance, and body fat index (p < 0.05). Multivariate logistic regression found that TRACP, β-CTX, and BAP were independently associated with the presence of MHO. Receiver operating characteristic curve analysis found that the maximum area under the curve value for the definition of MHO was (0.8221) and was obtained when sex, age, body mass index (BMI), TRACP, β-CTX and BAP were included simultaneously, resulting in a sensitivity of 81.25% and specificity: 72.3%. Conclusion The MHO group had significantly increased circulating TRACP and β-CTX compared with the MuHO group and BAP levels were within the physiological range. Obesity with the metabolically healthy phenotype had slightly increased bone turnover activity that may be an early compensatory response of skeletal metabolism to the increased BMI.
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Affiliation(s)
- Ning Zhang
- Department of Endocrinology, Beijing Chao-yang Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Guang Wang
- Department of Endocrinology, Beijing Chao-yang Hospital, Capital Medical University, Beijing, People’s Republic of China
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Luo M, Wang Z, Zhou B, Yang G, Shi Y, Chen J, Tang S, Huang J, Xiao Z. Risk factors for lumbar disc herniation recurrence after percutaneous endoscopic lumbar discectomy: a meta-analysis of 58 cohort studies. Neurosurg Rev 2023; 46:159. [PMID: 37392260 DOI: 10.1007/s10143-023-02041-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 05/18/2023] [Accepted: 05/27/2023] [Indexed: 07/03/2023]
Abstract
Recurrent lumbar disc herniation (rLDH) is one of the most serious complications and major causes of surgical failure and paralysis following percutaneous endoscopic lumbar discectomy (PELD). There are reports in the literature on the identification of risk factors associated with rLDH; however, the results are controversial. Therefore, we conducted a meta-analysis to identify risk factors for rLDH among patients following spinal surgery. PubMed, EMBASE, and the Cochrane Library were searched without language restrictions from inception to April 2018 for studies reporting risk factors for LDH recurrence after PELD. MOOSE guidelines were followed in this meta-analysis. We used a random effects model to aggregate odds ratios (ORs) with 95% confidence intervals (CIs). The evidence of observational studies was classified into high quality (class I), medium quality (class II/III), and low quality (class IV) based on the P value of the total sample size and heterogeneity between studies. Fifty-eight studies were identified with a mean follow-up of 38.8 months. Studies with high-quality (class I) evidence showed that postoperative LDH recurrence after PELD was significantly correlated with diabetes (OR, 1.64; 95% CI, 1.14 to 2.31), the protrusion type LDH (OR, 1.62; 95% CI, 1.02 to 2.61), and less experienced surgeons (OR, 1.54; 95% CI, 1.10 to 2.16). Studies with medium-quality (class II or III) evidence showed that postoperative LDH recurrence was significantly correlated with advanced age (OR, 1.11; 95% CI, 1.05 to 1.19), Modic changes (OR, 2.23; 95% CI, 1.53 to 2.29), smoking (OR, 1.31; 95% CI, 1.00 to 1.71), no college education (OR, 1.56; 95% CI, 1.05 to 2.31), obesity (BMI ≥ 25 kg/m2) (OR, 1.66; 95% CI, 1.11 to 2.47), and inappropriate manual labor (OR, 2.18; 95% CI, 1.33 to 3.59). Based on the current literature, eight patient-related and one surgery-related risk factor are predictors of postoperative LDH recurrence after PELD. These findings may help clinicians raise awareness of early intervention for patients at high risk of LDH recurrence after PELD.
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Affiliation(s)
- Mingjiang Luo
- Department of Spinal Surgery, Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang City, 421000, Hunan Province, China
| | - Zhongze Wang
- Department of Spinal Surgery, Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang City, 421000, Hunan Province, China
- Hengyang Medical School, University of South China, Hengyang City, Hunan Province, China
| | - Beijun Zhou
- Hengyang Medical School, University of South China, Hengyang City, Hunan Province, China
| | - Gaigai Yang
- Hengyang Medical School, University of South China, Hengyang City, Hunan Province, China
| | - Yuxin Shi
- Department of Pediatric Dentistry, First Affiliated Hospital (Affiliated Stomatological Hospital) of Xinjiang Medical University, Urumqi, 830054, China
| | - Jiang Chen
- Department of Spinal Surgery, Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang City, 421000, Hunan Province, China
| | - Siliang Tang
- Department of Spinal Surgery, Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang City, 421000, Hunan Province, China
| | - Jingshan Huang
- Department of Spinal Surgery, Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang City, 421000, Hunan Province, China
| | - Zhihong Xiao
- Department of Spinal Surgery, Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang City, 421000, Hunan Province, China.
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Bayartai ME, Määttä J, Karppinen J, Oura P, Takatalo J, Auvinen J, Raija K, Niemelä M, Luomajoki H. Association of accelerometer-measured physical activity, back static muscular endurance and abdominal obesity with radicular pain and non-specific low back pain. Sci Rep 2023; 13:7736. [PMID: 37173344 PMCID: PMC10181985 DOI: 10.1038/s41598-023-34733-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 05/06/2023] [Indexed: 05/15/2023] Open
Abstract
Low back pain (LBP) is the leading cause of disability worldwide and often associated with lifestyle factors. However, studies further examining the role of these lifestyle factors in non-specific low back pain in comparison with radicular pain are sparse. The aim of this cross sectional study was to investigate how diverse lifestyle factors are associated with LBP. The study population of 3385 middle aged adults with and without low back pain was drawn from a large Birth 1966 Cohort. Outcome measures were steps per day, abdominal obesity, physical activity and endurance of the back muscles. Back static muscular endurance, abdominal obesity and physical activity were measured by means of the Biering-Sørensen test, waist circumference and a wrist worn accelerometer, respectively. Logistic regression analysis was applied to estimate associations of back static muscular endurance, abdominal obesity and accelerometer-measured physical activity with non-specific low back pain and radicular pain. An additional 1000 steps per day were associated with 4% lower odds of having non-specific low back pain. Participants with abdominal obesity had 46% higher odds of having radicular pain, whereas increases of 10 s in back static muscular endurance and 10 min in daily vigorous physical activity were associated with 5% and 7% lower odds of having radicular pain, respectively. In this population-based study, non-specific low back pain and radicular pain were associated with different lifestyle and physical factors at midlife. Non-specific low back pain was associated only with the average daily number of steps, whereas abdominal obesity was the strongest determinant of radicular pain, followed by vigorous physical activity and back static muscular endurance. The findings of this study contribute to better understand the role of lifestyle factors in both non-specific low back pain and radicular pain. Future longitudinal studies are required to explore causality.
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Affiliation(s)
- Munkh-Erdene Bayartai
- Institute of Physiotherapy, School of Health Professions, Zurich University of Applied Sciences, ZHAW, Katharina-Sulzer-Platz 9, 8401, Winterthur, Switzerland.
- Department of Physical Therapy, School of Nursing, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia.
| | - Juhani Määttä
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
- Research Unit of Population Health, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Jaro Karppinen
- Research Unit of Population Health, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Petteri Oura
- Research Unit of Population Health, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Jani Takatalo
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Juha Auvinen
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
- Research Unit of Population Health, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Korpelainen Raija
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
- Research Unit of Population Health, Faculty of Medicine, University of Oulu, Oulu, Finland
- Department of Sports and Exercise Medicine, Oulu Deaconess Institute Foundation Sr., Oulu, Finland
| | - Maisa Niemelä
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
- Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland
- Research Unit of Health Sciences and Technology, University of Oulu, Oulu, Finland
| | - Hannu Luomajoki
- Institute of Physiotherapy, School of Health Professions, Zurich University of Applied Sciences, ZHAW, Katharina-Sulzer-Platz 9, 8401, Winterthur, Switzerland.
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12
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The role of individual physical body measurements and activity on spine kinematics during flexion, lateral bending and twist tasks in healthy young adults – Comparing marker(less) data. Biomed Signal Process Control 2023. [DOI: 10.1016/j.bspc.2022.104517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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13
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Coppock JA, Zimmer NE, Englander ZA, Danyluk ST, Kosinski AS, Spritzer CE, Goode AP, DeFrate LE. In vivo intervertebral disc mechanical deformation following a treadmill walking "stress test" is inversely related to T1rho relaxation time. Osteoarthritis Cartilage 2023; 31:126-133. [PMID: 36191831 PMCID: PMC10127291 DOI: 10.1016/j.joca.2022.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 09/12/2022] [Accepted: 09/24/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To assess the in vivo relationship between the mechanical response of intervertebral discs (IVDs) to dynamic activity and IVD biochemical composition assessed via T1rho relaxation imaging. DESIGN Eighteen asymptomatic participants with no history of low back pain (LBP), injury, or surgery underwent magnetic resonance (MR) imaging of their lumbar spine prior to and immediately following a treadmill walking "stress test." Anatomic (SPACE, FLASH) MR images were obtained pre- and post-exercise and utilized to measure IVD mechanical deformation. Quantitative (T1rho) imaging was performed pre-exercise to reflect IVD composition. Pre-exercise anatomic images were also utilized to assess IVD degenerative status based on the modified Pfirrmann scale. To quantify mechanical response, 3D surface models of the L1-L2-L5-S1 IVDs were created from manual segmentations of pre- and post-exercise anatomic images and utilized to assess changes in IVD height. IVD strain (%) was defined as change in IVD height normalized to pre-activity height. Linear mixed models were used to assess the relationships between IVD mechanical deformation (strain), composition (T1rho relaxation time), and degenerative status (Pfirrmann grade). RESULTS Increased compressive IVD strain was associated with lower T1rho relaxation times in the nucleus pulposus (NP) of the disc (βT1rho=5.07,CI:[1.52,7.77],Rmarg2=0.52,p=0.005). Thus, an inverse relationship between IVD strain and NP T1rho relaxation time was observed. CONCLUSION The in vivo mechanical response of the IVD to the "stress test" was sensitive to differences in NP composition. The results of this study suggest that quantification of in vivo IVD mechanical function and composition may provide insight into IVD health.
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Affiliation(s)
- J A Coppock
- Department of Biomedical Engineering, Duke University, Durham, NC, USA; Department of Orthopedic Surgery, Duke University School of Medicine, Durham, NC, USA
| | - N E Zimmer
- Department of Biomedical Engineering, Duke University, Durham, NC, USA; Department of Orthopedic Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Z A Englander
- Department of Biomedical Engineering, Duke University, Durham, NC, USA; Department of Orthopedic Surgery, Duke University School of Medicine, Durham, NC, USA
| | - S T Danyluk
- Department of Orthopedic Surgery, Duke University School of Medicine, Durham, NC, USA
| | - A S Kosinski
- Department of Biostatistics & Bioinformatics, Duke University, Durham, NC, USA; Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - C E Spritzer
- Department of Radiology, Duke University School of Medicine, Durham, NC, USA
| | - A P Goode
- Department of Orthopedic Surgery, Duke University School of Medicine, Durham, NC, USA; Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA; Department of Population Health Sciences, Duke University, Durham, NC, USA
| | - L E DeFrate
- Department of Biomedical Engineering, Duke University, Durham, NC, USA; Department of Orthopedic Surgery, Duke University School of Medicine, Durham, NC, USA; Department of Mechanical Engineering and Materials Science, Duke University, Durham, NC, USA.
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14
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Dombovy-Johnson ML, D'Souza RS, Ha CT, Hagedorn JM. Incidence and Risk Factors for Spinal Cord Stimulator Lead Migration With or Without Loss of Efficacy: A Retrospective Review of 91 Consecutive Thoracic Lead Implants. Neuromodulation 2022; 25:731-737. [PMID: 35803679 DOI: 10.1111/ner.13487] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 05/12/2021] [Accepted: 06/07/2021] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Lead migration after spinal cord stimulator (SCS) implant is a commonly reported complication and the most common reason for revision surgery in cases of loss of efficacy. The primary aims of this study are to describe the incidence and degree of lead migration in the subacute postoperative period after SCS implant and to report potential risk factors for lead migration. MATERIALS AND METHODS We performed a retrospective chart review of all patients at a single academic center who received an SCS implant from January 1, 2020, to December 31, 2020. Information on patient (age, sex, weight, and height) and operative factors (device manufacturer, epidural access level and method, and implantable pulse generator location) were extracted from medical records. Intraoperative imaging was compared to subacute follow-up imaging obtained less than 20 days postimplant to measure lead migration distance. Regression models were fitted to determine associations between lead migration distance and potential clinical risk factors. RESULTS A total of 91 cases (182 leads) were included in the study. Within 20 days of implantation, 88.5% of leads had migrated (86.3% caudal and 2.2% cephalad). Mean migration distance for leads with caudal migration only was 12.34 ± 12.19 mm based on anteroposterior radiographs and 16.95 ± 15.68 mm on lateral radiographs. There was an association of greater caudal lead migration as patient body mass index increased (β-coefficient 0.07 [95% confidence interval 0.01-0.13], p = 0.031). Within the entire cohort, one patient (1.1%) required lead revision for loss of efficacy. CONCLUSIONS In the subacute postoperative period after SCS implant, the majority of SCS leads migrated caudally with an average of two lead contacts. Knowledge of this expected migration and risk factors can better inform implanting physicians intraoperatively when deciding final lead placement location. The finding of high likelihood of caudal lead migration in the subacute postoperative period brings the need for a well-designed prospective study to the forefront of our field. This will allow implanting providers to make well-informed decisions for intraoperative lead placement.
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Affiliation(s)
- Marissa L Dombovy-Johnson
- Department of Anesthesiology and Perioperative Medicine, Division of Pain Medicine, Mayo Clinic, Rochester, MN, USA
| | - Ryan S D'Souza
- Department of Anesthesiology and Perioperative Medicine, Division of Pain Medicine, Mayo Clinic, Rochester, MN, USA
| | - Chris Thuc Ha
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, USA
| | - Jonathan M Hagedorn
- Department of Anesthesiology and Perioperative Medicine, Division of Pain Medicine, Mayo Clinic, Rochester, MN, USA.
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15
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Submaximal Electromyography-Driven Musculoskeletal Modeling of the Human Trunk during Static Tasks: Equilibrium and Stability Analyses. J Electromyogr Kinesiol 2022; 65:102664. [DOI: 10.1016/j.jelekin.2022.102664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 04/03/2022] [Accepted: 05/11/2022] [Indexed: 11/21/2022] Open
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16
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Overweight and smoking promote recurrent lumbar disk herniation after discectomy. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2022; 31:604-613. [PMID: 35072795 DOI: 10.1007/s00586-022-07116-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 12/22/2021] [Accepted: 01/10/2022] [Indexed: 10/19/2022]
Abstract
PURPOSE Recurrent lumbar disk herniation (rLDH) following lumbar microdiscectomy is common. While several risk factors for primary LDH have been described, risk factors for rLDH have only sparsely been investigated. We evaluate the effect of Body mass index (BMI) and smoking on the incidence and timing of rLDH. METHODS From a prospective registry, we identified all patients undergoing primary tubular microdiscectomy (tMD), with complete BMI and smoking data, and a minimum 12-month follow-up. We defined rLDH as reherniation at the same level and side requiring surgery. Overweight was defined as BMI > 25, and obesity as BMI > 30. Intergroup comparisons and age- and gender-adjusted multivariable regression were carried out. We conducted a survival analysis to assess the influence of BMI and smoking on time to reoperation. RESULTS Of 3012 patients, 166 (5.5%) underwent re-microdiscectomy for rLDH. Smokers were reoperated more frequently (6.4% vs. 4.0%, p = 0.007). Similarly, rLDH was more frequent in obese (7.5%) and overweight (5.9%) than in normal-weight patients (3.3%, p = 0.017). Overweight smokers had the highest rLDH rate (7.6%). This effect of smoking (Odds ratio: 1.63, 96% CI: 1.12-2.36, p = 0.010) and BMI (Odds ratio: 1.09, 95% CI: 1.02-1.17, p = 0.010) persisted after controlling for age and gender. Survival analysis demonstrated that rLDH did not occur earlier in overweight patients and/or smokers. CONCLUSIONS BMI and smoking may directly contribute to a higher risk of rLDH, but do not accelerate rLDH development. Smoking cessation and weight loss in overweight or obese patients ought to be recommended with discectomy to reduce the risk for rLDH.
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17
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Ghezelbash F, Shahvarpour A, Larivière C, Shirazi-Adl A. Evaluating stability of human spine in static tasks: a combined in vivo-computational study. Comput Methods Biomech Biomed Engin 2021; 25:1156-1168. [PMID: 34839772 DOI: 10.1080/10255842.2021.2004399] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Various interpretations and parameters have been proposed to assess spinal stability such as antagonist muscle coactivity, trunk stiffness and spinal buckling load; however, the correlation between these parameters remains unknown. We evaluated spinal stability during different tasks while changing the external moment and load height and investigated likely relationships between different EMG- and model-based parameters (e.g., EMG coactivity ratio, trunk stiffness, force coactivity ratio) and stability margins. EMG and kinematics of 40 young healthy subjects were recorded during various quasi-static tasks. Muscle forces, trunk stiffness and stability margins were calculated by a nonlinear subject-specific EMG-assisted-optimization musculoskeletal model of the trunk. The load elevation and external moment increased muscle activities and trunk stiffness while all stability margins (i.e., buckling loads) decreased. The force coactivity ratio was strongly correlated with the hand-load stability margin (i.e., additional weight in hands to initiate instability; R2 = 0.54) demonstrating the stabilizing role of abdominal muscles. The total trunk stiffness (Pearson's r = 0.96) and the sum of EMGs of back muscles (Pearson's r = 0.65) contributed the most to the T1 stability margin (i.e., additional required load at T1 for instability/buckling). Force coactivity ratio and trunk stiffness can be used as alternative spinal stability metrics.
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Affiliation(s)
- Farshid Ghezelbash
- Division of Applied Mechanics, Department of Mechanical Engineering, Polytechnique Montréal, Canada
| | - Ali Shahvarpour
- Institut de recherche Robert Sauvé en santé et en sécurité du travail, Montréal, Canada
| | - Christian Larivière
- Institut de recherche Robert Sauvé en santé et en sécurité du travail, Montréal, Canada
| | - Aboulfazl Shirazi-Adl
- Division of Applied Mechanics, Department of Mechanical Engineering, Polytechnique Montréal, Canada
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18
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Malfliet A, Quiroz Marnef A, Nijs J, Clarys P, Huybrechts I, Elma Ö, Tumkaya Yilmaz S, Deliens T. Obesity Hurts: The Why and How of Integrating Weight Reduction With Chronic Pain Management. Phys Ther 2021; 101:pzab198. [PMID: 34403478 DOI: 10.1093/ptj/pzab198] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 06/14/2021] [Accepted: 07/05/2021] [Indexed: 12/25/2022]
Abstract
Amongst adults with chronic pain, overweight and obesity are highly prevalent. The association between chronic pain and overweight is driven by several explanations, including increased biomechanical load, changes in the gut microbiome, and low-grade (neuro)inflammation. Moreover, the link between overweight, obesity and chronic pain can best be considered from a lifestyle perspective. Since conservative treatment for chronic pain is often limited to short-term and small effects, addressing important comorbidities within a lifestyle approach could be the next step towards precision medicine for these patients. Indeed, evidence shows that combining weight reduction with conservative pain management is more effective to reduce pain and disability, compared to either intervention alone. This perspective article aims to update the reader with the current understanding of the possible explanatory mechanisms behind the interaction between overweight/obesity and chronic pain in an adult population. Second, this paper applies this knowledge to clinical practice, including assessment and conservative treatment of overweight/obesity in adults with chronic pain. Henceforth, clinical recommendations and guidelines are provided based on available scientific evidence and the authors' clinical expertise. IMPACT This paper will guide clinicians in the implementation of weight reduction programs within pain management.
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Affiliation(s)
- Anneleen Malfliet
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
- Pain in Motion International Research Group, www.paininmotion.be
- Research Foundation Flanders (FWO), Brussels, Belgium
- Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Brussels, Belgium
| | - Arturo Quiroz Marnef
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Jo Nijs
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
- Pain in Motion International Research Group, www.paininmotion.be
- Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Brussels, Belgium
- Department of Health and Rehabilitation, Unit of Physiotherapy, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- University of Gothenburg Center for Person-Centred Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Peter Clarys
- Department of Movement and Sport Sciences, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussels, Brussels, Belgium
| | - Inge Huybrechts
- Nutrition and Metabolism Section, International Agency for Research on Cancer, Lyon, France
| | - Ömer Elma
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Movement and Sport Sciences, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussels, Brussels, Belgium
| | - Sevilay Tumkaya Yilmaz
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Movement and Sport Sciences, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussels, Brussels, Belgium
| | - Tom Deliens
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Movement and Sport Sciences, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussels, Brussels, Belgium
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Hayón-Ponce M, García-Fontana B, Avilés-Pérez MD, González-Salvatierra S, Andújar-Vera F, Moratalla-Aranda E, Muñoz-Torres M. Lower trabecular bone score in type 2 diabetes mellitus: A role for fat mass and insulin resistance beyond hyperglycaemia. DIABETES & METABOLISM 2021; 47:101276. [PMID: 34517124 DOI: 10.1016/j.diabet.2021.101276] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 08/20/2021] [Accepted: 08/26/2021] [Indexed: 02/08/2023]
Abstract
AIMS To examine the clinical and biochemical determinants of trabecular bone score (TBS) in type 2 diabetes mellitus (T2DM) patients. METHODS Cross-sectional observational study in 137 T2DM patients (49-85 years). Whole-body fat percentage was estimated using the relative fat mass (RFM) equation. Bone mineral density (BMD) and TBS were assessed using dual-energy X-ray absorptiometry and TBS iNsight Software respectively. RESULTS T2DM patients showed significantly lower TBS values (P < 0.001) despite significantly higher lumbar spine BMD (LS-BMD) (P = 0.025) compared to controls. TBS values were negatively correlated with body mass index (BMI) (P < 0.001), waist circumference (P < 0.001), and HOMA-2IR index (P = 0.004) and positively correlated with sex hormone-binding globulin (SHBG) (P = 0.01) and LS-BMD (P = 0.003). RFM was negatively associated with TBS in both males (P < 0.001) and females (P = 0.005). The multivariate analysis showed that RFM, HOMA2-IR (negative), SHBG, and LS-BMD (positive) were the variables independently associated with TBS. ROC analysis revealed RFM as the variable with the highest predictive value for risk of degraded bone microarchitecture. CONCLUSIONS The adiposity estimated by RFM may negatively affect TBS and this relationship may be influenced by insulin resistance and SHBG. RFM could act as a key estimator of degraded bone microarchitecture risk in the T2DM population.
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Affiliation(s)
- María Hayón-Ponce
- Bone Metabolic Unit, Endocrinology and Nutrition Division. University Hospital Clínico San Cecilio. Av. de la Ilustración, s/n, 18016, Granada, Spain
| | - Beatriz García-Fontana
- Bone Metabolic Unit, Endocrinology and Nutrition Division. University Hospital Clínico San Cecilio. Av. de la Ilustración, s/n, 18016, Granada, Spain; Instituto de Investigación Biosanitaria de Granada (Ibs.GRANADA). Av. Madrid 15, 18012, Granada, Spain; CIBERFES, Instituto de Salud Carlos III. C/ Sinesio Delgado, 4, 28029, Madrid, Spain.
| | - María Dolores Avilés-Pérez
- Bone Metabolic Unit, Endocrinology and Nutrition Division. University Hospital Clínico San Cecilio. Av. de la Ilustración, s/n, 18016, Granada, Spain; Instituto de Investigación Biosanitaria de Granada (Ibs.GRANADA). Av. Madrid 15, 18012, Granada, Spain; CIBERFES, Instituto de Salud Carlos III. C/ Sinesio Delgado, 4, 28029, Madrid, Spain
| | - Sheila González-Salvatierra
- Bone Metabolic Unit, Endocrinology and Nutrition Division. University Hospital Clínico San Cecilio. Av. de la Ilustración, s/n, 18016, Granada, Spain; Instituto de Investigación Biosanitaria de Granada (Ibs.GRANADA). Av. Madrid 15, 18012, Granada, Spain; Department of Medicine. University of Granada. Av. de la Investigación, 11, 18016, Granada, Spain
| | - Francisco Andújar-Vera
- Instituto de Investigación Biosanitaria de Granada (Ibs.GRANADA). Av. Madrid 15, 18012, Granada, Spain
| | - Enrique Moratalla-Aranda
- Instituto de Investigación Biosanitaria de Granada (Ibs.GRANADA). Av. Madrid 15, 18012, Granada, Spain; Department of Nuclear Medicine, University Hospital Clínico San Cecilio. Av. de la Ilustración, s/n, 18016, Granada, Spain
| | - Manuel Muñoz-Torres
- Bone Metabolic Unit, Endocrinology and Nutrition Division. University Hospital Clínico San Cecilio. Av. de la Ilustración, s/n, 18016, Granada, Spain; Instituto de Investigación Biosanitaria de Granada (Ibs.GRANADA). Av. Madrid 15, 18012, Granada, Spain; CIBERFES, Instituto de Salud Carlos III. C/ Sinesio Delgado, 4, 28029, Madrid, Spain; Department of Medicine. University of Granada. Av. de la Investigación, 11, 18016, Granada, Spain.
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20
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Artificial intelligence predicts disk re-herniation following lumbar microdiscectomy: development of the "RAD" risk profile. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2021; 30:2167-2175. [PMID: 34100112 DOI: 10.1007/s00586-021-06866-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 04/19/2021] [Accepted: 05/02/2021] [Indexed: 02/08/2023]
Abstract
PURPOSE Surgical treatment of herniated lumbar intervertebral disks is a common procedure worldwide. However, recurrent herniated nucleus pulposus (re-HNP) may develop, complicating outcomes and patient management. The purpose of this study was to utilize machine-learning (ML) analytics to predict lumbar re-HNP, whereby a personalized risk prediction can be developed as a clinical tool. METHODS A retrospective, single center study was conducted of 2630 consecutive patients that underwent lumbar microdiscectomy (mean follow-up: 22-months). Various preoperative patient pain/disability/functional profiles, imaging parameters, and anthropomorphic/demographic metrics were noted. An Extreme Gradient Boost (XGBoost) classifier was implemented to develop a predictive model identifying patients at risk for re-HNP. The model was exported to a web application software for clinical utility. RESULTS There were 1608 males and 1022 females, 114 of whom experienced re-HNP. Primary herniations were central (65.8%), paracentral (17.6%), and far lateral (17.1%). The XGBoost algorithm identified multiple re-HNP predictors and was incorporated into an open-access web application software, identifying patients at low or high risk for re-HNP. Preoperative VAS leg, disability, alignment parameters, elevated body mass index, symptom duration, and age were the strongest predictors. CONCLUSIONS Our predictive modeling via an ML approach of our large-scale cohort is the first study, to our knowledge, that has identified significant risk factors for the development of re-HNP after initial lumbar decompression. We developed the re-herniation after decompression (RAD) profile index that has been translated into an online screening tool to identify low-high risk patients for re-HNP. Additional validation is needed for potential global implementation.
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21
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Ghasemi M, Arjmand N. Spinal segment ranges of motion, movement coordination, and three-dimensional kinematics during occupational activities in normal-weight and obese individuals. J Biomech 2021; 123:110539. [PMID: 34044195 DOI: 10.1016/j.jbiomech.2021.110539] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 05/11/2021] [Accepted: 05/12/2021] [Indexed: 12/16/2022]
Abstract
Measurements of spinal segment ranges of motion (RoMs), movement coordination, and three-dimensional kinematics during occupational activities have implications in occupational/clinical biomechanics. Due to the large amount of adipose tissues, obese individuals may have different RoMs, lumbopelvic coordination, and kinematics than normal-weight ones. We aimed to measure/compare trunk, lumbar, and pelvis primary RoMs in all anatomical planes/directions, lumbopelvic ratios (lumbar to pelvis rotations at different trunk angles) in all anatomical planes/directions and three-dimensional spine kinematics during twelve symmetric/asymmetric statics load-handling activities in healthy normal-weight and obese individuals. Kinematics/motion data were collected from nine healthy young male normal-weight and nine age/height/sex matched obese individuals via a ten-camera Vicon motion capture system. Obese individuals had significantly smaller (p < 0.05) lumbar flexion (~9° in average) and larger pelvis right lateral bending (~5°) RoMs as well as smaller lumbopelvic ratios (~37%) in lateral bending and axial rotation movements as compared to normal-weight individuals. Moreover, the two groups had generally non-significant different segmental orientations (<20° and in most cases < 10°) in load-handling tasks that depended on the magnitude of load asymmetry angle (p < 0.05). Differences were larger for tasks performed near the floor, away from body, and at larger load asymmetry angles. Biomechanical models simulating pure lateral bending, axial rotation, or tasks involving large load asymmetry may therefore need subject-specific, rather than population-based, motion analysis due to the effects from body weight. In clinical applications, it should be noted that healthy obese individuals may have different RoMs and lumbopelvic rhythms than healthy normal-weight individuals in some anatomical planes/directions.
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Affiliation(s)
- M Ghasemi
- Department of Mechanical Engineering, Sharif University of Technology, Tehran, Iran
| | - N Arjmand
- Department of Mechanical Engineering, Sharif University of Technology, Tehran, Iran.
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22
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Mulvaney G, Rice OM, Rossi V, Peters D, Smith M, Patt J, Pfortmiller D, Asher AL, Kim P, Bernard J, McGirt M. Mild and Severe Obesity Reduce the Effectiveness of Lumbar Fusions: 1-Year Patient-Reported Outcomes in 8171 Patients. Neurosurgery 2021; 88:285-294. [PMID: 33009575 DOI: 10.1093/neuros/nyaa414] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 07/05/2020] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Elevated body mass index (BMI) is a well-known risk factor for surgical complications in lumbar surgery. However, its effect on surgical effectiveness independent of surgical complications is unclear. OBJECTIVE To determine increasing BMI's effect on functional outcomes following lumbar fusion surgery, independent of surgical complications. METHODS We retrospectively analyzed a prospectively built, patient-reported, quality of life registry representing 75 hospital systems. We evaluated 1- to 3-level elective lumbar fusions. Patients who experienced surgical complications were excluded. A stepwise multivariate regression model assessed factors independently associated with 1-yr Oswestry Disability Index (ODI), preop to 1-yr ODI change, and achievement of minimal clinically important difference (MCID). RESULTS A total of 8171 patients met inclusion criteria: 2435 with class I obesity (BMI 30-35 kg/m2), 1328 with class II (35-40 kg/m2), and 760 with class III (≥40 kg/m2). Increasing BMI was independently associated with worse 12-mo ODI (t = 8.005, P < .001) and decreased likelihood of achieving MCID (odds ratio [OR] = 0.977, P < .001). One year after surgery, mean ODI, ODI change, and percentage achieving MCID worsened with class I, class II, and class III vs nonobese cohorts (P < .001) in stepwise fashion. CONCLUSION Increasing BMI is associated with decreased effectiveness of 1- to 3-level elective lumbar fusion, despite absence of surgical complications. BMI ≥ 30 kg/m2 is, therefore, a risk factor for both surgical complication and reduced benefit from lumbar fusion.
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Affiliation(s)
- Graham Mulvaney
- Carolina Neurosurgery & Spine Associates, Charlotte, North Carolina.,Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, North Carolina
| | - Olivia M Rice
- Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, North Carolina
| | - Vincent Rossi
- Carolina Neurosurgery & Spine Associates, Charlotte, North Carolina.,Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, North Carolina
| | - David Peters
- Carolina Neurosurgery & Spine Associates, Charlotte, North Carolina.,Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, North Carolina
| | - Mark Smith
- Carolina Neurosurgery & Spine Associates, Charlotte, North Carolina.,Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, North Carolina
| | - Joshua Patt
- Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, North Carolina
| | - Deborah Pfortmiller
- Carolina Neurosurgery & Spine Associates, Charlotte, North Carolina.,Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, North Carolina
| | - Anthony L Asher
- Carolina Neurosurgery & Spine Associates, Charlotte, North Carolina.,Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, North Carolina
| | - Paul Kim
- Carolina Neurosurgery & Spine Associates, Charlotte, North Carolina
| | - Joe Bernard
- Carolina Neurosurgery & Spine Associates, Charlotte, North Carolina
| | - Matthew McGirt
- Carolina Neurosurgery & Spine Associates, Charlotte, North Carolina.,Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, North Carolina
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Coppock JA, Danyluk ST, Englander ZA, Spritzer CE, Goode AP, DeFrate LE. Increasing BMI increases lumbar intervertebral disc deformation following a treadmill walking stress test. J Biomech 2021; 121:110392. [PMID: 33819699 DOI: 10.1016/j.jbiomech.2021.110392] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 02/22/2021] [Accepted: 03/13/2021] [Indexed: 10/21/2022]
Abstract
High body mass index (BMI) and obesity have been implicated as risk factors for lumbar degenerative disc disease and low back pain. Despite this, there is limited in vivo data to quantify how obesity influences the mechanical function of intervertebral discs (IVD) in response to activities of daily living. Recently, our lab has developed methodologies to non-invasively measure in vivo IVD deformation resulting from activities of daily living using magnetic resonance (MR) imaging and solid modeling techniques. This pilot study expands on these methodologies to assess how BMI influences IVD deformation following treadmill walking in eight asymptomatic individuals. Ordinary least squares regression analyses revealed a statistically significant relationship between BMI and compressive deformation (strain (%)) in the L5-S1 IVD (R2 = 0.61, p < 0.05). This relationship was weaker in the L3-L4 (R2 = 0.28, p > 0.05) and L4-L5 IVDs (R2 = 0.28, p > 0.05). Importantly, no relationship between pre-exercise disc height and BMI was identified (p > 0.05). Therefore, the results of this study suggest that BMI may alter the mechanical response of lumbar spine IVDs, particularly at the L5-S1 level. Furthermore, the observed relationship between increased BMI and IVD compressive deformation, in the absence of a detected relationship between pre-exercise disc height and BMI, suggests that changes in IVD mechanical function may be more sensitive to alterations in disc health than static clinical imaging alone. This finding highlights the importance of quantifying disc mechanical function when examining the relationship between BMI and IVD degeneration.
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Affiliation(s)
- James A Coppock
- Department of Orthopedic Surgery, Duke University School of Medicine, United States; Department of Biomedical Engineering, Duke University, United States
| | - Stephanie T Danyluk
- Department of Orthopedic Surgery, Duke University School of Medicine, United States
| | - Zoë A Englander
- Department of Orthopedic Surgery, Duke University School of Medicine, United States; Department of Biomedical Engineering, Duke University, United States
| | - Charles E Spritzer
- Department of Radiology, Duke University School of Medicine, United States
| | - Adam P Goode
- Department of Orthopedic Surgery, Duke University School of Medicine, United States; Duke Clinical Research Institute, Duke University School of Medicine, United States; Department of Population Health Sciences, United States
| | - Louis E DeFrate
- Department of Orthopedic Surgery, Duke University School of Medicine, United States; Department of Biomedical Engineering, Duke University, United States; Department of Mechanical Engineering and Materials Science, Duke University, United States.
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24
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Comparison of different lifting analysis tools in estimating lower spinal loads - Evaluation of NIOSH criterion. J Biomech 2020; 112:110024. [PMID: 32961423 DOI: 10.1016/j.jbiomech.2020.110024] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 08/12/2020] [Accepted: 08/26/2020] [Indexed: 11/24/2022]
Abstract
Excessive loads on the human spine is recognized as a risk factor for back injuries/pain. Various lifting analysis tools such as musculoskeletal models, regression equations and NIOSH (National Institute for Occupational Safety and Health) lifting equation (NLE) have been proposed to evaluate and mitigate associated risks during manual material handling activities. Present study aims to compare predicted spinal loads from 5 different lifting analysis tools as well as to critically evaluate the NIOSH recommended weight limit (RWL). Spinal loads were estimated under different symmetric/asymmetric lifting tasks in which hand-load mass at each task was set based on RWL from NLE. Estimated intradiscal pressures (IDPs) of various tools were also compared with in vivo measurements. We compared RWL by NLE versus our estimations of RWL calculated from our regression equations using biomechanical criteria (compression <3400 N with/without shear <1000, 1250 or 1500 N). Our regression equations followed by OpenSim, AnyBody, simple polynomial and 3DSSPP satisfactorily predicted L4-L5 IDPs. Lifting analysis tools estimated comparable spinal compression forces (mean Pearson's r = 0.80; standard deviation of relative difference = 26%) while in shear, differences were greater (mean Pearson's r = 0.68; standard deviation of relative difference = 56%). NLE estimations of RWL were conservative in comparison with our estimations for lean individuals (BMI < 25 kg/m2) when compression <3400 N and shear <1250 N were considered as the biomechanical criteria. For heavier individuals, however, NLE estimations of RWL generated spinal compression >3400 N (NIOSH biomechanical safety threshold) as well as shear >1000 N. Although RWLs estimated by NLE was body weight independent, body weight substantially altered RWLs estimated from our regression equations. For improved estimation of the risk of injury, more accurate failure criteria for spinal segments are essential.
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25
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Stokes A, Lundberg DJ, Hempstead K, Berry KM, Baker JF, Preston SH. Obesity and Incident Prescription Opioid Use in the U.S., 2000-2015. Am J Prev Med 2020; 58:766-775. [PMID: 32229057 DOI: 10.1016/j.amepre.2019.12.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 12/03/2019] [Accepted: 12/04/2019] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Prior studies have identified associations between obesity and numerous conditions that increase risks for chronic pain. However, the impact of obesity on prescription opioid use is not well known. This study investigates the association between obesity and incidence of long-term prescription opioid use. METHODS Fifteen panels of the Medical Expenditure Panel Survey from 2000 to 2015 were pooled to generate a sample of civilian non-institutionalized adults aged 30-84 years who were prescription opioid-naïve for approximately 9 months. Incident long-term prescription opioid use was defined as reporting use at 2 of 3 interviews during a 15-month follow-up. BMI was reported at baseline. Analyses were completed in 2019. RESULTS Among opioid-naïve adults (n=89,629), obesity was strongly associated with incident long-term prescription opioid use. The association increased at progressively higher BMI values, with 24% elevated odds (95% CI=7%, 44%) in adults with overweight (25-29.9 kg/m2) and 158% increased odds (95% CI=106%, 224%) among adults with Class III obesity (40-49.9 kg/m2). These associations grew with higher-dosage opioids. Of the reasons for opioid use, joint pain, back pain, injury, and muscle/nerve pain contributed the most to the excess use observed among adults with obesity. At the population level, 27.0% of incident long-term prescription opioid use (95% CI=19.0%, 34.8%) was attributable to adults having a BMI above normal weight (25-49.9 kg/m2). CONCLUSIONS These findings suggest that obesity has contributed to prescription opioid use in the U.S. Future investments in chronic pain reduction may benefit from increased integration with obesity prevention and treatment.
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Affiliation(s)
- Andrew Stokes
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts.
| | - Dielle J Lundberg
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts
| | | | - Kaitlyn M Berry
- Department of Epidemiology, University of Minnesota School of Public Health, Minneapolis, Minnesota
| | - Joshua F Baker
- Philadelphia VA Medical Center, Philadelphia, Pennsylvania; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Samuel H Preston
- Department of Sociology and Population Studies Center, University of Pennsylvania, Philadelphia, Pennsylvania
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26
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Luo J, Lee RY. How Does Obesity Influence the Risk of Vertebral Fracture? Findings From the UK Biobank Participants. JBMR Plus 2020; 4:e10358. [PMID: 32382691 PMCID: PMC7202417 DOI: 10.1002/jbm4.10358] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 02/13/2020] [Accepted: 03/08/2020] [Indexed: 12/29/2022] Open
Abstract
Obesity and osteoporotic‐related fractures are two common public health problems, although it is unclear how obesity affects the risk of vertebral fractures. The purpose of this study was to examine the association between different measures of obesity and the risk of vertebral fracture, and to establish the various clinical factors that can predict such risk. We analyzed data obtained from 502,543 participants in the UK Biobank (229,138 men and 273,405 women), aged 40 to 69 years. Imaging information was available in a subset of this cohort (5189 participants: 2473 men and 2716 women). We further examined how BMD and geometry of the vertebrae were related to body fat measures. It was shown that a larger waist circumference (WC), but not BMI, was associated with an increase in fracture risk in men, but in women, neither BMI nor WC affected the risk. Trunk fat mass, visceral adipose tissue (VAT) mass, and limb fat mass were negatively associated with vertebral body BMD and geometry in men and women. BMD and geometry are related to vertebral strength, but may not be directly related to the risk of fractures, which is also influenced by other factors. The binary logistic regression equation established in this study may be useful to clinicians for the prediction of vertebral fracture risks, and may provide further information to supplement the fracture risk assessment tool, which assesses general fracture risks. © 2020 The Authors. JBMR Plus published by Wiley Periodicals, Inc. on behalf of American Society for Bone and Mineral Research.
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Affiliation(s)
- Jin Luo
- School of Applied Sciences London South Bank University London UK
| | - Raymond Yw Lee
- Faculty of Technology University of Portsmouth Portsmouth UK
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27
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Ghezelbash F, Shirazi-Adl A, El Ouaaid Z, Plamondon A, Arjmand N. Subject-specific regression equations to estimate lower spinal loads during symmetric and asymmetric static lifting. J Biomech 2020; 102:109550. [DOI: 10.1016/j.jbiomech.2019.109550] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 11/26/2019] [Accepted: 11/29/2019] [Indexed: 01/11/2023]
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28
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The Transverse Gravitational Deviation Index, a Novel Gravity Line-Related Spinal Parameter, Relates to Balance Control and Health-Related Quality of Life in Adults With Spinal Deformity. Spine (Phila Pa 1976) 2020; 45:E25-E36. [PMID: 31842109 DOI: 10.1097/brs.0000000000003301] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Prospective cross-sectional case-control study design. OBJECTIVE This study aims to analyze the relation between balance control as well as health-related quality of life (HRQOL) in patients with adult spinal deformity (ASD), with a novel gravity line (GL)-related 3D spinal alignment parameter, the transverse gravitational deviation index (TGDI), defined to quantify the transverse plane position of any vertebra with respect to the GL. SUMMARY OF BACKGROUND DATA Demographic data and balance control have both been identified as important determinants of HRQOL in ASD patients during a preoperative setting. Therefore, a better understanding of the relation between spinal alignment and balance is required. METHODS After informed consent, 15 asymptomatic healthy volunteers (mean age 60.1 ± 11.6 years old) and 55 ASD patients (mean age 63.5 ± 10.1 years old) were included. Relation between performance on BESTest as well as core outcome measures index (COMI) with spinopelvic alignment was explored using General Linear Modeling (GLM). A P-value ≤0.05 was considered statistically significant. RESULTS The L3 TGDI was identified to relate to balance control in the total ASD population after correction for confounding demographic factors (P = 0.001; adjusted R = 0.500) and explained 19% of the observed variance in balance performance. In addition, COMI is related to L3 TGDI in a subgroup of ASD patients with combined coronal and sagittal malalignment of L3 (P = 0.027; slope B = 0.047), despite significant influence of age (P = 0.020). CONCLUSION In ASD patients with a combined coronal and sagittal malalignment of the L3 vertebra, both the level of balance impairment as well as HRQOL are related to the distance component of the L3 TGDI, that is, the offset between the center of the L3 vertebral body and the GL in the transverse plane. LEVEL OF EVIDENCE 2.
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29
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Paiva PC, Figueiredo CA, Reis-Silva A, Francisca-Santos A, Paineiras-Domingos LL, Martins-Anjos E, Melo-Oliveira MES, Lourenço-Revelles GMG, Moreira-Marconi E, Guedes-Aguiar EO, Brandão AA, Neves MFT, Xavier VL, Borges DL, Lacerda ACR, Mendonça VA, Sonza A, Quinart H, Boyer FC, Taiar R, Sartorio A, Cochrane DJ, Bernardo-Filho M, Sá-Caputo DC. Acute and Cumulative Effects With Whole-Body Vibration Exercises Using 2 Biomechanical Conditions on the Flexibility and Rating of Perceived Exertion in Individuals With Metabolic Syndrome: A Randomized Clinical Trial Pilot Study. Dose Response 2019; 17:1559325819886495. [PMID: 31802991 PMCID: PMC6876186 DOI: 10.1177/1559325819886495] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 09/27/2019] [Accepted: 10/08/2019] [Indexed: 12/18/2022] Open
Abstract
This study evaluated the effects of 6 weeks of whole-body vibration (WBV) exercise on flexibility and the rating of perceived exertion (RPE) in metabolic syndrome (MetS) individuals using 2 biomechanical conditions (fixed frequency [FF] and variable frequency [VF]). Nineteen MetS individuals were randomly allocated in FF-WBV (n = 9, 7 women and 2 men) and VF-WBV (n = 10, 8 women and 2 men) groups. Anterior trunk flexion (ATF) and RPE were determined before and after each session. The acute cumulative exposure effects were analyzed. The FF-WBV group was exposed to 5 Hz on a side alternating vibrating platform (SAVP), exposed to 10 and 50 seconds with the SAVP turned off. The VF-WBV group individuals were intermittently exposed (1 minute WBV exercise/1 minute rest) to 5 to 16 Hz, increased by 1 Hz per session and the peak-to-peak displacement (PPD) were 2.5, 5.0, and 7.5 mm. Regarding to ATF, significant improvements (P < .05) were observed in the in the acute (VF group) and cumulative intervention (FF and VF-WBV groups). The RPE significantly (P < .05) improved only in VF-WBV (cumulative intervention). In conclusion, WBV exercise improved the flexibility and decreased the RPE in MetS individuals. These findings suggest that WBV exercise can be incorporated into physical activities for MetS individuals.
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Affiliation(s)
- P. C. Paiva
- Mestrado Profissional em Saúde, Medicina Laboratorial e Tecnologia Forense, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
- Laboratório de Vibrações Mecânicas e Práticas Integrativas, Departamento de Biofísica e Biometria, Instituto de Biologia Roberto Alcântara Gomes e Policlínica Piquet Carneiro, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - C. A. Figueiredo
- Mestrado Profissional em Saúde, Medicina Laboratorial e Tecnologia Forense, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
- Laboratório de Vibrações Mecânicas e Práticas Integrativas, Departamento de Biofísica e Biometria, Instituto de Biologia Roberto Alcântara Gomes e Policlínica Piquet Carneiro, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - A. Reis-Silva
- Mestrado Profissional em Saúde, Medicina Laboratorial e Tecnologia Forense, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
- Laboratório de Vibrações Mecânicas e Práticas Integrativas, Departamento de Biofísica e Biometria, Instituto de Biologia Roberto Alcântara Gomes e Policlínica Piquet Carneiro, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - A. Francisca-Santos
- Laboratório de Vibrações Mecânicas e Práticas Integrativas, Departamento de Biofísica e Biometria, Instituto de Biologia Roberto Alcântara Gomes e Policlínica Piquet Carneiro, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
- Faculdade Bezerra de Araújo, Rio de Janeiro, Brazil
| | - L. L. Paineiras-Domingos
- Laboratório de Vibrações Mecânicas e Práticas Integrativas, Departamento de Biofísica e Biometria, Instituto de Biologia Roberto Alcântara Gomes e Policlínica Piquet Carneiro, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
- Faculdade Bezerra de Araújo, Rio de Janeiro, Brazil
- Programa de Pós-Graduação em Ciências Médicas, Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
- L. L. Paineiras-Domingos, Departamento de Biofísica e Biometria, Laboratório de Vibrações Mecânicas e Práticas Integrativas, Instituto de Biologia Roberto Alcântara Gomes e Policlínica Piquet Carneiro, Universidade do Estado do Rio de Janeiro, Avenida 28 de setembro, 87 fundos, 4º andar, Vila Isabel, Rio de Janeiro 20551-030, Brazil.
| | - E. Martins-Anjos
- Laboratório de Vibrações Mecânicas e Práticas Integrativas, Departamento de Biofísica e Biometria, Instituto de Biologia Roberto Alcântara Gomes e Policlínica Piquet Carneiro, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - M. E. S. Melo-Oliveira
- Laboratório de Vibrações Mecânicas e Práticas Integrativas, Departamento de Biofísica e Biometria, Instituto de Biologia Roberto Alcântara Gomes e Policlínica Piquet Carneiro, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - G. M. G. Lourenço-Revelles
- Laboratório de Vibrações Mecânicas e Práticas Integrativas, Departamento de Biofísica e Biometria, Instituto de Biologia Roberto Alcântara Gomes e Policlínica Piquet Carneiro, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - E. Moreira-Marconi
- Laboratório de Vibrações Mecânicas e Práticas Integrativas, Departamento de Biofísica e Biometria, Instituto de Biologia Roberto Alcântara Gomes e Policlínica Piquet Carneiro, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
- Programa de Pós-Graduação em Fisiopatologia Clínica e Experimental, Instituto de Biologia Roberto Alcântara Gomes, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - E. O. Guedes-Aguiar
- Laboratório de Vibrações Mecânicas e Práticas Integrativas, Departamento de Biofísica e Biometria, Instituto de Biologia Roberto Alcântara Gomes e Policlínica Piquet Carneiro, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
- Programa de Pós-Graduação em Ciências Médicas, Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
- Programa de Pós-graduação em Ciências da Saúde, Universidade Federal do Rio de Grande do Norte, Natal, Rio de Grande do Norte, Brazil
| | - A. A. Brandão
- Programa de Pós-Graduação em Ciências Médicas, Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
- Departamento de Cardiologia do Hospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - M. F. T. Neves
- Programa de Pós-Graduação em Ciências Médicas, Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - V. L. Xavier
- Departamento de Estatística, Instituto de Matemática e Estatística, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - D. L. Borges
- Hospital Universitário, Universidade Federal do Maranhão, São Luís do Maranhão, MA, Brazil
| | - A. C. R. Lacerda
- Faculdade de Ciências Biológicas e da Saúde, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Minas Gerais, Brazil
| | - V. A. Mendonça
- Faculdade de Ciências Biológicas e da Saúde, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Minas Gerais, Brazil
| | - A. Sonza
- Universidade do Estado de Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - H. Quinart
- Institut de Formation en Masso-kinésithérapie, Reims, France
| | - F. C. Boyer
- Physical and Rehabilitation Medicine Department, Sebastopol Hospital, University of Reims Champagne-Ardenne, Reims, France
| | - R. Taiar
- GRESPI, Université de Reims, Reims, France
| | - A. Sartorio
- Division of Metabolic Diseases & Auxology, Istituto Auxologico Italiano, IRCCS, Experimental Laboratory for Auxo-endocrinological Research, Milan and Verbania, Italy
| | - D. J. Cochrane
- School of Sport, Exercise & Nutrition, Massey University, Palmerston North, New Zealand
| | - M. Bernardo-Filho
- Laboratório de Vibrações Mecânicas e Práticas Integrativas, Departamento de Biofísica e Biometria, Instituto de Biologia Roberto Alcântara Gomes e Policlínica Piquet Carneiro, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - D. C. Sá-Caputo
- Laboratório de Vibrações Mecânicas e Práticas Integrativas, Departamento de Biofísica e Biometria, Instituto de Biologia Roberto Alcântara Gomes e Policlínica Piquet Carneiro, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
- Faculdade Bezerra de Araújo, Rio de Janeiro, Brazil
- Programa de Pós-Graduação em Ciências Médicas, Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
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Jankowicz-Szymańska A, Bibro M, Wodka K, Smola E. Does Excessive Body Weight Change the Shape of the Spine in Children? Child Obes 2019; 15:346-352. [PMID: 30977672 DOI: 10.1089/chi.2018.0361] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background: Excessive body weight is a lifestyle issue, which is commonly found in children in many countries worldwide, and has enormous medical implications. This study aimed to determine the effect of overweight and obesity on the shape of the spine in children. Materials and Methods: A total of 910 children 10-12 years of age participated in this study. Their height, weight, and fat tissue content were measured. Their BMI was calculated, and their body weight status was categorized. The shape of the spinal curvature was assessed using an ultrasound Zebris Pointer system. The following parameters were used for the assessment: the shape of the thoracic kyphosis and lumbar lordosis, the sagittal trunk inclination, and alignment of the spine in the frontal plane. Results: An overweight or obesity was found in 23.7% of participants. The thoracic kyphosis was similar in children with a normal and an excessive weight. The BMI and body fat correlated statistically significantly with the shape of lumbar lordosis as well as with the tilt of the long axis of the body. The results revealed that overweight or obesity did not have any effect on the lateral bending of the spine. Conclusions: Excessive body weight was found to increase the risk for developing the lumbar hyperlordosis and cause posterior axial tilt. Therefore, overweight and obese children should participate in gymnastic classes that can help correct faulty posture. Special attention should be paid to correct the position of the lower part of the trunk.
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Affiliation(s)
| | - Marta Bibro
- Institute of Health Sciences, State Higher Vocational School, Tarnow, Poland
| | - Katarzyna Wodka
- Institute of Health Sciences, State Higher Vocational School, Tarnow, Poland
| | - Eliza Smola
- Institute of Health Sciences, State Higher Vocational School, Tarnow, Poland
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Back pain and sagittal spine alignment in obese patients eligible for bariatric surgery. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2019; 28:967-975. [PMID: 30877387 DOI: 10.1007/s00586-019-05935-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 02/14/2019] [Accepted: 02/26/2019] [Indexed: 12/17/2022]
Abstract
OBJECTIVE The objective of this research was to evaluate the prevalence of cervical and lumbar pain in obese patients eligible for bariatric surgery and to investigate possible changes in sagittal spine alignment in these patients. METHODS The following parameters were compared in 30 obese patients and a control group of 25 non-obese volunteers: body mass index, prevalence of cervical and lumbar pain assessed by visual analog scale (VAS), Neck Disability Index [NDI] and Oswestry Disability Index [ODI], as well as radiographic parameters of the spine and pelvis measured with Surgimap software. RESULTS The cervical and lumbar VAS and the NDI and ODI were significantly worse in obese patients. Compared with the control group, the cervical sagittal vertical axis (cSVA) of the obese group had higher variance (p value = 0.0025) and the cervical lordosis was diminished (p value = 0.0023). Thoracic kyphosis, lumbar lordosis, and the pelvic parameters were not significantly different between the groups. CONCLUSIONS Obese patients demonstrated lower functional performance compared with their non-obese counterparts, while cervical lordosis was diminished and the cSVA was increased in obese patients. These slides can be retrieved under Electronic Supplementary Material.
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Abstract
Overweight and obesity according to the definition of the WHO are considered as an abnormal or excessive fat accumulation that may impair health. Studies comparing fracture incidence in obese and non-obese individuals have demonstrated that obesity, defined on the basis of body mass index (BMI), is associated with increased risk of fracture at some sites but seems to be protective at others. The results of the studies are influenced by the distribution of BMI in the population studied; for example, in cohorts with a low prevalence of obesity, a predilection for certain fracture sites in obese individuals becomes difficult to detect, whereas, in populations with a high prevalence of obesity, previously unreported associations may emerge. Furthermore, obesity can bring with itself many complications (Type 2 diabetes mellitus, vitamin D deficiency, and motor disability) which, in the long run, can have a definite influence in terms of overall risk and quality of life, as well. This is a narrative review focusing on the relationship between bone metabolism and overweight/obesity and dealing with the fundamental dilemma of a disease (obesity) apparently associated with improved values of bone mineral density, part of a complicated relationship which revolves around obesity called "the obesity paradox".
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Ghezelbash F, El Ouaaid Z, Shirazi-Adl A, Plamondon A, Arjmand N. Trunk musculoskeletal response in maximum voluntary exertions: A combined measurement-modeling investigation. J Biomech 2018; 70:124-133. [PMID: 29198368 DOI: 10.1016/j.jbiomech.2017.11.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2017] [Revised: 11/03/2017] [Accepted: 11/07/2017] [Indexed: 02/05/2023]
Abstract
Maximum voluntary exertion (MVE) tasks quantify trunk strength and maximal muscle electromyography (EMG) activities with both clinical and biomechanical implications. The aims here are to evaluate the performance of an existing trunk musculoskeletal model, estimate maximum muscle stresses and spinal forces, and explore likely differences between males and females in maximum voluntary exertions. We, therefore, measured trunk strength and EMG activities of 19 healthy right-handed subjects (9 females and 10 males) in flexion, extension, lateral and axial directions. MVEs for all subjects were then simulated in a subject-specific trunk musculoskeletal model, and estimated muscle activities were compared with EMGs. Analysis of variance was used to compare measured moments and estimated spinal loads at the L5-S1 level between females and males. MVE moments in both sexes were greatest in extension (means of 236 Nm in males and 190 Nm in females) and least in left axial torque (97 Nm in males and 64 Nm in females). Being much greater in lateral and axial MVEs, coupled moments reached ∼50% of primary moments in average. Females exerted less moments in all directions reaching significance except in flexion. Muscle activity estimations were strongly correlated with measurements in flexion and extension (Pearson's r = 0.69 and 0.76), but the correlations were very weak in lateral and axial MVEs (Pearson's r = 0.27 and 0.13). Maximum muscle stress was in average 0.80 ± 0.42 MPa but varied among muscles from 0.40 ± 0.22 MPa in rectus abdominis to 0.99 ± 0.29 MPa in external oblique. To estimate maximum muscle stresses and evaluate validity of a musculoskeletal model, MVEs in all directions with all coupled moments should be considered.
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Affiliation(s)
- F Ghezelbash
- Division of Applied Mechanics, Department of Mechanical Engineering, Ecole Polytechnique, Montréal, Canada.
| | - Z El Ouaaid
- Institut de recherche Robert Sauvé en santé et en sécurité du travail, Montréal, Canada
| | - A Shirazi-Adl
- Division of Applied Mechanics, Department of Mechanical Engineering, Ecole Polytechnique, Montréal, Canada
| | - A Plamondon
- Institut de recherche Robert Sauvé en santé et en sécurité du travail, Montréal, Canada
| | - N Arjmand
- Department of Mechanical Engineering, Sharif University of Technology, Tehran, Iran
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Akhavanfar M, Kazemi H, Eskandari A, Arjmand N. Obesity and spinal loads; a combined MR imaging and subject-specific modeling investigation. J Biomech 2018; 70:102-112. [DOI: 10.1016/j.jbiomech.2017.08.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Revised: 08/03/2017] [Accepted: 08/05/2017] [Indexed: 12/14/2022]
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Effects of motion segment simulation and joint positioning on spinal loads in trunk musculoskeletal models. J Biomech 2018; 70:149-156. [DOI: 10.1016/j.jbiomech.2017.07.014] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 06/22/2017] [Accepted: 07/17/2017] [Indexed: 12/15/2022]
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