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Nelson AM, Lacinski RA, Steller JG. Spaceflight-associated pain. Curr Opin Anaesthesiol 2024; 37:581-587. [PMID: 39011662 DOI: 10.1097/aco.0000000000001401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/17/2024]
Abstract
PURPOSE OF REVIEW Consequences of the expanding commercial spaceflight industry include an increase in total number of spaceflight participants and an accompanying surge in the average number of medical comorbidities compared with government-based astronaut corps. A sequela of these developments is an anticipated rise in acute and chronic pain concerns associated with spaceflight. This review will summarize diagnostic and therapeutic areas of interest that can support the comfort of humans in spaceflight. RECENT FINDINGS Painful conditions that occur in space may be due to exposure to numerous stressors such as acceleration and vibration during launch, trauma associated with extravehicular activities, and morbidity resulting directly from weightlessness. Without normal gravitational forces and biomechanical stress, the hostile environment of space causes muscle atrophy, bone demineralization, joint stiffness, and spinal disc dysfunction, resulting in a myriad of pain generators. Repeated insults from abnormal environmental exposures are thought to contribute to the development of painful musculoskeletal and neuropathic conditions. SUMMARY As humanity invests in Lunar and Martian exploration, understanding the painful conditions that will impede crew productivity and mission outcomes is critical. Preexisting pain and new-onset acute or chronic pain resulting from spaceflight will require countermeasures and treatments to mitigate long-term health effects.
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Affiliation(s)
- Ariana M Nelson
- Department of Anesthesiology & Perioperative Care, University of California, Irvine School of Medicine, Orange, California
| | - Ryan A Lacinski
- Department of Orthopaedics, West Virginia University School of Medicine, Morgantown, West Virginia
| | - Jonathan G Steller
- Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, University of California, Irvine School of Medicine, Orange, California, USA
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Jiang J, Huang Y, He B. Advances in the interaction between lumbar intervertebral disc degeneration and fat infiltration of paraspinal muscles: critical summarization, classification, and perspectives. Front Endocrinol (Lausanne) 2024; 15:1353087. [PMID: 38978618 PMCID: PMC11228240 DOI: 10.3389/fendo.2024.1353087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Accepted: 06/10/2024] [Indexed: 07/10/2024] Open
Abstract
More than 619 million people in the world suffer from low back pain (LBP). As two potential inducers of LBP, intervertebral disc degeneration (IVDD) and fat infiltration of paraspinal muscles (PSMs) have attracted extensive attention in recent years. So far, only one review has been presented to summarize their relationship and relevant mechanisms. Nevertheless, it has several noticeable drawbacks, such as incomplete categorization and discussion, lack of practical proposals, etc. Consequently, this paper aims to systematically summarize and classify the interaction between IVDD and fat infiltration of PSMs, thus providing a one-stop search handbook for future studies. As a result, four mechanisms of IVDD leading to fat infiltration of PSMs and three mechanisms of fat infiltration in PSMs causing IVDD are thoroughly analyzed and summarized. The typical reseaches are tabulated and evaluated from four aspects, i.e., methods, conclusions, benefits, and drawbacks. We find that IVDD and fat infiltration of PSMs is a vicious cycle that can promote the occurrence and development of each other, ultimately leading to LBP and disability. Finally, eight perspectives are proposed for future in-depth research.
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Affiliation(s)
- Jiaqiu Jiang
- Department of Medical Imaging, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Yilong Huang
- Department of Medical Imaging, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Bo He
- Department of Medical Imaging, The First Affiliated Hospital of Kunming Medical University, Kunming, China
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Lee Satcher R, Fiedler B, Ghali A, Dirschl DR. Effect of Spaceflight and Microgravity on the Musculoskeletal System: A Review. J Am Acad Orthop Surg 2024; 32:535-541. [PMID: 38652883 DOI: 10.5435/jaaos-d-23-00954] [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: 11/08/2023] [Accepted: 03/11/2024] [Indexed: 04/25/2024] Open
Abstract
With National Aeronautics and Space Administration's plans for longer distance, longer duration spaceflights such as missions to Mars and the surge in popularity of space tourism, the need to better understand the effects of spaceflight on the musculoskeletal system has never been more present. However, there is a paucity of information on how spaceflight affects orthopaedic health. This review surveys existing literature and discusses the effect of spaceflight on each aspect of the musculoskeletal system. Spaceflight reduces bone mineral density at rapid rates because of multiple mechanisms. While this seems to be recoverable upon re-exposure to gravity, concern for fracture in spaceflight remains as microgravity impairs bone strength and fracture healing. Muscles, tendons, and entheses similarly undergo microgravity adaptation. These changes result in decreased muscle mass, increased tendon laxity, and decreased enthesis stiffness, thus decreasing the strength of the muscle-tendon-enthesis unit with variable recovery upon gravity re-exposure. Spaceflight also affects joint health; unloading of the joints facilitates changes that thin and atrophy cartilage similar to arthritic phenotypes. These changes are likely recoverable upon return to gravity with exercise. Multiple questions remain regarding effects of longer duration flights on health and implications of these findings on terrestrial medicine, which should be the target of future research.
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Affiliation(s)
- Robert Lee Satcher
- From the Department of Orthopedic Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX (Lee Satcher), and the Department of Orthopedic Surgery, Baylor College of Medicine, Houston, TX (Fiedler, Ghali, and Dirschl)
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Suryadevara M, Mishra GV, Parihar P, Javvaji CK, Sood A, Reddy H, Reddy NS, Shelar SS. Role of End Plate Changes and Paraspinal Muscle Pathology in Lower Back Pain: A Narrative Review. Cureus 2024; 16:e61319. [PMID: 38947594 PMCID: PMC11213362 DOI: 10.7759/cureus.61319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Accepted: 05/28/2024] [Indexed: 07/02/2024] Open
Abstract
Degenerative changes of the lumbar intervertebral disc are the most significant causes of enduring lower back pain. The possibility of the diagnosis is limited in people with this low back pain. Therefore, it is essential to identify the relevant back pain subgroups. The paraspinal muscles, that is, the muscles that attach to the spine, are necessary for the proper functioning of the spine and the body; insufficiency can result in back pain. Lower back pain disorders are strongly associated with altered function or structure of these paraspinal muscles, especially fibrosis and fatty infiltration. Modic changes are the bone marrow changes of the end plate in the vertebral body seen on MRI. These are strongly related to degeneration of the disc and are common in individuals with back pain symptoms. Articles were selected from Google Scholar using the terms 'Modic changes,' 'end plate changes,' 'paraspinal muscles,' and 'lower back pain. ' This article compiled different studies aiming to enhance the comprehension of biochemical processes resulting in the development of lumbar pain. Search using the keywords 'Modic changes,'' end plate changes lower back pain,' 'paraspinal muscles lower back pain,' and 'Modic changes lower back pain' on Google Scholar yielded 33000, 41000, 49400, and 17,800 results, and 958, 118, 890 and 560 results on Pubmed respectively.
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Affiliation(s)
- Manasa Suryadevara
- Radiodiagnosis, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Gaurav V Mishra
- Radiodiagnosis, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Pratapsingh Parihar
- Radiodiagnosis, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | | | - Anshul Sood
- Radiodiagnosis, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Harshitha Reddy
- Internal Medicine, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | | | - Sheetal S Shelar
- Radiodiagnosis, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Güngör E, Karakuzu Güngör Z. Obstetric-related lower back pain: the effect of number of pregnancy on development of chronic lower back pain, worsening of lumbar disc degeneration and alteration of lumbar sagittal balance. J Orthop Surg Res 2024; 19:174. [PMID: 38454457 PMCID: PMC10921574 DOI: 10.1186/s13018-024-04647-6] [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: 12/06/2023] [Accepted: 02/26/2024] [Indexed: 03/09/2024] Open
Abstract
OBJECTIVE This study aims to determine whether the number of pregnancies contributes to the development of chronic lower back pain, worsening the lumbar disc degeneration and altering the normal lumbar sagittal balance. MATERIAL METHOD There are 134 ladies participated in this study. They are divided into two groups based on their number of pregnancies (parity). All patients with chronic back pain were assessed using a visual analog scale for pain and the Oswestry Disability Index for their functional status assessment. Degenerative signs in lumbar MRI, which are Modic changes and the presence of Schmorl's node, were evaluated. Besides that, the sagittal balance of the lumbar spine was also measured via an erect lumbar plain radiograph. RESULTS Patients with parities < 5 were included in Group 1, and those with parities ≥ 5 in Group 2. The mean visual analog scale score of Group 2 was significantly higher than that of Group 1 (8.42 ± 1.34 vs.6.50 ± 1.61). The mean Oswestry Disability Index score in Group 2 was significantly higher than that of Group 1 (29.87 ± 6.75 vs.18.41 ± 7.97). This relationship between the groups in terms of Modic change was statistically significant. The relationship between the groups regarding the presence of Schmorl's nodes was also statistically significant. The difference between the groups in terms of sagittal balance parameters was not statistically significant. CONCLUSION Chronic lower back pain is significantly worse and associated with more disability in patients with more than five previous pregnancies. MRI degenerative changes are also significantly higher in these grand multipara groups.
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Affiliation(s)
- Erdal Güngör
- Batman Training and Research Hospital, Department of Orthopaedic and Traumatology, Batman, Turkey.
| | - Zeynep Karakuzu Güngör
- Batman Training and Research Hospital, Department of Physical Medicine and Rehabilitation, Batman, Turkey
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Zhou M, Theologis AA, O’Connell GD. Understanding the etiopathogenesis of lumbar intervertebral disc herniation: From clinical evidence to basic scientific research. JOR Spine 2024; 7:e1289. [PMID: 38222810 PMCID: PMC10782075 DOI: 10.1002/jsp2.1289] [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: 04/20/2023] [Revised: 08/01/2023] [Accepted: 09/20/2023] [Indexed: 01/16/2024] Open
Abstract
Lumbar intervertebral disc herniation, as a leading cause of low back pain, productivity loss, and disability, is a common musculoskeletal disorder that results in significant socioeconomic burdens. Despite extensive clinical and basic scientific research efforts, herniation etiopathogenesis, particularly its initiation and progression, is not well understood. Understanding herniation etiopathogenesis is essential for developing effective preventive measures and therapeutic interventions. Thus, this review seeks to provide a thorough overview of the advances in herniation-oriented research, with a discussion on ongoing challenges and potential future directions for clinical, translational, and basic scientific investigations to facilitate innovative interdisciplinary research aimed at understanding herniation etiopathogenesis. Specifically, risk factors for herniation are identified and summarized, including familial predisposition, obesity, diabetes mellitus, smoking tobacco, selected cardiovascular diseases, disc degeneration, and occupational risks. Basic scientific experimental and computational research that aims to understand the link between excessive mechanical load, catabolic tissue remodeling due to inflammation or insufficient nutrient supply, and herniation, are also reviewed. Potential future directions to address the current challenges in herniation-oriented research are explored by combining known progressive development in existing research techniques with ongoing technological advances. More research on the relationship between occupational risk factors and herniation, as well as the relationship between degeneration and herniation, is needed to develop preventive measures for working-age individuals. Notably, researchers should explore using or modifying existing degeneration animal models to study herniation etiopathogenesis, as such models may allow for a better understanding of how to prevent mild-to-moderately degenerated discs from herniating.
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Affiliation(s)
- Minhao Zhou
- Department of Mechanical EngineeringUniversity of California, Berkeley (UC Berkeley)BerkeleyCaliforniaUSA
| | - Alekos A. Theologis
- Department of Orthopaedic SurgeryUniversity of California, San Francisco (UCSF)San FranciscoCaliforniaUSA
| | - Grace D. O’Connell
- Department of Mechanical EngineeringUniversity of California, Berkeley (UC Berkeley)BerkeleyCaliforniaUSA
- Department of Orthopaedic SurgeryUniversity of California, San Francisco (UCSF)San FranciscoCaliforniaUSA
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Schoenrock B, Muckelt PE, Hastermann M, Albracht K, MacGregor R, Martin D, Gunga HC, Salanova M, Stokes MJ, Warner MB, Blottner D. Muscle stiffness indicating mission crew health in space. Sci Rep 2024; 14:4196. [PMID: 38378866 PMCID: PMC10879143 DOI: 10.1038/s41598-024-54759-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 02/16/2024] [Indexed: 02/22/2024] Open
Abstract
Muscle function is compromised by gravitational unloading in space affecting overall musculoskeletal health. Astronauts perform daily exercise programmes to mitigate these effects but knowing which muscles to target would optimise effectiveness. Accurate inflight assessment to inform exercise programmes is critical due to lack of technologies suitable for spaceflight. Changes in mechanical properties indicate muscle health status and can be measured rapidly and non-invasively using novel technology. A hand-held MyotonPRO device enabled monitoring of muscle health for the first time in spaceflight (> 180 days). Greater/maintained stiffness indicated countermeasures were effective. Tissue stiffness was preserved in the majority of muscles (neck, shoulder, back, thigh) but Tibialis Anterior (foot lever muscle) stiffness decreased inflight vs. preflight (p < 0.0001; mean difference 149 N/m) in all 12 crewmembers. The calf muscles showed opposing effects, Gastrocnemius increasing in stiffness Soleus decreasing. Selective stiffness decrements indicate lack of preservation despite daily inflight countermeasures. This calls for more targeted exercises for lower leg muscles with vital roles as ankle joint stabilizers and in gait. Muscle stiffness is a digital biomarker for risk monitoring during future planetary explorations (Moon, Mars), for healthcare management in challenging environments or clinical disorders in people on Earth, to enable effective tailored exercise programmes.
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Affiliation(s)
- Britt Schoenrock
- NeuroMuscular System & Signaling Group, Berlin Center of Space Medicine and Extreme Environments, 10115 Berlin, Germany, Institute of Integrative Neuroanatomy, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 10115 Berlin, Germany, 10115, Berlin, Germany
| | - Paul E Muckelt
- School of Health Sciences, University of Southampton, Southampton, UK
| | - Maria Hastermann
- Experimental and Clinical Research Center (ECRC) and NeuroCure Clinical Research Center (NCRC), Charité - Universitätsmedizin Berlin, Berlin, Germany
| | | | | | | | - Hans-Christian Gunga
- Institute of Physiology, Berlin Center of Space Medicine and Extreme Environments, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 10115 Berlin, Germany, Berlin, Germany
| | - Michele Salanova
- NeuroMuscular System & Signaling Group, Berlin Center of Space Medicine and Extreme Environments, 10115 Berlin, Germany, Institute of Integrative Neuroanatomy, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 10115 Berlin, Germany, 10115, Berlin, Germany
| | - Maria J Stokes
- School of Health Sciences, University of Southampton, Southampton, UK
| | - Martin B Warner
- School of Health Sciences, University of Southampton, Southampton, UK
| | - Dieter Blottner
- NeuroMuscular System & Signaling Group, Berlin Center of Space Medicine and Extreme Environments, 10115 Berlin, Germany, Institute of Integrative Neuroanatomy, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 10115 Berlin, Germany, 10115, Berlin, Germany.
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Shu D, Dai S, Wang J, Meng F, Zhang C, Zhao Z. Impact of Running Exercise on Intervertebral Disc: A Systematic Review. Sports Health 2024:19417381231221125. [PMID: 38204324 DOI: 10.1177/19417381231221125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2024] Open
Abstract
CONTEXT Running is one of the most popular sports worldwide. However, controversies exist regarding how running affects runner's intervertebral discs (IVD). OBJECTIVE The purpose of this study was to systematically review studies that evaluated IVD morphology or composition changes in response to running exercise, to determine the impact of running exercise on IVD. DATA SOURCES A systematic literature search was performed for 4 major databases: PubMed, Cochrane, Embase, and Web of Science. STUDY SELECTION Inclusion criteria were as follows: (1) healthy people without known IVD disease or major complications such as tuberculosis (IVD degeneration or low back pain are considered as minor complications); (2) subjects performed 1-time or regular running exercises; (3) pre and post comparison of runners or comparison between runners and healthy control subjects; (4) direct or indirect IVD morphology or composition measured; (5) IVD assessed before and after either acute or chronic running exercise, or compared cross-sectionally between runners and controls. Exclusion criteria were as follows: (1) reviews, editorials, letters or abstracts only; (2) animal studies; (3) subjects performed exercise other than running. STUDY DESIGN Systematic review. LEVEL OF EVIDENCE Level 3. DATA EXTRACTION The extracted data included study design and primary outcomes of the included studies. The Newcastle-Ottawa scale (NOS) was used to evaluate study quality and risk of bias. RESULTS A total of 13 studies with 632 participants were included in the final analysis; 4 studies measured IVD changes using stature or spinal height, and the other 9 measured IVD changes using magnetic resonance imaging; 6 studies found that running acutely and negatively impacts IVD; 3 out of 5 cross-sectional studies found that IVD parameters are better for runners than controls; 1 longitudinal study found no significant difference in IVD before and after training for marathon in runners; 1 longitudinal study found no significant difference in changes of IVD between runners and controls after 15 years of follow-up. CONCLUSION Negative changes in IVD exist for a short period of time after running, which may be due to the temporary compression pushing water content out of the disc. Cross-sectional studies suggest that long-term running exerts a mild positive effect on IVD; however, this inference has not been confirmed by high-quality longitudinal studies.
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Affiliation(s)
- Dingbo Shu
- Department of Radiology, Shaoxing People's Hospital (Shaoxing Hospital of Zhejiang University), Shaoxing, China
- Shaoxing Key Laboratory of Functional Molecular Imaging of Tumor and Interventional Diagnosis and Treatment, Shaoxing People's Hospital (Shaoxing Hospital of Zhejiang University), Shaoxing, China
| | - Siyu Dai
- School of Clinical Medicine, Hangzhou Normal University, Hangzhou, China
- Department of Radiology, Affiliated Hospital of Hangzhou Normal University, Hangzhou, China
- Institute of Sport Medicine, Hangzhou Normal University, Hangzhou, China
| | - Jianping Wang
- Department of Radiology, Shaoxing People's Hospital (Shaoxing Hospital of Zhejiang University), Shaoxing, China
- Shaoxing Key Laboratory of Functional Molecular Imaging of Tumor and Interventional Diagnosis and Treatment, Shaoxing People's Hospital (Shaoxing Hospital of Zhejiang University), Shaoxing, China
| | - Fanjing Meng
- School of Clinical Medicine, Hangzhou Normal University, Hangzhou, China
- Department of Radiology, Affiliated Hospital of Hangzhou Normal University, Hangzhou, China
- Institute of Sport Medicine, Hangzhou Normal University, Hangzhou, China
| | - Chuan Zhang
- School of Physical Education and Sport, Central China Normal University, Wuhan, China
| | - Zhenhua Zhao
- Department of Radiology, Shaoxing People's Hospital (Shaoxing Hospital of Zhejiang University), Shaoxing, China
- Shaoxing Key Laboratory of Functional Molecular Imaging of Tumor and Interventional Diagnosis and Treatment, Shaoxing People's Hospital (Shaoxing Hospital of Zhejiang University), Shaoxing, China
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Sauer AK, Vigouroux M, Dougherty PM, Cata JP, Ingelmo PM. Pain Experience and Sensory Changes in Astronauts During and After Short-Lasting Commercial Spaceflight: A Proof-of-Concept Study. J Pain Res 2023; 16:4253-4266. [PMID: 38107368 PMCID: PMC10723599 DOI: 10.2147/jpr.s440630] [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] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 12/02/2023] [Indexed: 12/19/2023] Open
Abstract
Space travel has been associated with musculoskeletal pain, yet little is known about the nociceptive changes and pain experience during spaceflight. This preliminary study aims to investigate the pain experience and sensory alterations in astronauts following a 17-day mission to the International Space Station (ISS) on Axiom Space's AX-1 commercial space flight. Two participants were enrolled, and data were collected pre-flight, in-flight, post-flight, and three-month post-flight. Validated pain questionnaires assessed anxiety, catastrophizing, impact on physical and mental health, disability, and overall pain experience. Qualitative interviews were conducted post-landing and conditioned pain modulation (CPM) and quantitative sensory testing (QST) were performed. Both astronauts reported musculoskeletal pain during and after the flight, which was managed with anti-inflammatories and stretching techniques. Pain levels returned to baseline after three months. Pain questionnaires revealed heightened pain experiences in-flight and immediately post-flight, although their adequacy in assessing pain in space is uncertain. Qualitative interviews allowed astronauts to describe their pain experiences during the flight. Sensory changes included increased mechanical touch detection thresholds, temporal pain summation, heat pain thresholds, and differences in conditioned pain modulation post-flight. This preliminary study suggested that spaceflight may affect various aspects of sensory perception and regulation in astronauts, albeit in a variable manner. More data are needed to gain insight of on gain and loss of sensory functions during space missions. Further investigation into the multifactorial stressors affecting the somatosensory system during space travel could contribute to advancements in space and pain medicine.
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Affiliation(s)
- Andrea K Sauer
- Department of Anesthesia, University of Bonn, Bonn, Germany
| | - Marie Vigouroux
- Department of Anesthesia, McGill University, Montreal, QC, Canada
- Edwards Family Interdisciplinary Center for Complex Pain, Montreal Children’s Hospital, Montreal, QC, Canada
| | - Patrick M Dougherty
- Department of Pain Medicine, The University of Texas – MD Anderson Cancer Center, Houston, TX, USA
| | - Juan Pablo Cata
- Department of Anesthesia and Perioperative Medicine, The University of Texas – MD Anderson Cancer Center, Houston, TX, USA
- Anesthesiology and Surgical Oncology Research Group, Houston, TX, USA
| | - Pablo M Ingelmo
- Department of Anesthesia, McGill University, Montreal, QC, Canada
- Edwards Family Interdisciplinary Center for Complex Pain, Montreal Children’s Hospital, Montreal, QC, Canada
- Alan Edwards Centre for Research on Pain, McGill University, Montreal, QC, Canada
- Research Institute, McGill University Health Center, Montreal, QC, Canada
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Tian G, Wang Y, Xia J, Wen J, Li T, Li Y, Dai G. Correlation of multifidus degeneration with sex, age and side of herniation in patients with lumbar disc herniation. BMC Musculoskelet Disord 2023; 24:652. [PMID: 37587417 PMCID: PMC10428591 DOI: 10.1186/s12891-023-06783-2] [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: 04/24/2023] [Accepted: 08/06/2023] [Indexed: 08/18/2023] Open
Abstract
OBJECTIVE The aim of this study was to determine the relationship between multifidus degeneration and sex, age and side of protrusion in patients with lumbar disc herniation(LDH). METHODS Data were collected from September 2015 to September 2022 from patients with L4/5 and L5/S1 LDH. A total of 104 patients (62 males and 42 females) were included in this study, and there were 35 and 69 cases of L4/5 and L5/S1 LDH, respectively. Patients were divided into 4 groups according to age: group 1 (20-29), group 2 (30-39), group 3 (40-49) and group 4 (50-59). Magnetic resonance spectroscopy analysis was used to observe the fat fraction (FF) and functional cross-sectional area (f-CSA) of the defatted multifidus muscle of the protruding side (affected side) and the nonprotruding side (healthy side) of the L4/5 and L5/S1 gaps to evaluate the relationship between multifidus degeneration and sex, age and protruding side in patients with LDH. RESULTS Between sexes, the FF of the multifidus muscle was significantly greater in women than in men, regardless of whether it was on the affected or healthy side of the L4/5 segment or on the affected or healthy side of the L5/S1 segment (P < 0.05). Between age groups, there was a significantly positive relationship between the change in FF (%) of the multifidus muscle in patients with LDH and age, with increasing fatty infiltration of the multifidus increasing with age (P < 0.05); notably, there was a significant difference between group 4 and the remaining three groups but no significant difference between groups 1, 2 and 3. The f-CSA of the multifidus (cm2) was negatively correlated with age, with the f-CSA of the multifidus becoming more atrophic with increasing age; specifically, there was a significant difference between group 1 and the other three groups (P < 0.05) but not between groups 2, 3 and 4. Regarding the side of the herniated disc, (1) the differences in FF and f-CSA at the L4/5 and L5/S1 levels were not statistically significant between the affected side and the healthy side in patients with lumbar disc herniation at the L4/5 segment (P > 0.05); (2) the differences in FF and f-CSA at the L5/S1 level were not statistically significant between the affected side and the healthy side in patients with LDH at the L5/S1 segment (P > 0.05); (3) the difference between FF at the L4/5 level and f-CSA and FF at the L5/S1 level was not statistically significant (P > 0.05); and (4) the f-CSA at the L5/S1 level was significantly greater on the healthy side than on the affected side (P < 0.05). CONCLUSION The proportion of lipoatrophy in female patients with L4/5 and L5/S1 disc herniations was greater than that in male patients. Lipoatrophy of the multifidus muscle increased with age and was significantly worse in patients over 50 years of age. The f-CSA of the multifidus muscle was negatively related to age, and the f-CSA of the multifidus muscle became more atrophic with increasing age. A comparison of degeneration showed no significant difference between the L4/5 patients and the L5/S1 patients in terms of f-CSA atrophy on the affected side of the herniated disc compared to the healthy side.
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Affiliation(s)
- Guogang Tian
- Cervicodynia/Omalgia/Lumbago/Sciatica Department 2, Sichuan Provincial Orthopedic Hospital, 132 West First Section First Ring Road, Chengdu, Sichuan Province, China
| | - Yi Wang
- Cervicodynia/Omalgia/Lumbago/Sciatica Department 2, Sichuan Provincial Orthopedic Hospital, 132 West First Section First Ring Road, Chengdu, Sichuan Province, China
| | - Jiao Xia
- Cervicodynia/Omalgia/Lumbago/Sciatica Department 2, Sichuan Provincial Orthopedic Hospital, 132 West First Section First Ring Road, Chengdu, Sichuan Province, China
| | - Jiang Wen
- Cervicodynia/Omalgia/Lumbago/Sciatica Department 2, Sichuan Provincial Orthopedic Hospital, 132 West First Section First Ring Road, Chengdu, Sichuan Province, China
| | - Tao Li
- Cervicodynia/Omalgia/Lumbago/Sciatica Department 2, Sichuan Provincial Orthopedic Hospital, 132 West First Section First Ring Road, Chengdu, Sichuan Province, China
| | - Yuewen Li
- Cervicodynia/Omalgia/Lumbago/Sciatica Department 2, Sichuan Provincial Orthopedic Hospital, 132 West First Section First Ring Road, Chengdu, Sichuan Province, China
| | - Guogang Dai
- Cervicodynia/Omalgia/Lumbago/Sciatica Department 2, Sichuan Provincial Orthopedic Hospital, 132 West First Section First Ring Road, Chengdu, Sichuan Province, China.
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11
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Swanenburg J, Easthope CA, Meinke A, Langenfeld A, Green DA, Schweinhardt P. Lunar and mars gravity induce similar changes in spinal motor control as microgravity. Front Physiol 2023; 14:1196929. [PMID: 37565140 PMCID: PMC10411353 DOI: 10.3389/fphys.2023.1196929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 07/13/2023] [Indexed: 08/12/2023] Open
Abstract
Introduction: Once more, plans are underway to send humans to the Moon or possibly even to Mars. It is therefore, important to know potential physiological effects of a prolonged stay in space and to minimize possible health risks to astronauts. It has been shown that spinal motor control strategies change during microgravity induced by parabolic flight. The way in which spinal motor control strategies change during partial microgravity, such as that encountered on the Moon and on Mars, is not known. Methods: Spinal motor control measurements were performed during Earth, lunar, Mars, and micro-gravity conditions and two hypergravity conditions of a parabola. Three proxy measures of spinal motor control were recorded: spinal stiffness of lumbar L3 vertebra using the impulse response, muscle activity of lumbar flexors and extensors using surface electromyography, and lumbar curvature using two curvature distance sensors placed at the upper and lower lumbar spine. The participants were six females and six males, with a mean age of 33 years (standard deviation: 7 years). Results: Gravity condition had a statistically significant (Friedmann tests) effect spinal stiffness (p < 0.001); on EMG measures (multifidus (p = 0.047), transversus abdominis (p < 0.001), and psoas (p < 0.001) muscles) and on upper lumbar curvature sensor (p < 0.001). No effect was found on the erector spinae muscle (p = 0.063) or lower curvature sensor (p = 0.170). Post hoc tests revealed a significant increase in stiffness under micro-, lunar-, and Martian gravity conditions (all p's < 0.034). Spinal stiffness decreased under both hypergravity conditions (all p's ≤ 0.012) and decreased during the second hypergravity compared to the first hypergravity condition (p = 0.012). Discussion: Micro-, lunar-, and Martian gravity conditions resulted in similar increases in spinal stiffness, a decrease in transversus abdominis muscle activity, with no change in psoas muscle activity and thus modulation of spinal motor stabilization strategy compared to those observed under Earth's gravity. These findings suggest that the spine is highly sensitive to gravity transitions but that Lunar and Martian gravity are below that required for normal modulation of spinal motor stabilization strategy and thus may be associated with LBP and/or IVD risk without the definition of countermeasures.
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Affiliation(s)
- Jaap Swanenburg
- Department of Chiropractic Medicine, Integrative Spinal Research ISR, Balgrist University Hospital, Zürich, Switzerland
- Faculty of Medicine, Institute of Anatomy, University of Zurich, Zurich, Switzerland
- Innovation Cluster Space and Aviation (UZH Space Hub), Air Force Center, University of Zurich, Dübendorf, Switzerland
| | - Christopher A. Easthope
- Cereneo—Center for Interdisciplinary Research, Vitznau, Switzerland
- Lake Lucerne Institute, Vitznau, Switzerland
| | - Anita Meinke
- Department of Chiropractic Medicine, Integrative Spinal Research ISR, Balgrist University Hospital, Zürich, Switzerland
| | - Anke Langenfeld
- Department of Chiropractic Medicine, Integrative Spinal Research ISR, Balgrist University Hospital, Zürich, Switzerland
| | - David A. Green
- Centre of Human and Applied Physiological Sciences, King’s College London, London, United Kingdom
- Space Medicine Team, European Astronaut Centre, European Space Agency, Cologne, Germany
- KBRwyle GmbH, Cologne, Germany
| | - Petra Schweinhardt
- Department of Chiropractic Medicine, Integrative Spinal Research ISR, Balgrist University Hospital, Zürich, Switzerland
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12
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Wei W, Wang T, Liu J, Mao K, Pan C, Li H, Zhao Y. Biomechanical effect of proximal multifidus injury on adjacent segments during posterior lumbar interbody fusion: a finite element study. BMC Musculoskelet Disord 2023; 24:521. [PMID: 37355581 DOI: 10.1186/s12891-023-06649-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 06/17/2023] [Indexed: 06/26/2023] Open
Abstract
BACKGROUND Adjacent segment degeneration (ASD) is a common complication of lumbar interbody fusion; the paraspinal muscles significantly maintain spinal biomechanical stability. This study aims to investigate the biomechanical effects of proximal multifidus injury on adjacent segments during posterior lumbar interbody fusion (PLIF). METHODS Data from a lumbosacral vertebral computed tomography scan of a healthy adult male volunteer were used to establish a normal lumbosacral vertebral finite element model and load the muscle force of the multifidus. A normal model, an L4/5 PLIF model (PFM) based on a preserved proximal multifidus, a total laminectomy PLIF model (TLPFM), and a hemi-laminectomy PLIF model based on a severed proximal multifidus were established, respectively. The range of motion (ROM) and maximum von Mises stress of the upper and lower adjacent segments were analyzed along with the total work of the multifidus muscle force. RESULTS This model verified that the ROMs of all segments with four degrees of freedom were similar to those obtained in previous research data, which validated the model. PLIF resulted in an increased ROM and maximum von Mises stress in the upper and lower adjacent segments. The ROM and maximum von Mises stress in the TLPFM were most evident in the upper adjacent segment, except for lateral bending. The ROM of the lower adjacent segment increased most significantly in the PFM in flexion and extension and increased most significantly in the TLPFM in lateral bending and axial rotation, whereas the maximum von Mises stress of the lower adjacent segment increased the most in the TLPFM, except in flexion. The muscle force and work of the multifidus were the greatest in the TLPFM. CONCLUSIONS PLIF increased the ROM and maximum von Mises stress in adjacent cranial segments. The preservation of the proximal multifidus muscle contributes to the maintenance of the physiological mechanical behavior of adjacent segments, thus preventing the occurrence and development of ASD.
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Affiliation(s)
- Wei Wei
- Medical School of Chinese PLA, Beijing, 100048, China
- Department of Orthopaedics, the First Medical Center, Chinese PLA General Hospital, Beijing, 100048, China
| | - Tianhao Wang
- Department of Orthopaedics, the First Medical Center, Chinese PLA General Hospital, Beijing, 100048, China
| | - Jianheng Liu
- Department of Orthopaedics, the First Medical Center, Chinese PLA General Hospital, Beijing, 100048, China
| | - Keya Mao
- Department of Orthopaedics, the First Medical Center, Chinese PLA General Hospital, Beijing, 100048, China
| | - Chun'ang Pan
- Beijing Engineering and Technology Research Center for Medical Endoplants, Beijing, 100082, China
- Beijing Engineering Laboratory of Functional Medical Materials and Instruments, Beijing, 100082, China
| | - Hui Li
- Beijing Engineering and Technology Research Center for Medical Endoplants, Beijing, 100082, China
- Beijing Engineering Laboratory of Functional Medical Materials and Instruments, Beijing, 100082, China
| | - Yongfei Zhao
- Department of Orthopaedics, the First Medical Center, Chinese PLA General Hospital, Beijing, 100048, China.
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13
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Rosa-Caldwell ME, Mortreux M, Wadhwa A, Kaiser UB, Sung DM, Bouxsein ML, Rutkove SB. Influence of gonadectomy on muscle health in micro- and partial-gravity environments in rats. J Appl Physiol (1985) 2023; 134:1438-1449. [PMID: 37102698 PMCID: PMC10228673 DOI: 10.1152/japplphysiol.00023.2023] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 04/19/2023] [Accepted: 04/21/2023] [Indexed: 04/28/2023] Open
Abstract
Gonadal hormones, such as testosterone and estradiol, modulate muscle size and strength in males and females. However, the influence of sex hormones on muscle strength in micro- and partial-gravity environments (e.g., the Moon or Mars) is not fully understood. The purpose of this study was to determine the influence of gonadectomy (castration/ovariectomy) on progression of muscle atrophy in both micro- and partial-gravity environments in male and female rats. Male and female Fischer rats (n = 120) underwent castration/ovariectomy (CAST/OVX) or sham surgery (SHAM) at 11 wk of age. After 2 wk of recovery, rats were exposed to hindlimb unloading (0 g), partial weight bearing at 40% of normal loading (0.4 g, Martian gravity), or normal loading (1.0 g) for 28 days. In males, CAST did not exacerbate body weight loss or other metrics of musculoskeletal health. In females, OVX animals tended to have greater body weight loss and greater gastrocnemius loss. Within 7 days of exposure to either microgravity or partial gravity, females had detectable changes to estrous cycle, with greater time spent in low-estradiol phases diestrus and metestrus (∼47% in 1 g vs. 58% in 0 g and 72% in 0.4 g animals, P = 0.005). We conclude that in males testosterone deficiency at the initiation of unloading has little effect on the trajectory of muscle loss. In females, initial low estradiol status may result in greater musculoskeletal losses.NEW & NOTEWORTHY We find that removal of gonadal hormones does not exacerbate muscle loss in males or females during exposure to either simulated microgravity or partial-gravity environments. However, simulated micro- and partial gravity did affect females' estrous cycles, with more time spent in low-estrogen phases. Our findings provide important data on the influence of gonadal hormones on the trajectory of muscle loss during unloading and will help inform NASA for future crewed missions to space and other planets.
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Affiliation(s)
- Megan E Rosa-Caldwell
- Department of Neurology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, United States
| | - Marie Mortreux
- Department of Neurology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, United States
- Department of Nutrition and Food Sciences, University of Rhode Island, Kingston, Rhode Island, United States
| | - Anna Wadhwa
- Department of Neurology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, United States
| | - Ursula B Kaiser
- Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, United States
| | - Dong-Min Sung
- Department of Neurology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, United States
| | - Mary L Bouxsein
- Center for Advanced Orthopedic Studies, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, United States
| | - Seward B Rutkove
- Department of Neurology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, United States
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14
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Marfia G, Guarnaccia L, Navone SE, Ampollini A, Balsamo M, Benelli F, Gaudino C, Garzia E, Fratocchi C, Di Murro C, Ligarotti GK, Campanella C, Landolfi A, Perelli P, Locatelli M, Ciniglio Appiani G. Microgravity and the intervertebral disc: The impact of space conditions on the biomechanics of the spine. Front Physiol 2023; 14:1124991. [PMID: 36998982 PMCID: PMC10043412 DOI: 10.3389/fphys.2023.1124991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 02/22/2023] [Indexed: 03/16/2023] Open
Abstract
The environmental conditions to which astronauts and other military pilots are subjected represent a unique example for understanding and studying the biomechanical events that regulate the functioning of the human body. In particular, microgravity has shown a significant impact on various biological systems, such as the cardiovascular system, immune system, endocrine system, and, last but not least, musculoskeletal system. Among the potential risks of flying, low back pain (LBP) has a high incidence among astronauts and military pilots, and it is often associated with intervertebral disc degeneration events. The mechanisms of degeneration determine the loss of structural and functional integrity and are accompanied by the aberrant production of pro-inflammatory mediators that exacerbate the degenerative environment, contributing to the onset of pain. In the present work, the mechanisms of disc degeneration, the conditions of microgravity, and their association have been discussed in order to identify possible molecular mechanisms underlying disc degeneration and the related clinical manifestations in order to develop a model of prevention to maintain health and performance of air- and space-travelers. The focus on microgravity also allows the development of new proofs of concept with potential therapeutic implications.
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Affiliation(s)
- Giovanni Marfia
- Laboratory of Experimental Neurosurgery and Cell Therapy, Neurosurgery Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Clinical Pathology Unit, Istituto di Medicina Aerospaziale “A. Mosso”, Aeronautica Militare, Milan, Italy
- *Correspondence: Giovanni Marfia,
| | - Laura Guarnaccia
- Laboratory of Experimental Neurosurgery and Cell Therapy, Neurosurgery Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Stefania Elena Navone
- Laboratory of Experimental Neurosurgery and Cell Therapy, Neurosurgery Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Antonella Ampollini
- Laboratory of Experimental Neurosurgery and Cell Therapy, Neurosurgery Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Melissa Balsamo
- Laboratory of Experimental Neurosurgery and Cell Therapy, Neurosurgery Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Francesca Benelli
- Laboratory of Experimental Neurosurgery and Cell Therapy, Neurosurgery Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Chiara Gaudino
- Department of Neuroradiology, Azienda Ospedaliero-Universitaria Policlinico Umberto I, Rome, Italy
| | - Emanuele Garzia
- Istituto di Medicina Aerospaziale “A. Mosso”, Aeronautica Militare, Milan, Italy
| | - Claudia Fratocchi
- Clinical Pathology Unit, Istituto di Medicina Aerospaziale “A. Mosso”, Aeronautica Militare, Milan, Italy
| | - Claudia Di Murro
- Clinical Pathology Unit, Istituto di Medicina Aerospaziale “A. Mosso”, Aeronautica Militare, Milan, Italy
| | | | - Carmelo Campanella
- Istituto di Medicina Aerospaziale “Aldo Di Loreto”, Aeronautica Militare, Rome, Italy
| | | | | | - Marco Locatelli
- Laboratory of Experimental Neurosurgery and Cell Therapy, Neurosurgery Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Medical-Surgical Physiopathology and Transplantation, University of Milan, Milan, Italy
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15
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Capri M, Conte M, Ciurca E, Pirazzini C, Garagnani P, Santoro A, Longo F, Salvioli S, Lau P, Moeller R, Jordan J, Illig T, Villanueva MM, Gruber M, Bürkle A, Franceschi C, Rittweger J. Long-term human spaceflight and inflammaging: Does it promote aging? Ageing Res Rev 2023; 87:101909. [PMID: 36918115 DOI: 10.1016/j.arr.2023.101909] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 03/07/2023] [Accepted: 03/08/2023] [Indexed: 03/14/2023]
Abstract
Spaceflight and its associated stressors, such as microgravity, radiation exposure, confinement, circadian derailment and disruptive workloads represent an unprecedented type of exposome that is entirely novel from an evolutionary stand point. Within this perspective, we aimed to review the effects of prolonged spaceflight on immune-neuroendocrine systems, brain and brain-gut axis, cardiovascular system and musculoskeletal apparatus, highlighting in particular the similarities with an accelerated aging process. In particular, spaceflight-induced muscle atrophy/sarcopenia and bone loss, vascular and metabolic changes, hyper and hypo reaction of innate and adaptive immune system appear to be modifications shared with the aging process. Most of these modifications are mediated by molecular events that include oxidative and mitochondrial stress, autophagy, DNA damage repair and telomere length alteration, among others, which directly or indirectly converge on the activation of an inflammatory response. According to the inflammaging theory of aging, such an inflammatory response could be a driver of an acceleration of the normal, physiological rate of aging and it is likely that all the systemic modifications in turn lead to an increase of inflammaging in a sort of vicious cycle. The most updated countermeasures to fight these modifications will be also discussed in the light of their possible application not only for astronauts' benefit, but also for older adults on the ground.
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Affiliation(s)
- Miriam Capri
- Department of Medical and Surgical Science, University of Bologna, Bologna, Italy; Alma Mater Research Institute on Global Challenges and Climate Change (Alma Climate), University of Bologna, Bologna, Italy
| | - Maria Conte
- Department of Medical and Surgical Science, University of Bologna, Bologna, Italy; Alma Mater Research Institute on Global Challenges and Climate Change (Alma Climate), University of Bologna, Bologna, Italy.
| | - Erika Ciurca
- Department of Medical and Surgical Science, University of Bologna, Bologna, Italy
| | - Chiara Pirazzini
- Department of Medical and Surgical Science, University of Bologna, Bologna, Italy
| | - Paolo Garagnani
- Department of Medical and Surgical Science, University of Bologna, Bologna, Italy; Alma Mater Research Institute on Global Challenges and Climate Change (Alma Climate), University of Bologna, Bologna, Italy; Clinical Chemistry Department of Laboratory Medicine, Karolinska Institutet at Huddinge University Hospital, Stockholm, Sweden; CNR Institute of Molecular Genetics, Unit of Bologna, Bologna, Italy; Center for Applied Biomedical Research (CRBA), St. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Aurelia Santoro
- Department of Medical and Surgical Science, University of Bologna, Bologna, Italy; Alma Mater Research Institute on Global Challenges and Climate Change (Alma Climate), University of Bologna, Bologna, Italy
| | - Federica Longo
- Department of Medical and Surgical Science, University of Bologna, Bologna, Italy
| | - Stefano Salvioli
- Department of Medical and Surgical Science, University of Bologna, Bologna, Italy; IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Patrick Lau
- Institute of Aerospace Medicine, German Aerospace Center (DLR), Cologne, Germany
| | - Ralf Moeller
- Institute of Aerospace Medicine, German Aerospace Center (DLR), Cologne, Germany
| | - Jens Jordan
- Institute of Aerospace Medicine, German Aerospace Center (DLR), Cologne, Germany; Medical Faculty, University of Cologne, Cologne, Germany
| | - Thomas Illig
- Department of Human Genetics, Hannover Medical School, Hannover, Germany
| | - Maria-Moreno Villanueva
- Human Performance Research Centre, Department of Sport Science, University of Konstanz, Konstanz, Germany
| | - Markus Gruber
- Human Performance Research Centre, Department of Sport Science, University of Konstanz, Konstanz, Germany
| | - Alexander Bürkle
- Department of Biology, University of Konstanz, Konstanz, Germany
| | - Claudio Franceschi
- Department of Applied Mathematics of the Institute of ITMM, National Research Lobachevsky State University of Nizhny Novgorod, the Russian Federation
| | - Jörn Rittweger
- Institute of Aerospace Medicine, German Aerospace Center (DLR), Cologne, Germany; Department of Pediatrics and Adolescent Medicine, University of Cologne, Cologne, Germany
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16
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Shaikh N, Yung A, Zhang H, Street J, Laule C, Oxland T, Wilson DR. Muscle activity with 0.5 T upright MRI-DESS to measure T 2 in biceps and triceps. J Orthop Res 2023; 41:698-704. [PMID: 35716162 DOI: 10.1002/jor.25402] [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] [Received: 11/26/2021] [Revised: 05/24/2022] [Accepted: 06/15/2022] [Indexed: 02/04/2023]
Abstract
The purpose of this study was to determine if muscle activity of the biceps followed by isometric flexion changes T2 measured in the biceps. It is hypothesized that an increase in T2 will be observed in the biceps but not in the triceps after flexion exercise. Ten healthy volunteers were imaged with a one-channel neck coil while seated in a 0.5 T upright open magnetic resonance imaging (MRI) scanner using a three-dimensional double echo steady-state (DESS) sequence. Volunteers were imaged while relaxing their arm for 10, 20, and 30 min during an isometric biceps flexion immediately following performance of biceps curls to exhaustion, and again after relaxing for 10 and 20 min. Voxel-wise T2 was calculated by fitting to a DESS signal equation in regions segmented at muscle centers to determine mean T2 . During isometric biceps flexion immediately following biceps curls, mean T2 increased (average 33%, p < 0.05) in the biceps but not in the triceps. By 20 min after curls, mean T2 decreased (p < 0.05), and was near preactivity values. In contrast, there was no change in triceps T2 across any activity or postactivity time points. Intra-rater repeatability was excellent (ICC: 0.90-0.97). This study demonstrated that measuring T2 in an active muscle is feasible using a DESS sequence in an upright open MRI scanner. This could enable the study of muscle function while the muscle is working and weight-bearing, rather than of the "fatigue" of the muscles after activity. In comparison to electromyography, MRI also enables the study of deep muscles and allows simultaneous assessment of activity and function.
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Affiliation(s)
- Noor Shaikh
- School of Biomedical Engineering, University of British Columbia (UBC), Vancouver, British Columbia, Canada.,International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Mechanical Engineering, University of British Columbia, Vancouver, British Columbia, Canada
| | - Andrew Yung
- UBC MRI Research Center, University of British Columbia, Vancouver, British Columbia, Canada
| | - Honglin Zhang
- Centre for Hip Health and Mobility, University of British Columbia, Vancouver, British Columbia, Canada
| | - John Street
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Cornelia Laule
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Physics & Astronomy, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Pathology & Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Thomas Oxland
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Mechanical Engineering, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada
| | - David R Wilson
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, British Columbia, Canada.,Centre for Hip Health and Mobility, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada
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17
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Breen A, Carvil P, Green DA, Russomano T, Breen A. Effects of a microgravity SkinSuit on lumbar geometry and kinematics. 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 2023; 32:839-847. [PMID: 36645514 DOI: 10.1007/s00586-022-07454-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 09/12/2022] [Accepted: 11/05/2022] [Indexed: 01/17/2023]
Abstract
PURPOSE Astronauts returning from long ISS missions have demonstrated an increased incidence of lumbar disc herniation accompanied by biomechanical and morphological changes associated with spine elongation. This research describes a ground-based study of the effects of an axial compression countermeasure Mk VI SkinSuit designed to reload the spine and reduce these changes before return to terrestrial gravity. METHODS Twenty healthy male volunteers aged 21-36 without back pain participated. Each lay overnight on a Hyper Buoyancy Flotation (HBF) bed for 12 h on two occasions 6 weeks apart. On the second occasion participants donned a Mk VI SkinSuit designed to axially load the spine at 0.2 Gz during the last 4 h of flotation. Immediately after each exposure, participants received recumbent MRI and flexion-extension quantitative fluoroscopy scans of their lumbar spines, measuring differences between spine geometry and intervertebral kinematics with and without the SkinSuit. This was followed by the same procedure whilst weight bearing. Paired comparisons were performed for all measurements. RESULTS Following Mk VI SkinSuit use, participants evidenced more flexion RoM at L3-4 (p = 0.01) and L4-5 (p = 0.003), more translation at L3-4 (p = 0.02), lower dynamic disc height at L5-S1 (p = 0.002), lower lumbar spine length (p = 0.01) and greater lordosis (p = 0.0001) than without the Mk VI SkinSuit. Disc cross-sectional area and volume were not significantly affected. CONCLUSION The MkVI SkinSuit restores lumbar mobility and lordosis following 4 h of wearing during hyper buoyancy flotation in a healthy control population and may be an effective countermeasure for post space flight lumbar disc herniation.
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Affiliation(s)
- Alexander Breen
- Faculty of Science and Technology, Bournemouth University, Poole, BH12 5BB, UK
| | - Philip Carvil
- Centre of Human and Applied Physiological Sciences, King's College London, Strand, London, WC2R 2LS, UK
| | - David Andrew Green
- Centre of Human and Applied Physiological Sciences, King's College London, Strand, London, WC2R 2LS, UK.,Space Medicine Team, European Astronaut Centre, European Space Agency, Cologne, Germany.,KBRwyle, Cologne, Germany
| | - Thais Russomano
- CEMA, Faculty of Medicine, University of Lisbon, Avenida Professor Egas Moniz (Edifício Comum ao Hospital de Santa Maria), 1649-028, Lisbon, Portugal
| | - Alan Breen
- Faculty of Science and Technology, Bournemouth University, Poole, BH12 5BB, UK.
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18
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Vande Berg BC, Mourad C, Omoumi P, Malghem J. Magnetic Resonance Imaging of Accelerated Bone Remodeling. Semin Musculoskelet Radiol 2023; 27:114-123. [PMID: 36868249 DOI: 10.1055/s-0043-1761611] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2023]
Abstract
A regional acceleration of bone remodeling may possibly follow biomechanical insults to the bone. This review assesses the literature and clinical arguments supporting the hypothetical association between accelerated bone remodeling and bone marrow edema (BME)-like signal intensity on magnetic resonance imaging. BME-like signal is defined as a confluent ill-delimited area of bone marrow with a moderate decrease in signal intensity on fat-sensitive sequences and a high signal intensity on fat-suppressed fluid-sensitive sequences. In addition to this confluent pattern, a linear subcortical pattern and a patchy disseminated pattern have also been recognized on fat-suppressed fluid-sensitive sequences. These particular BME-like patterns may remain occult on T1-weighted spin-echo images. We hypothesize that these BME-like patterns, with particular characteristics in terms of distribution and signal, are associated with accelerated bone remodeling. Limitations in recognizing these BME-like patterns are also discussed.
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Affiliation(s)
- Bruno C Vande Berg
- Department of Radiology, Musculoskeletal Section, Centre Hospitalier Chrétien, CHC, Clinique Mont Legia, Liege, Belgium
| | - Charbel Mourad
- Department of Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.,Department of Diagnostic and Interventional Radiology, Hôpital Libanais Geitaoui- CHU, Beyrouth, Lebanon
| | - Patrick Omoumi
- Department of Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Jacques Malghem
- Department of Radiology, Cliniques Universitaires Saint-Luc Université Catholique de Louvain, Brussels, Belgium
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19
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Krittanawong C, Singh NK, Scheuring RA, Urquieta E, Bershad EM, Macaulay TR, Kaplin S, Dunn C, Kry SF, Russomano T, Shepanek M, Stowe RP, Kirkpatrick AW, Broderick TJ, Sibonga JD, Lee AG, Crucian BE. Human Health during Space Travel: State-of-the-Art Review. Cells 2022; 12:cells12010040. [PMID: 36611835 PMCID: PMC9818606 DOI: 10.3390/cells12010040] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 12/05/2022] [Accepted: 12/07/2022] [Indexed: 12/24/2022] Open
Abstract
The field of human space travel is in the midst of a dramatic revolution. Upcoming missions are looking to push the boundaries of space travel, with plans to travel for longer distances and durations than ever before. Both the National Aeronautics and Space Administration (NASA) and several commercial space companies (e.g., Blue Origin, SpaceX, Virgin Galactic) have already started the process of preparing for long-distance, long-duration space exploration and currently plan to explore inner solar planets (e.g., Mars) by the 2030s. With the emergence of space tourism, space travel has materialized as a potential new, exciting frontier of business, hospitality, medicine, and technology in the coming years. However, current evidence regarding human health in space is very limited, particularly pertaining to short-term and long-term space travel. This review synthesizes developments across the continuum of space health including prior studies and unpublished data from NASA related to each individual organ system, and medical screening prior to space travel. We categorized the extraterrestrial environment into exogenous (e.g., space radiation and microgravity) and endogenous processes (e.g., alteration of humans' natural circadian rhythm and mental health due to confinement, isolation, immobilization, and lack of social interaction) and their various effects on human health. The aim of this review is to explore the potential health challenges associated with space travel and how they may be overcome in order to enable new paradigms for space health, as well as the use of emerging Artificial Intelligence based (AI) technology to propel future space health research.
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Affiliation(s)
- Chayakrit Krittanawong
- Department of Medicine and Center for Space Medicine, Section of Cardiology, Baylor College of Medicine, Houston, TX 77030, USA
- Translational Research Institute for Space Health, Houston, TX 77030, USA
- Department of Cardiovascular Diseases, New York University School of Medicine, New York, NY 10016, USA
- Correspondence: or (C.K.); (B.E.C.); Tel.: +1-713-798-4951 (C.K.); +1-281-483-0123 (B.E.C.)
| | - Nitin Kumar Singh
- Biotechnology and Planetary Protection Group, Jet Propulsion Laboratory, California Institute of Technology, Pasadena, CA 91109, USA
| | | | - Emmanuel Urquieta
- Translational Research Institute for Space Health, Houston, TX 77030, USA
- Department of Emergency Medicine and Center for Space Medicine, Baylor College of Medicine, Houston, TX 77030, USA
| | - Eric M. Bershad
- Department of Neurology, Center for Space Medicine, Baylor College of Medicine, Houston, TX 77030, USA
| | | | - Scott Kaplin
- Department of Cardiovascular Diseases, New York University School of Medicine, New York, NY 10016, USA
| | - Carly Dunn
- Department of Dermatology, Baylor College of Medicine, Houston, TX 77030, USA
| | - Stephen F. Kry
- Department of Radiation Physics, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | | | - Marc Shepanek
- Office of the Chief Health and Medical Officer, NASA, Washington, DC 20546, USA
| | | | - Andrew W. Kirkpatrick
- Department of Surgery and Critical Care Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada
| | | | - Jean D. Sibonga
- Division of Biomedical Research and Environmental Sciences, NASA Lyndon B. Johnson Space Center, Houston, TX 77058, USA
| | - Andrew G. Lee
- Department of Ophthalmology, University of Texas Medical Branch School of Medicine, Galveston, TX 77555, USA
- Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital, Houston, TX 77030, USA
- Department of Ophthalmology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
- Department of Ophthalmology, Texas A and M College of Medicine, College Station, TX 77807, USA
- Department of Ophthalmology, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA
- Departments of Ophthalmology, Neurology, and Neurosurgery, Weill Cornell Medicine, New York, NY 10021, USA
| | - Brian E. Crucian
- National Aeronautics and Space Administration (NASA) Johnson Space Center, Human Health and Performance Directorate, Houston, TX 77058, USA
- Correspondence: or (C.K.); (B.E.C.); Tel.: +1-713-798-4951 (C.K.); +1-281-483-0123 (B.E.C.)
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20
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Gong Z, Li D, Zou F, Liu S, Wang H, Ma X. Low lumbar multifidus muscle status and bone mineral density are important risk factors for adjacent segment disease after lumbar fusion: a case–control study. J Orthop Surg Res 2022; 17:490. [DOI: 10.1186/s13018-022-03388-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 11/05/2022] [Indexed: 11/17/2022] Open
Abstract
Abstract
Background
The quantity and quality of the paraspinal muscles are important factors that lead to spinal diseases. However, the role of paraspinal muscles in the pathogenesis of adjacent segment disease (ASD) after lumbar fusion surgery is rarely studied. The purpose of the research is to investigate the relationship between paraspinal muscles and ASD.
Methods
Thirty-three patients with ASD were included, and 33 controls without ASD were matched according to the basic demographic information. Cross-sectional images of the paraspinal muscles at each intervertebral disk level (L1–S1) before the first operation were analyzed, and the cross-sectional area (CSA) and degree of fat infiltration (FI) of the multifidus (MF) muscle and the erector spinae muscle were compared.
Results
There was no significant difference in demographic characteristics (P > 0.05) except for the bone mineral density (BMD) (P = 0.037) between the two groups. There were significant differences in the CSA and FI of the lower lumbar multifidus (P < 0.05). The CSA of the MF muscle at L3–L4, FI of the MF muscle at L4–L5 and L5–S1 and BMD were important risk factors for ASD. Among patients who received two-segment fusion for the first time, significant difference was observed in the degree of FI of the MF muscle in the lower lumbar segment (P < 0.05).
Conclusions
The CSA, FI and BMD of the lower lumbar MF muscle were closely related to the occurrence of ASD. The CSA of the MF muscle at L3–L4, the degree of FI of the MF muscle at L4–L5 and L5–S1 and BMD were important risk factors for ASD. The number of fusion segments in the first operation has a certain impact on the above-mentioned conclusions.
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21
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Liu Z, Fu C. Application of single and cooperative different delivery systems for the treatment of intervertebral disc degeneration. Front Bioeng Biotechnol 2022; 10:1058251. [PMID: 36452213 PMCID: PMC9702580 DOI: 10.3389/fbioe.2022.1058251] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 11/01/2022] [Indexed: 11/07/2023] Open
Abstract
Intervertebral disc (IVD) degeneration (IDD) is the most universal pathogenesis of low back pain (LBP), a prevalent and costly medical problem across the world. Persistent low back pain can seriously affect a patient's quality of life and even lead to disability. Furthermore, the corresponding medical expenses create a serious economic burden to both individuals and society. Intervertebral disc degeneration is commonly thought to be related to age, injury, obesity, genetic susceptibility, and other risk factors. Nonetheless, its specific pathological process has not been completely elucidated; the current mainstream view considers that this condition arises from the interaction of multiple mechanisms. With the development of medical concepts and technology, clinicians and scientists tend to intervene in the early or middle stages of intervertebral disc degeneration to avoid further aggravation. However, with the aid of modern delivery systems, it is now possible to intervene in the process of intervertebral disc at the cellular and molecular levels. This review aims to provide an overview of the main mechanisms associated with intervertebral disc degeneration and the delivery systems that can help us to improve the efficacy of intervertebral disc degeneration treatment.
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Affiliation(s)
- Zongtai Liu
- Department of Orthopedics, Affiliated Hospital of Beihua University, Jilin, China
| | - Changfeng Fu
- Department of Spine Surgery, First Hospital of Jilin University, Changchun, China
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22
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Plehuna A, Green DA, Amirova LE, Tomilovskaya ES, Rukavishnikov IV, Kozlovskaya IB. Dry immersion induced acute low back pain and its relationship with trunk myofascial viscoelastic changes. Front Physiol 2022; 13:1039924. [PMID: 36311233 PMCID: PMC9606241 DOI: 10.3389/fphys.2022.1039924] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 09/26/2022] [Indexed: 08/12/2023] Open
Abstract
Microgravity induces spinal elongation and Low Back Pain (LBP) but the pathophysiology is unknown. Changes in paraspinal muscle viscoelastic properties may play a role. Dry Immersion (DI) is a ground-based microgravity analogue that induces changes in m. erector spinae superficial myofascial tissue tone within 2 h. This study sought to determine whether bilateral m. erector spinae tone, creep, and stiffness persist beyond 2 h; and if such changes correlate with DI-induced spinal elongation and/or LBP. Ten healthy males lay in the DI bath at the Institute of Biomedical Problems (Moscow, Russia) for 6 h. Bilateral lumbar (L1, L4) and thoracic (T11, T9) trunk myofascial tone, stiffness and creep (MyotonPRO), and subjective LBP (0-10 NRS) were recorded before DI, after 1h, 6 h of DI, and 30min post. The non-standing spinal length was evaluated on the bath lifting platform using a bespoke stadiometer before and following DI. DI significantly modulated m. erector spinae viscoelastic properties at L4, L1, T11, and T9 with no effect of laterality. Bilateral tissue tone was significantly reduced after 1 and 6 h DI at L4, L1, T11, and T9 to a similar extent. Stiffness was also reduced by DI at 1 h but partially recovered at 6 h for L4, L1, and T11. Creep was increased by DI at 1 h, with partial recovery at 6 h, although only T11 was significant. All properties returned to baseline 30 min following DI. Significant spinal elongation (1.17 ± 0.20 cm) with mild (at 1 h) to moderate (at 6 h) LBP was induced, mainly in the upper lumbar and lower thoracic regions. Spinal length increases positively correlated (Rho = 0.847, p = 0.024) with middle thoracic (T9) tone reduction, but with no other stiffness or creep changes. Spinal length positively correlated (Rho = 0.557, p = 0.039) with Max LBP; LBP failed to correlate with any m. erector spinae measured parameters. The DI-induced bilateral m. erector spinae tone, creep, and stiffness changes persist beyond 2 h. Evidence of spinal elongation and LBP allows suggesting that the trunk myofascial tissue changes could play a role in LBP pathogenesis observed in real and simulated microgravity. Further study is warranted with longer duration DI, assessment of IVD geometry, and vertebral column stability.
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Affiliation(s)
- Anastasija Plehuna
- King’s College London, Centre of Human & Applied Physiological Sciences, London, United Kingdom
- Laboratory of Gravitational Physiology of the Sensorimotor System, Institute of Biomedical Problems, Russian Academy of Sciences, Moscow, Russia
| | - David Andrew Green
- King’s College London, Centre of Human & Applied Physiological Sciences, London, United Kingdom
- Space Medicine Team, HRE-OM, European Astronaut Centre, European Space Agency, Cologne, Germany
- KBRwyle Laboratories GmbH, Cologne, Germany
| | - Liubov E. Amirova
- Laboratory of Gravitational Physiology of the Sensorimotor System, Institute of Biomedical Problems, Russian Academy of Sciences, Moscow, Russia
| | - Elena S. Tomilovskaya
- Laboratory of Gravitational Physiology of the Sensorimotor System, Institute of Biomedical Problems, Russian Academy of Sciences, Moscow, Russia
| | - Ilya V. Rukavishnikov
- Laboratory of Gravitational Physiology of the Sensorimotor System, Institute of Biomedical Problems, Russian Academy of Sciences, Moscow, Russia
| | - Inessa B. Kozlovskaya
- Laboratory of Gravitational Physiology of the Sensorimotor System, Institute of Biomedical Problems, Russian Academy of Sciences, Moscow, Russia
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23
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Marcos-Lorenzo D, Frett T, Gil-Martinez A, Speer M, Swanenburg J, Green DA. Effect of trunk exercise upon lumbar IVD height and vertebral compliance when performed supine with 1 g at the CoM compared to upright in 1 g. BMC Sports Sci Med Rehabil 2022; 14:177. [PMID: 36207739 PMCID: PMC9540696 DOI: 10.1186/s13102-022-00575-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 09/27/2022] [Indexed: 11/21/2022]
Abstract
Background Spinal unloading in microgravity is associated with stature increments, back pain, intervertebral disc (IVD) swelling and impaired spinal kinematics. The aim of this study was to determine the effect of lateral stabilization, trunk rotation and isometric abdominal exercise upon lumbar IVD height, and both passive and active vertebral compliance when performed supine on a short-arm human centrifuge (SAHC)—a candidate microgravity countermeasure—with 1 g at the CoM, compared to that generated with equivalent upright exercise in 1 g. Methods 12 (8 male) healthy subjects (33.8 ± 7 years, 178.4 ± 8.2 cm, 72.1 ± 9.6 kg) gave written informed consent. Subjects performed three sets of upper body trunk exercises either when standing upright (UPRIGHT), or when being spun on the SAHC. Lumbar IVD height and vertebral compliance (active and passive) were evaluated prior to SAHC (PRE SAHC) and following the first SAHC (POST SPIN 1) and second Spin (POST SPIN 2), in addition to before (PRE UPRIGHT), and after upright trunk exercises (POST UPRIGHT). Results No significant effect upon IVD height (L2–S1) when performed UPRIGHT or on the SAHC was observed. Trunk muscle exercise induced significant (p < 0.05) reduction of active thoracic vertebral compliance when performed on the SAHC, but not UPRIGHT. However, no effect was observed in the cervical, lumbar or across the entire vertebral column. On passive or active vertebral compliance. Conclusion This study, the first of its kind demonstrates that trunk exercise were feasible and tolerable. Whilst trunk muscle exercise appears to have minor effect upon IVD height, it may be a candidate approach to mitigate—particularly active—vertebral stability on Earth, and in μg via concurrent SAHC. However, significant variability suggests larger studies including optimization of trunk exercise and SAHC prescription with MRI are warranted. Trial Registration North Rhine ethical committee (Number: 6000223393) and registered on 29/09/2020 in the German Clinical Trials Register (DRKS00021750).
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Affiliation(s)
- D Marcos-Lorenzo
- School of Medicine of Autonomous, University of Madrid, 28029, Madrid, Spain
| | - T Frett
- Department of Aerospace Physiology, Institute for Aerospace Medicine, German Aerospace Center E.V. (DLR), 51147, Cologne, Germany
| | - A Gil-Martinez
- Department of Physiotherapy, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, 28023, Madrid, Spain
| | - M Speer
- Space Medicine Team, European Astronaut Centre, European Space Agency, Linder Höhe, 51147, Cologne, Germany
| | - J Swanenburg
- Integrative Spinal Research ISR, Department of Chiropractic Medicine, Balgrist University Hospital, UZH Space Hub Space Life Sciences, University of Zurich, Lengghalde 5, 8008, Zurich, Switzerland. .,University of Zurich, Zurich, Switzerland.
| | - D A Green
- Space Medicine Team, European Astronaut Centre, European Space Agency, Linder Höhe, 51147, Cologne, Germany.,Centre of Human and Applied Physiological Sciences, King's College London, London, SE1 1UL, UK.,KBRwyle GmbH, Albin Köbis Straße 4, 51147, Cologne, Germany
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24
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Frett T, Lecheler L, Speer M, Marcos D, Pesta D, Tegtbur U, Schmitz MT, Jordan J, Green DA. Comparison of trunk muscle exercises in supine position during short arm centrifugation with 1 g at centre of mass and upright in 1 g. Front Physiol 2022; 13:955312. [PMID: 36060705 PMCID: PMC9428406 DOI: 10.3389/fphys.2022.955312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Accepted: 07/26/2022] [Indexed: 12/02/2022] Open
Abstract
Spaceflight is associated with reduced antigravitational muscle activity, which results in trunk muscle atrophy and may contribute to post-flight postural and spinal instability. Exercise in artificial gravity (AG) performed via short-arm human centrifugation (SAHC) is a promising multi-organ countermeasure, especially to mitigate microgravity-induced postural muscle atrophy. Here, we compared trunk muscular activity (mm. rectus abdominis, ext. obliques and multifidi), cardiovascular response and tolerability of trunk muscle exercises performed during centrifugation with 1 g at individual center of mass on a SAHC against standard upright exercising. We recorded heart rate, blood pressure, surface trunk muscle activity, motion sickness and rating of perceived exertion (BORG) of 12 participants (8 male/4 female, 34 ± 7 years, 178.4 ± 8.2 cm, 72.1 ± 9.6 kg). Heart rate was significantly increased (p < 0.001) during exercises without differences in conditions. Systolic blood pressure was higher (p < 0.001) during centrifugation with a delayed rise during exercises in upright condition. Diastolic blood pressure was lower in upright (p = 0.018) compared to counter-clockwise but not to clockwise centrifugation. Target muscle activation were comparable between conditions, although activity of multifidi was lower (clockwise: p = 0.003, counter-clockwise: p < 0.001) and rectus abdominis were higher (clockwise: p = 0.0023, counter-clockwise: < 0.001) during centrifugation in one exercise type. No sessions were terminated, BORG scoring reflected a relevant training intensity and no significant increase in motion sickness was reported during centrifugation. Thus, exercising trunk muscles during centrifugation generates comparable targeted muscular and heart rate response and appears to be well tolerated. Differences in blood pressure were relatively minor and not indicative of haemodynamic challenge. SAHC-based muscle training is a candidate to reduce microgravity-induced inter-vertebral disc pathology and trunk muscle atrophy. However, further optimization is required prior to performance of a training study for individuals with trunk muscle atrophy/dysfunction.
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Affiliation(s)
- Timo Frett
- German Aerospace Center, Institute of Aerospace Medicine, Cologne, Germany
- *Correspondence: Timo Frett,
| | - Leopold Lecheler
- German Aerospace Center, Institute of Aerospace Medicine, Cologne, Germany
| | | | | | - Dominik Pesta
- German Aerospace Center, Institute of Aerospace Medicine, Cologne, Germany
- Center for Endocrinology, Diabetes and Preventive Medicine (CEDP), University Hospital Cologne, Cologne, Germany
- Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Cologne, Germany
| | - Uwe Tegtbur
- Hannover Medical School, Institutes of Sports Medicine, Hannover, Germany
| | - Marie-Therese Schmitz
- German Aerospace Center, Institute of Aerospace Medicine, Cologne, Germany
- Informatics and Epidemiology, Institute of Medical Biometry, Medical Faculty, University of Bonn, Bonn, Germany
| | - Jens Jordan
- German Aerospace Center, Institute of Aerospace Medicine, Cologne, Germany
- Chair of Aerospace Medicine, University of Cologne, Cologne, Germany
| | - David Andrew Green
- European Space Agency, Cologne, Germany
- King’s College London, London, United Kingdom
- Space Medicine Team, European Astronaut Centre, European Space Agency, Cologne, Germany
- KBRwyle GmbH, Cologne, Germany
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25
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Belavy DL, Armbrecht G, Albracht K, Brisby H, Falla D, Scheuring R, Sovelius R, Wilke HJ, Rennerfelt K, Martinez-Valdes E, Arvanitidis M, Goell F, Braunstein B, Kaczorowski S, Karner V, Arora NK. Cervical spine and muscle adaptation after spaceflight and relationship to herniation risk: protocol from 'Cervical in Space' trial. BMC Musculoskelet Disord 2022; 23:772. [PMID: 35964076 PMCID: PMC9375326 DOI: 10.1186/s12891-022-05684-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 07/24/2022] [Indexed: 11/21/2022] Open
Abstract
Background Astronauts have a higher risk of cervical intervertebral disc herniation. Several mechanisms have been attributed as causative factors for this increased risk. However, most of the previous studies have examined potential causal factors for lumbar intervertebral disc herniation only. Hence, we aim to conduct a study to identify the various changes in the cervical spine that lead to an increased risk of cervical disc herniation after spaceflight. Methods A cohort study with astronauts will be conducted. The data collection will involve four main components: a) Magnetic resonance imaging (MRI); b) cervical 3D kinematics; c) an Integrated Protocol consisting of maximal and submaximal voluntary contractions of the neck muscles, endurance testing of the neck muscles, neck muscle fatigue testing and questionnaires; and d) dual energy X-ray absorptiometry (DXA) examination. Measurements will be conducted at several time points before and after astronauts visit the International Space Station. The main outcomes of interest are adaptations in the cervical discs, muscles and bones. Discussion Astronauts are at higher risk of cervical disc herniation, but contributing factors remain unclear. The results of this study will inform future preventive measures for astronauts and will also contribute to the understanding of intervertebral disc herniation risk in the cervical spine for people on Earth. In addition, we anticipate deeper insight into the aetiology of neck pain with this research project. Trial registration German Clinical Trials Register, DRKS00026777. Registered on 08 October 2021. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-022-05684-0.
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Affiliation(s)
- Daniel L Belavy
- Department of Applied Health Sciences, Division of Physiotherapy, Hochschule für Gesundheit (University of Applied Sciences), Gesundheitscampus 6-8, 44801, Bochum, Germany.
| | - Gabriele Armbrecht
- Center for Muscle and Bone Research, Charité - University Medicine Berlin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Kirsten Albracht
- Department of Medical Engineering and Technomathematics, Aachen University of Applied Sciences, Aachen, Germany.,Institute of Movement and Neuroscience, German Sport University, Am Sportpark Müngersdorf 6, Cologne, 50933, Germany
| | - Helena Brisby
- Department of Orthopedic Surgery, Sahlgrenska University Hospital, 415 45, Göteborg, Sweden
| | - Deborah Falla
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Edgbaston, B15 2TT, UK
| | - Richard Scheuring
- NASA Johnson Space Center, 2101 NASA Parkway SD4, Houston, TX, 77058, USA
| | - Roope Sovelius
- Centre for Military Medicine, Satakunta Air Command, P.O.Box 761, 33101, Tampere, Finland
| | | | - Kajsa Rennerfelt
- Orthopaedics and Spine Surgery, Sahlgrenska University Hospital, Bruna Stråket 11B, Göteborg, 413 45, Sweden
| | - Eduardo Martinez-Valdes
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Edgbaston, B15 2TT, UK
| | - Michail Arvanitidis
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Edgbaston, B15 2TT, UK
| | - Fabian Goell
- Institute of Movement and Neuroscience, German Sport University, Am Sportpark Müngersdorf 6, Cologne, 50933, Germany
| | - Bjoern Braunstein
- Institute of Movement and Neuroscience, German Sport University, Am Sportpark Müngersdorf 6, Cologne, 50933, Germany.,Institute of Biomechanics and Orthopaedics, German Sport University Cologne, Am Sportpark Müngersdorf 6, 50933, Cologne, Germany
| | - Svenja Kaczorowski
- Department of Applied Health Sciences, Division of Physiotherapy, Hochschule für Gesundheit (University of Applied Sciences), Gesundheitscampus 6-8, 44801, Bochum, Germany
| | - Vera Karner
- Department of Applied Health Sciences, Division of Physiotherapy, Hochschule für Gesundheit (University of Applied Sciences), Gesundheitscampus 6-8, 44801, Bochum, Germany
| | - Nitin Kumar Arora
- Department of Applied Health Sciences, Division of Physiotherapy, Hochschule für Gesundheit (University of Applied Sciences), Gesundheitscampus 6-8, 44801, Bochum, Germany
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26
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Age- and sex-dependent differences in the morphology and composition of paraspinal muscles between subjects with and without lumbar degenerative diseases. BMC Musculoskelet Disord 2022; 23:734. [PMID: 35915426 PMCID: PMC9341069 DOI: 10.1186/s12891-022-05692-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 07/25/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The quality of the paraspinal muscles has been recommended as a surrogate marker for the evaluation of the severity of the lumbar degenerative diseases (LDD). The purpose of this study is to determine the age- and sex-dependent differences in the morphology and composition of the paraspinal muscles between LDD and asymptomatic subjects. METHODS We analyzed data from 370 patients and 327 asymptomatic volunteers aged between 18-85 years. The measurement of the cross-sectional area (CSA) of the erector spinae, multifidus, and psoas at the L4/5-disc level was performed by the magnetic resonance imaging (MRI). The fatty infiltration ratio (FI %) of the multifidus and erector spinae was calculated. RESULTS FI % of the lumbar paraspinal muscles were significantly and positively correlated with the severity of LDD instead of the CSA. Males had greater CSA than females, and females showed higher FI % than males in the paraspinal muscles. With the increase of age, the CSA of the lumbar paraspinal muscles gradually decreased, and the psoas showed the most significant decreasing trend. However, the FI % gradually increased in both LDD and asymptomatic groups with aging. CONCLUSION Age- and sex-dependent differences were found in the morphology and composition of the paraspinal muscles between subjects with and without LDD. Further long-term follow up investigations and basic studies will continue to confirm the natural history of the paraspinal muscles with aging and their association with LDD.
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27
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Using hierarchical unsupervised learning to integrate and reduce multi-level and multi-paraspinal muscle MRI data in relation to low back pain. 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; 31:2046-2056. [PMID: 35333958 PMCID: PMC9338899 DOI: 10.1007/s00586-022-07169-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 02/23/2022] [Accepted: 02/28/2022] [Indexed: 01/20/2023]
Abstract
PURPOSE The paraspinal muscles (PSM) are a key feature potentially related to low back pain (LBP), and their structure and composition can be quantified using MRI. Most commonly, quantifying PSM measures across individual muscles and individual spinal levels renders numerous separate metrics that are analyzed in isolation. However, comprehensive multivariate approaches would be more appropriate for analyzing the PSM within an individual. To establish and test these methods, we hypothesized that multivariate summaries of PSM MRI measures would associate with the presence of LBP symptoms (i.e., pain intensity). METHODS We applied hierarchical multiple factor analysis (hMFA), an unsupervised integrative method, to clinical PSM MRI data from unique cohort datasets including a longitudinal cohort of astronauts with pre- and post-spaceflight data and a cohort of chronic LBP subjects and asymptomatic controls. Three specific use cases were investigated: (1) predicting longitudinal changes in pain using combinations of baseline PSM measures; (2) integrating baseline and post-spaceflight MRI to assess longitudinal change in PSM and how it relates to pain; and (3) integrating PSM quality and adjacent spinal pathology between LBP patients and controls. RESULTS Overall, we found distinct complex relationships with pain intensity between particular muscles and spinal levels. Subjects with high asymmetry between left and right lean muscle composition and differences between spinal segments PSM quality and structure are more likely to increase in pain reported outcome after prolonged time in microgravity. Moreover, changes in PSM quality and structure between pre and post-spaceflight relate to increase in pain after prolonged microgravity. Finally, we show how unsupervised hMFA recapitulates previous research on the association of CEP damage and LBP diagnostic. CONCLUSION Our analysis considers the spine as a multi-segmental unit as opposed to a series of discrete and isolated spine segments. Integrative and multivariate approaches can be used to distill large and complex imaging datasets thereby improving the clinical utility of MRI-based biomarkers, and providing metrics for further analytical goals, including phenotyping.
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Greene KA, Tooze JA, Lenchik L, Weaver AA. Change in Lumbar Muscle Size and Composition on MRI with Long-Duration Spaceflight. Ann Biomed Eng 2022; 50:816-824. [PMID: 35459964 PMCID: PMC9167780 DOI: 10.1007/s10439-022-02968-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 04/08/2022] [Indexed: 11/27/2022]
Abstract
Prolonged microgravity results in muscle atrophy, especially among the anti-gravity spinal muscles. How individual paravertebral muscle groups change in size and composition with spaceflight needs further exploration. This study investigates lumbar spine musculature changes among six crewmembers on long-duration space missions using non-invasive measurement of muscle changes with magnetic resonance imaging (MRI). Pre- and post-flight lumbar images were analyzed for changes in cross-sectional area, volume, and fat infiltration of the psoas (PS), quadratus lumborum (QL), and paraspinal [erector spinae and multifidus (ES + MF)] muscles using mixed models. Crewmembers used onboard exercise equipment, including a cycle ergometer (CEVIS), treadmill (T2/COLBERT), and the advanced resistive exercise device (ARED). Correlations were used to assess muscle changes related to exercise modality. There was substantial variability in muscle changes across crewmembers but collectively a significant decrease in paraspinal area (- 9.0 ± 4.8%, p = 0.04) and a significant increase in QL fat infiltration (7.3 ± 4.1%, p = 0.05). More CEVIS time may have protected against PS volume loss (p = 0.05) and PS fat infiltration (p < 0.01), and more ARED usage may have protected against ES + MF volume loss (p = 0.05). Crewmembers using modern onboard exercise equipment may be less susceptible to muscle changes. However, variability between crewmembers and muscle size and quality losses suggest additional research is needed to ensure in-flight countermeasures preserve muscle health.
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Affiliation(s)
- Katelyn A Greene
- Department of Biomedical Engineering, Center for Injury Biomechanics, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Janet A Tooze
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Leon Lenchik
- Department of Radiology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Ashley A Weaver
- Department of Biomedical Engineering, Center for Injury Biomechanics, Wake Forest School of Medicine, Winston-Salem, NC, USA.
- Department of Biomedical Engineering, Wake Forest School of Medicine, Winston-Salem, NC, 27101, USA.
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De Martino E, Hides J, Elliott JM, Hoggarth MA, Zange J, Lindsay K, Debuse D, Winnard A, Beard D, Cook JA, Salomoni SE, Weber T, Scott J, Hodges PW, Caplan N. The Effects of Reconditioning Exercises Following Prolonged Bed Rest on Lumbopelvic Muscle Volume and Accumulation of Paraspinal Muscle Fat. Front Physiol 2022; 13:862793. [PMID: 35774286 PMCID: PMC9237402 DOI: 10.3389/fphys.2022.862793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 05/25/2022] [Indexed: 11/13/2022] Open
Abstract
Reduced muscle size and accumulation of paraspinal muscle fat content (PFC) have been reported in lumbopelvic muscles after spaceflights and head-down tilt (HDT) bed rest. While some information is available regarding reconditioning programs on muscle atrophy recovery, the effects on the accumulation of PFC are unknown. Recently, a device (the Functional Re-adaptive Exercise Device—FRED) has been developed which aims to specifically recruit lumbopelvic muscles. This study aimed to investigate the effects of a standard reconditioning (SR) program and SR program supplemented by FRED (SR + FRED) on the recovery of the lumbopelvic muscles following 60-day HDT bed rest. Twenty-four healthy participants arrived at the facility for baseline data collection (BDC) before the bed rest period. They remained in the facility for 13-day post-HDT bed rest and were randomly allocated to one of two reconditioning programs: SR or SR + FRED. Muscle volumes of the lumbar multifidus (LM), lumbar erector spinae (LES), quadratus lumborum (QL), and psoas major (PM) muscles were measured from axial T1-weighted magnetic resonance imaging (MRI) at all lumbar intervertebral disc levels. PFC was determined using a chemical shift-based lipid/water Dixon sequence. Each lumbopelvic muscle was segmented into four equal quartiles (from medial to lateral). MRI of the lumbopelvic region was conducted at BDC, Day-59 of bed rest (HDT59), and Day-13 after reconditioning (R13). Comparing R13 with BDC, the volumes of the LM muscle at L4/L5 and L5/S1, LES at L1/L2, and QL at L3/L4 had not recovered (all—p < 0.05), and the PM muscle remained larger at L1/L2 (p = 0.001). Accumulation of PFC in the LM muscle at the L4/L5 and L5/S1 levels remained higher in the centro-medial regions at R13 than BDC (all—p < 0.05). There was no difference between the two reconditioning programs. A 2-week reconditioning program was insufficient to fully restore all volumes of lumbopelvic muscles and reverse the accumulation of PFC in the muscles measured to BDC values, particularly in the LM muscle at the lower lumbar levels. These findings suggest that more extended reconditioning programs or alternative exercises may be necessary to fully restore the size and properties of the lumbopelvic muscles after prolonged bed rest.
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Affiliation(s)
- Enrico De Martino
- Aerospace Medicine and Rehabilitation Laboratory, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, United Kingdom
- *Correspondence: Enrico De Martino,
| | - Julie Hides
- School of Health Sciences and Social Work, Griffith University, Brisbane, QLD, Australia
| | - James M. Elliott
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
- Northern Sydney Local Health District, Faculty of Medicine and Health, The Kolling Institute Sydney, The University of Sydney, Sydney, NSW, Australia
| | - Mark A. Hoggarth
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
- Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, IL, United States
| | - Jochen Zange
- German Aerospace Center, Institute of Aerospace Medicine, Cologne, Germany
| | - Kirsty Lindsay
- Aerospace Medicine and Rehabilitation Laboratory, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, United Kingdom
| | - Dorothée Debuse
- Aerospace Medicine and Rehabilitation Laboratory, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, United Kingdom
| | - Andrew Winnard
- Aerospace Medicine and Rehabilitation Laboratory, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, United Kingdom
| | - David Beard
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, United Kingdom
| | - Jonathan A. Cook
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, United Kingdom
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Centre for Statistics in Medicine, University of Oxford, Oxford, United Kingdom
| | - Sauro E. Salomoni
- NHMRC Centre for Clinical Research Excellence in Spinal Pain, Injury and Health, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia
| | - Tobias Weber
- Space Medicine Team, European Astronaut Centre, Cologne, Germany
- KBR GmbH, Cologne, Germany
| | - Jonathan Scott
- Space Medicine Team, European Astronaut Centre, Cologne, Germany
- KBR GmbH, Cologne, Germany
| | - Paul W. Hodges
- NHMRC Centre for Clinical Research Excellence in Spinal Pain, Injury and Health, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia
| | - Nick Caplan
- Aerospace Medicine and Rehabilitation Laboratory, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, United Kingdom
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De Martino E, Hides J, Elliott JM, Hoggarth MA, Zange J, Lindsay K, Debuse D, Winnard A, Beard D, Cook JA, Salomoni SE, Weber T, Scott J, Hodges PW, Caplan N. Intramuscular lipid concentration increased in localized regions of the lumbar muscles following 60 day bedrest. Spine J 2022; 22:616-628. [PMID: 34813960 DOI: 10.1016/j.spinee.2021.11.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 10/18/2021] [Accepted: 11/15/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Prolonged bedrest induces accumulation of intramuscular lipid concentration (ILC) in the lumbar musculature; however, spatial distribution of ILC has not been determined. Artificial gravity (AG) mitigates some adaptations induced by 60 day bedrest by creating a head-to-feet force while participants are in a supine position. PURPOSE To quantify the spatial distribution of accumulation of ILC in the lumbar musculature after 60 day bedrest, and whether this can be mitigated by AG exposure. STUDY DESIGN Prospective longitudinal study. PATIENT SAMPLE Twenty-four healthy individuals (8 females) participated in the study: Eight received 30 min continuous AG (cAG); Eight received 6 × 5 min AG (iAG), interspersed with rests; Eight were not exposed to AG (CRTL). OUTCOME MEASURES From 3T magnetic resonance imaging (MRI), axial images were selected to assess lumbar multifidus (LM), lumbar erector spinae (LES), quadratus lumborum (QL), and psoas major (PM) muscles from L1/L2 to L5/S1 intervertebral disc levels. Chemical shift-based 2-echo lipid and/or water Dixon sequence was used to measure tissue composition. Each lumbar muscle was segmented into four equal quartiles (from medial to lateral). METHODS Participants arrived at the facility for the baseline data collection before undergoing a 60 day strict 6° head-down tilt (HDT) bedrest period. MRI of the lumbopelvic region was conducted at baseline and Day-59 of bedrest. Participants performed all activities, including hygiene, in 6° HDT and were discouraged from moving excessively or unnecessarily. RESULTS At the L4/L5 and L5/S1 intervertebral disc levels, 60-day bedrest induced a greater increase in ILC in medial and lateral regions (∼+4%) of the LM than central regions (∼+2%; p<.05). A smaller increase in ILC was induced in the lateral region of LES (∼+1%) at L1/L2 and L2/L3 than at the centro-medial region (∼+2%; p<.05). There was no difference between CRTL and intervention groups. CONCLUSIONS Inhomogeneous spatial distribution of accumulation of ILC was found in the lumbar musculature after 60 day bedrest. These findings might reflect pathophysiological mechanisms related to muscle disuse and contribute to localized lumbar spine dysfunction. Altered spatial distribution of ILC may impair lumbar spine function after prolonged body unloading, which could increase injury risk to vulnerable soft tissues, such as the lumbar intervertebral discs. These novel results may represent a new biomarker of lumbar deconditioning for astronauts, bedridden, sedentary individuals, or those with chronic back pain. Changes are potentially modifiable but not by the AG protocols tested here.
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Affiliation(s)
- Enrico De Martino
- Aerospace Medicine and Rehabilitation Laboratory, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, United Kingdom.
| | - Julie Hides
- School of Health Sciences and Social Work, Griffith University, Nathan Campus, Brisbane, Australia
| | - James M Elliott
- Northwestern University, Feinberg School of Medicine Department of Physical Therapy and Human Movement Sciences, Chicago, IL, USA; Northern Sydney Local Health District and The University of Sydney, Faculty of Medicine and Health, The Kolling Institute Sydney, Australia
| | - Mark A Hoggarth
- Northwestern University, Feinberg School of Medicine Department of Physical Therapy and Human Movement Sciences, Chicago, IL, USA; Northwestern University, McCormick School of Engineering, Department of Biomedical Engineering, Evanston, IL, USA
| | - Jochen Zange
- Institute of Aerospace Medicine, German Aerospace Center (DLR), Cologne, Germany
| | - Kirsty Lindsay
- Aerospace Medicine and Rehabilitation Laboratory, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, United Kingdom
| | - Dorothée Debuse
- Aerospace Medicine and Rehabilitation Laboratory, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, United Kingdom
| | - Andrew Winnard
- Aerospace Medicine and Rehabilitation Laboratory, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, United Kingdom
| | - David Beard
- NIHR Oxford Biomedical Research Center, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - Jonathan A Cook
- NIHR Oxford Biomedical Research Center, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom; Center for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - Sauro E Salomoni
- The University of Queensland, NHMRC Center for Clinical Research Excellence in Spinal Pain, Injury and Health, School of Health and Rehabilitation Sciences, Brisbane, Australia
| | - Tobias Weber
- Space Medicine Team (HRE-OM), European Astronaut Center, Cologne, Germany; KBR GmbH, Cologne, Germany
| | - Jonathan Scott
- Space Medicine Team (HRE-OM), European Astronaut Center, Cologne, Germany; KBR GmbH, Cologne, Germany
| | - Paul W Hodges
- The University of Queensland, NHMRC Center for Clinical Research Excellence in Spinal Pain, Injury and Health, School of Health and Rehabilitation Sciences, Brisbane, Australia
| | - Nick Caplan
- Aerospace Medicine and Rehabilitation Laboratory, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, United Kingdom
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Zoetebier B, Schmitz T, Ito K, Karperien M, Tryfonidou MA, Paez J. Injectable hydrogels for articular cartilage and nucleus pulposus repair: Status quo and prospects. Tissue Eng Part A 2022; 28:478-499. [PMID: 35232245 DOI: 10.1089/ten.tea.2021.0226] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Osteoarthritis (OA) and chronic low back pain due to degenerative (intervertebral) disc disease (DDD) are two of the major causes of disabilities worldwide, affecting hundreds of millions of people and leading to a high socioeconomic burden. Although OA occurs in synovial joints and DDD occurs in cartilaginous joints, the similarities are striking, with both joints showing commonalities in the nature of the tissues and in the degenerative processes during disease. Consequently, repair strategies for articular cartilage (AC) and nucleus pulposus (NP), the core of the intervertebral disc, in the context of OA and DDD share common aspects. One of such tissue engineering approaches is the use of injectable hydrogels for AC and NP repair. In this review, the state-of-the-art and recent developments in injectable hydrogels for repairing, restoring, and regenerating AC tissue suffering from OA and NP tissue in DDD are summarized focusing on cell-free approaches. The various biomaterial strategies exploited for repair of both tissues are compared, and the synergies that could be gained by translating experiences from one tissue to the other are identified.
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Affiliation(s)
- Bram Zoetebier
- University of Twente Faculty of Science and Technology, 207105, Developmental BioEngineering , Drienerlolaan 5, Enschede, Netherlands, 7500 AE;
| | - Tara Schmitz
- Eindhoven University of Technology, 3169, Department of Biomedical Engineering, Eindhoven, Noord-Brabant, Netherlands;
| | - Keita Ito
- Eindhoven University of Technology, Department of Biomedical Engineering, P.O. Box 513, GEMZ 4.115, Eindhoven, Netherlands, 5600 MB;
| | | | - Marianna A Tryfonidou
- Utrecht University, Faculty of Veterinary Medicine, Clinical Sciences of Companion Animals, Yalelaan 108, Utrecht, Netherlands, 3584 CM;
| | - Julieta Paez
- University of Twente Faculty of Science and Technology, 207105, Developmental Bioengineering, University of Twente P.O. Box 217, Enschede The Netherlands, Enschede, Netherlands, 7500 AE;
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Biomechanical changes in the lumbar spine following spaceflight and factors associated with postspaceflight disc herniation. Spine J 2022; 22:197-206. [PMID: 34343665 DOI: 10.1016/j.spinee.2021.07.021] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 06/23/2021] [Accepted: 07/27/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT For chronic low back pain, the causal mechanisms between pathological features from imaging and patient symptoms are unclear. For instance, disc herniations can often be present without symptoms. There remains a need for improved knowledge of the pathophysiological mechanisms that explore spinal tissue damage and clinical manifestations of pain and disability. Spaceflight and astronaut health provides a rare opportunity to study potential low back pain mechanisms longitudinally. Spaceflight disrupts diurnal loading on the spine and several lines of evidence indicate that astronauts are at a heightened risk for low back pain and disc herniation following spaceflight. PURPOSE To examine the relationship between prolonged exposure to microgravity and the elevated incidence of postflight disc herniation, we conducted a longitudinal study to track the spinal health of twelve NASA astronauts before and after approximately 6 months in space. We hypothesize that the incidence of postflight disc herniation and low back complaints associates with spaceflight-included muscle atrophy and pre-existing spinal pathology. STUDY DESIGN This is a prospective longitudinal study. PATIENT SAMPLE Our sample included a cohort of twelve astronaut crewmembers. OUTCOME MEASURES From 3T MRI, we quantified disc water content (ms), disc degeneration (Pfirrmann grade), vertebral endplate irregularities, facet arthropathy and/ fluid, high intensity zones, disc herniation, multifidus total cross-sectional area (cm2), multifidus lean muscle cross-sectional area (cm2), and muscle quality/composition (%). From quantitative fluoroscopy we quantified, maximum flexion-extension ROM (°), maximum lateral bending ROM (°), and maximum translation (%). Lastly, patient outcomes and clinical notes were used for identifying postflight symptoms associated with disc herniations from 3T MRI. METHODS Advanced imaging data from 3T MRI were collected at three separate time points in relation to spending six months in space: (1) within a year before launch ("pre-flight"), (2) within a week after return to Earth ("post-flight"), and (3) between 1 and 2 months after return to Earth ("recovery"). Fluoroscopy of segmental kinematics was collected at preflight and postflight timepoints. We assessed the effect of spaceflight and postflight recovery on longitudinal changes in spinal structure and function, as well as differences between crew members who did and did not present a symptomatic disc herniation following spaceflight. RESULTS Half of our astronauts (n=6) experienced new symptoms associated with a new or previously asymptomatic lumbar disc protrusion or extrusion following spaceflight. We observed decreased multifidus muscle quality following spaceflight in the lower lumbar spine, with a reduced percentage of lean muscle at L4L5 (-6.2%, p=.009) and L5S1 (-7.0%, p=.006) associated with the incidence of new disc herniation. Additionally, we observed reduced lumbar segment flexion-extension ROM for L2L3 (-17.2%, p=.006) and L3L4 (-20.5%, p=.02) following spaceflight, and furthermore that reduced ROM among the upper three lumbar segments (-24.1%, p=.01) associated with the incidence of disc herniation. Existing endplate pathology was most prevalent in the upper lumbar spine and associated with reduced segmental ROM (-20.5%, p=.02). CONCLUSIONS In conclusion from a 10-year study investigating the effects of spaceflight on the lumbar spine and risk for disc herniation, we found the incidence of lumbar disc herniation following spaceflight associates with compromised multifidus muscle quality and spinal segment kinematics, as well as pre-existing spinal endplate irregularities. These findings suggest differential effects of spinal stiffness and muscle loss in the upper versus lower lumbar spine regions that may specifically provoke risk for symptomatic disc herniation in the lower lumbar spine following spaceflight. Results from this study provide a unique longitudinal assessment of mechanisms and possible risk factors for developing disc herniations and related low back pain. Furthermore, these findings will help inform physiologic countermeasures to maintain spinal health in astronauts during long-duration missions in space.
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Hodges PW, Bailey JF, Fortin M, Battié MC. Paraspinal muscle imaging measurements for common spinal disorders: review and consensus-based recommendations from the ISSLS degenerative spinal phenotypes group. 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; 30:3428-3441. [PMID: 34542672 DOI: 10.1007/s00586-021-06990-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 08/12/2021] [Accepted: 09/05/2021] [Indexed: 12/17/2022]
Abstract
PURPOSE Paraspinal muscle imaging is of growing interest related to improved phenotyping, prognosis, and treatment of common spinal disorders. We reviewed issues related to paraspinal muscle imaging measurement that contribute to inconsistent findings between studies and impede understanding. METHODS Three key contributors to inconsistencies among studies of paraspinal muscle imaging measurements were reviewed: failure to consider possible mechanisms underlying changes in paraspinal muscles, lack of control of confounding factors, and variations in spinal muscle imaging modalities and measurement protocols. Recommendations are provided to address these issues to improve the quality and coherence of future research. RESULTS Possible pathophysiological responses of paraspinal muscle to various common spinal disorders in acute or chronic phases are often overlooked, yet have important implications for the timing, distribution, and nature of changes in paraspinal muscle. These considerations, as well as adjustment for possible confounding factors, such as sex, age, and physical activity must be considered when planning and interpreting paraspinal muscle measurements in studies of spinal conditions. Adoption of standardised imaging measurement protocols for paraspinal muscle morphology and composition, considering the strengths and limitations of various imaging modalities, is critically important to interpretation and synthesis of research. CONCLUSION Study designs that consider physiological and pathophysiological responses of muscle, adjust for possible confounding factors, and use common, standardised measures are needed to advance knowledge of the determinants of variations or changes in paraspinal muscle and their influence on spinal health.
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Affiliation(s)
- Paul W Hodges
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, 4072, Australia.
| | - Jeannie F Bailey
- Department of Orthopedic Surgery, University of California, San Francisco, CA, USA
| | - Maryse Fortin
- Department of Health, Kinesiology & Applied Physiology, Concordia University, Montreal, QC, Canada
| | - Michele C Battié
- Faculty of Health Sciences and Western's Bone and Joint Institute, Western University, London, ON, Canada
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Tran V, De Martino E, Hides J, Cable G, Elliott JM, Hoggarth M, Zange J, Lindsay K, Debuse D, Winnard A, Beard D, Cook JA, Salomoni SE, Weber T, Scott J, Hodges PW, Caplan N. Gluteal Muscle Atrophy and Increased Intramuscular Lipid Concentration Are Not Mitigated by Daily Artificial Gravity Following 60-Day Head-Down Tilt Bed Rest. Front Physiol 2021; 12:745811. [PMID: 34867450 PMCID: PMC8634875 DOI: 10.3389/fphys.2021.745811] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 10/13/2021] [Indexed: 11/27/2022] Open
Abstract
Exposure to spaceflight and head-down tilt (HDT) bed rest leads to decreases in the mass of the gluteal muscle. Preliminary results have suggested that interventions, such as artificial gravity (AG), can partially mitigate some of the physiological adaptations induced by HDT bed rest. However, its effect on the gluteal muscles is currently unknown. This study investigated the effects of daily AG on the gluteal muscles during 60-day HDT bed rest. Twenty-four healthy individuals participated in the study: eight received 30 min of continuous AG; eight received 6 × 5 min of AG, interspersed with rest periods; eight belonged to a control group. T1-weighted Dixon magnetic resonance imaging of the hip region was conducted at baseline and day 59 of HDT bed rest to establish changes in volumes and intramuscular lipid concentration (ILC). Results showed that, across groups, muscle volumes decreased by 9.2% for gluteus maximus (GMAX), 8.0% for gluteus medius (GMED), and 10.5% for gluteus minimus after 59-day HDT bed rest (all p < 0.005). The ILC increased by 1.3% for GMAX and 0.5% for GMED (both p < 0.05). Neither of the AG protocols mitigated deconditioning of the gluteal muscles. Whereas all gluteal muscles atrophied, the ratio of lipids to intramuscular water increased only in GMAX and GMED muscles. These changes could impair the function of the hip joint and increased the risk of falls. The deconditioning of the gluteal muscles in space may negatively impact the hip joint stability of astronauts when reexpose to terrestrial gravity.
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Affiliation(s)
- Vienna Tran
- Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia
| | - Enrico De Martino
- Aerospace Medicine and Rehabilitation Laboratory, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, United Kingdom
| | - Julie Hides
- School of Health Sciences and Social Work, Griffith University, Brisbane, QLD, Australia
| | - Gordon Cable
- Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia
- School of Medicine, University of Tasmania, Hobart, TAS, Australia
| | - James M. Elliott
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
- Faculty of Medicine and Health, The Kolling Research Institute Sydney, Northern Sydney Local Health District, The University of Sydney, Sydney, NSW, Australia
| | - Mark Hoggarth
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
- Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, IL, United States
| | - Jochen Zange
- Institute of Aerospace Medicine, German Aerospace Center (DLR), Cologne, Germany
| | - Kirsty Lindsay
- Aerospace Medicine and Rehabilitation Laboratory, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, United Kingdom
| | - Dorothée Debuse
- Aerospace Medicine and Rehabilitation Laboratory, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, United Kingdom
| | - Andrew Winnard
- Aerospace Medicine and Rehabilitation Laboratory, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, United Kingdom
| | - David Beard
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, United Kingdom
| | - Jonathan A. Cook
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, United Kingdom
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Centre for Statistics in Medicine, University of Oxford, Oxford, United Kingdom
| | - Sauro E. Salomoni
- NHMRC Centre for Clinical Research Excellence in Spinal Pain, Injury and Health, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia
| | - Tobias Weber
- Space Medicine Team (HRE-OM), European Astronaut Centre, Cologne, Germany
- KBR GmbH, Cologne, Germany
| | - Jonathan Scott
- Space Medicine Team (HRE-OM), European Astronaut Centre, Cologne, Germany
- KBR GmbH, Cologne, Germany
| | - Paul W. Hodges
- NHMRC Centre for Clinical Research Excellence in Spinal Pain, Injury and Health, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia
| | - Nick Caplan
- Aerospace Medicine and Rehabilitation Laboratory, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, United Kingdom
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Early Deconditioning of Human Skeletal Muscles and the Effects of a Thigh Cuff Countermeasure. Int J Mol Sci 2021; 22:ijms222112064. [PMID: 34769492 PMCID: PMC8584355 DOI: 10.3390/ijms222112064] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 10/29/2021] [Accepted: 10/30/2021] [Indexed: 01/12/2023] Open
Abstract
Muscle deconditioning is a major consequence of a wide range of conditions from spaceflight to a sedentary lifestyle, and occurs as a result of muscle inactivity, leading to a rapid decrease in muscle strength, mass, and oxidative capacity. The early changes that appear in the first days of inactivity must be studied to determine effective methods for the prevention of muscle deconditioning. To evaluate the mechanisms of muscle early changes and the vascular effect of a thigh cuff, a five-day dry immersion (DI) experiment was conducted by the French Space Agency at the MEDES Space Clinic (Rangueil, Toulouse). Eighteen healthy males were recruited and divided into a control group and a thigh cuff group, who wore a thigh cuff at 30 mmHg. All participants underwent five days of DI. Prior to and at the end of the DI, the lower limb maximal strength was measured and muscle biopsies were collected from the vastus lateralis muscle. Five days of DI resulted in muscle deconditioning in both groups. The maximal voluntary isometric contraction of knee extension decreased significantly. The muscle fiber cross-sectional area decreased significantly by 21.8%, and the protein balance seems to be impaired, as shown by the reduced activation of the mTOR pathway. Measurements of skinned muscle fibers supported these results and potential changes in oxidative capacity were highlighted by a decrease in PGC1-α levels. The use of the thigh cuff did not prevent muscle deconditioning or impact muscle function. These results suggest that the major effects of muscle deconditioning occur during the first few days of inactivity, and countermeasures against muscle deconditioning should target this time period. These results are also relevant for the understanding of muscle weakness induced by muscle diseases, aging, and patients in intensive care.
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Pollock RD, Hodkinson PD, Smith TG. Oh G: The x, y and z of human physiological responses to acceleration. Exp Physiol 2021; 106:2367-2384. [PMID: 34730860 DOI: 10.1113/ep089712] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Accepted: 10/18/2021] [Indexed: 01/06/2023]
Abstract
NEW FINDINGS What is the topic of this review? This review focuses on the main physiological challenges associated with exposure to acceleration in the Gx, Gy and Gz directions and to microgravity. What advances does it highlight? Our current understanding of the physiology of these environments and latest strategies to protect against them are discussed in light of the limited knowledge we have in some of these areas. ABSTRACT The desire to go higher, faster and further has taken us to environments where the accelerations placed on our bodies far exceed or are much lower than that attributable to Earth's gravity. While on the ground, racing drivers of the fastest cars are exposed to high degrees of lateral acceleration (Gy) during cornering. In the air, while within the confines of the lower reaches of Earth's atmosphere, fast jet pilots are routinely exposed to high levels of acceleration in the head-foot direction (Gz). During launch and re-entry of suborbital and orbital spacecraft, astronauts and spaceflight participants are exposed to high levels of chest-back acceleration (Gx), whereas once in space the effects of gravity are all but removed (termed microgravity, μG). Each of these environments has profound effects on the homeostatic mechanisms within the body and can have a serious impact, not only for those with underlying pathology but also for healthy individuals. This review provides an overview of the main challenges associated with these environments and our current understanding of the physiological and pathophysiological adaptations to them. Where relevant, protection strategies are discussed, with the implications of our future exposure to these environments also being considered.
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Affiliation(s)
- Ross D Pollock
- Centre for Human and Applied Physiological Sciences, King's College London, London, UK
| | - Peter D Hodkinson
- Centre for Human and Applied Physiological Sciences, King's College London, London, UK
| | - Thomas G Smith
- Centre for Human and Applied Physiological Sciences, King's College London, London, UK.,Department of Anaesthesia, Guy's and St Thomas' NHS Foundation Trust, London, UK
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Shaikh N, Zhang H, Brown SHM, Lari H, Lasry O, Street J, Wilson DR, Oxland T. Synchronous imaging of pelvic geometry and muscle morphometry: a pilot study of pelvic retroversion using upright MRI. Sci Rep 2021; 11:20127. [PMID: 34635683 PMCID: PMC8505414 DOI: 10.1038/s41598-021-99305-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 09/22/2021] [Indexed: 02/05/2023] Open
Abstract
This study investigated feasibility of imaging lumbopelvic musculature and geometry in tandem using upright magnetic resonance imaging (MRI) in asymptomatic adults, and explored the effect of pelvic retroversion on lumbopelvic musculature and geometry. Six asymptomatic volunteers were imaged (0.5 T upright MRI) in 4 postures: standing, standing pelvic retroversion, standing 30° flexion, and supine. Measures included muscle morphometry [cross-sectional area (CSA), circularity, radius, and angle] of the gluteus and iliopsoas, and pelvic geometry [pelvic tilt (PT), pelvic incidence (PI), sacral slope (SS), L3-S1 lumbar lordosis (LL)] L3-coccyx. With four volunteers repeating postures, and three raters assessing repeatability, there was generally good repeatability [ICC(3,1) 0.80-0.97]. Retroversion had level dependent effects on muscle measures, for example gluteus CSA and circularity increased (up to 22%). Retroversion increased PT, decreased SS, and decreased L3-S1 LL, but did not affect PI. Gluteus CSA and circularity also had level-specific correlations with PT, SS, and L3-S1 LL. Overall, upright MRI of the lumbopelvic musculature is feasible with good reproducibility, and the morphometry of the involved muscles significantly changes with posture. This finding has the potential to be used for clinical consideration in designing and performing future studies with greater number of healthy subjects and patients.
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Affiliation(s)
- Noor Shaikh
- School of Biomedical Engineering, University of British Columbia, Vancouver, Canada.,ICORD, University of British Columbia, Vancouver, Canada.,Department of Mechanical Engineering, University of British Columbia, Vancouver, Canada
| | - Honglin Zhang
- Centre for Hip Health and Mobility, University of British Columbia, Vancouver, Canada
| | - Stephen H M Brown
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, Canada
| | - Hamza Lari
- Department of Radiology, Vancouver General Hospital, Vancouver, Canada
| | - Oliver Lasry
- ICORD, University of British Columbia, Vancouver, Canada.,Department of Orthopaedics, University of British Columbia, Vancouver, Canada
| | - John Street
- ICORD, University of British Columbia, Vancouver, Canada.,Department of Orthopaedics, University of British Columbia, Vancouver, Canada
| | - David R Wilson
- ICORD, University of British Columbia, Vancouver, Canada.,Centre for Hip Health and Mobility, University of British Columbia, Vancouver, Canada.,Department of Orthopaedics, University of British Columbia, Vancouver, Canada
| | - Thomas Oxland
- ICORD, University of British Columbia, Vancouver, Canada. .,Department of Mechanical Engineering, University of British Columbia, Vancouver, Canada. .,Department of Orthopaedics, University of British Columbia, Vancouver, Canada. .,University of British Columbia, ICORD, Blusson Spinal Cord Centre at VGH, 3rd Floor, 818 West 10th Avenue, Vancouver, BC, V5Z 1M9, Canada.
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De Martino E, Salomoni SE, Hodges PW, Hides J, Lindsay K, Debuse D, Winnard A, Elliott J, Hoggarth M, Beard D, Cook JA, Ekman R, Hinterwaldner L, Scott J, Weber T, Caplan N. Intermittent short-arm centrifugation is a partially effective countermeasure against upright balance deterioration following 60-day head-down tilt bed rest. J Appl Physiol (1985) 2021; 131:689-701. [PMID: 34197228 DOI: 10.1152/japplphysiol.00180.2021] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
This study investigated whether artificial gravity (AG), induced by short-radius centrifugation, mitigated deterioration in standing balance and anticipatory postural adjustments (APAs) of trunk muscles following 60-day head-down tilt bed rest. Twenty-four participants were allocated to one of three groups: control group (n = 8); 30-min continuous AG daily (n = 8); and intermittent 6 × 5 min AG daily (n = 8). Before and immediately after bed rest, standing balance was assessed in four conditions: eyes open and closed on both stable and foam surfaces. Measures including sway path, root mean square, and peak sway velocity, sway area, sway frequency power, and sway density curve were extracted from the center of pressure displacement. APAs were assessed during rapid arm movements using intramuscular or surface electromyography electrodes of the rectus abdominis; obliquus externus and internus abdominis; transversus abdominis; erector spinae at L1, L2, L3, and L4 vertebral levels; and deep lumbar multifidus muscles. The relative latency between the EMG onset of the deltoid and each of the trunk muscles was calculated. All three groups had poorer balance performance in most of the parameters (all P < 0.05) and delayed APAs of the trunk muscles following bed rest (all P < 0.05). Sway path and sway velocity were deteriorated, and sway frequency power was less in those who received intermittent AG than in the control group (all P < 0.05), particularly in conditions with reduced proprioceptive feedback. These data highlight the potential of intermittent AG to mitigate deterioration of some aspects of postural control induced by gravitational unloading, but no protective effects on trunk muscle responses were observed.NEW & NOTEWORTHY This study presents novel insights into the effect of artificial gravity (AG) on the deterioration of standing balance and anticipatory postural adjustments (APAs) of trunk muscles induced by 60-day strict head-down bed rest. The results indicated severe balance dysfunction and delayed APAs during rapid arm movement. AG partially mitigated the deterioration in standing balance and may thus be considered as a potential countermeasure for future planetary surface explorations. Optimization of AG protocols might enhance effects.
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Affiliation(s)
- Enrico De Martino
- Aerospace Medicine and Rehabilitation Laboratory, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, United Kingdom
| | - Sauro E Salomoni
- National Health and Medical Research Council Centre for Clinical Research Excellence in Spinal Pain, Injury and Health, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Paul W Hodges
- National Health and Medical Research Council Centre for Clinical Research Excellence in Spinal Pain, Injury and Health, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Julie Hides
- School of Health Sciences and Social Work, Griffith University, Nathan Campus, Brisbane, Australia
| | - Kirsty Lindsay
- Aerospace Medicine and Rehabilitation Laboratory, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, United Kingdom
| | - Dorothée Debuse
- Aerospace Medicine and Rehabilitation Laboratory, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, United Kingdom
| | - Andrew Winnard
- Aerospace Medicine and Rehabilitation Laboratory, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, United Kingdom
| | - James Elliott
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.,Northern Sydney Local Health District and The University of Sydney, Faculty of Medicine and Health, The Kolling Research Institute Sydney, Australia
| | - Mark Hoggarth
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.,Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, Illinois
| | - David Beard
- National Institute for Health Research Oxford Biomedical Research Centre, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - Jonathan A Cook
- National Institute for Health Research Oxford Biomedical Research Centre, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom.,Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - Robert Ekman
- European Astronaut Centre, Space Medicine Team (HRE-OM), European Space Agency, Cologne, Germany
| | - Luis Hinterwaldner
- European Astronaut Centre, Space Medicine Team (HRE-OM), European Space Agency, Cologne, Germany
| | - Jonathan Scott
- European Astronaut Centre, Space Medicine Team (HRE-OM), European Space Agency, Cologne, Germany.,KBR GmbH, Cologne, Germany
| | - Tobias Weber
- European Astronaut Centre, Space Medicine Team (HRE-OM), European Space Agency, Cologne, Germany.,KBR GmbH, Cologne, Germany
| | - Nick Caplan
- Aerospace Medicine and Rehabilitation Laboratory, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, United Kingdom
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Bychkov A, Reshetnikova P, Bychkova E, Podgorbunskikh E, Koptev V. The current state and future trends of space nutrition from a perspective of astronauts' physiology. Int J Gastron Food Sci 2021. [DOI: 10.1016/j.ijgfs.2021.100324] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Wang W, Zhou C, Guo R, Cha T, Li G. Prediction of biomechanical responses of human lumbar discs - a stochastic finite element model analysis. Comput Methods Biomech Biomed Engin 2021; 24:1730-1741. [PMID: 34121532 DOI: 10.1080/10255842.2021.1914023] [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: 12/26/2022]
Abstract
BACKGROUND Accurate biomechanical investigation of human intervertebral discs (IVDs) is difficult because of their complicated structural and material features. AIM To investigate probabilistic distributions of the biomechanical responses of the IVD by considering varying nonlinear structural and material properties using a stochastic finite element (FE) model. METHODS A FE model of a L3-4 disc was reconstructed, including the nucleus pulposus (NP), annular matrix and fibers. A Monte Carlo method was used to randomly generate 500 sets of the nonlinear material properties and fiber orientations of the disc that were implemented into the FE model. The FE model was analyzed under seven loading conditions: a 500 N compressive force, a 7.5Nm moment simulating flexion, extension, left-right lateral bending, and left-right axial rotation, respectively. The distributions of the ranges of motion (ROMs), intradiscal pressures (IDP), fiber stresses and matrix strains of the disc were analyzed. RESULTS Under the compressive load, the displacement varied between 0.29 mm and 0.76 mm. Under the 7.5Nm moment, the ROMs varied between 3.0° and 6.0° in primary rotations. The IDPs varied within 0.3 MPa under all the loading conditions. The maximal fiber stress (3.22 ± 0.64 MPa) and matrix strain (0.27 ± 0.12%) were observed under the flexion and extension moments, respectively. CONCLUSION The IVD biomechanics could be dramatically affected by the structural and material parameters used to construct the FE model. The stochastic FE model that includes the probabilistic distributions of the structural and material parameters provides a useful approach to analyze the statistical ranges of the biomechanical responses of the IVDs.
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Affiliation(s)
- Wei Wang
- Orthopaedic Bioengineering Research Center, Department of Orthopaedic Surgery, Newton-Wellesley Hospital, Newton, MA, USA.,Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Chaochao Zhou
- Orthopaedic Bioengineering Research Center, Department of Orthopaedic Surgery, Newton-Wellesley Hospital, Newton, MA, USA.,Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Runsheng Guo
- Orthopaedic Bioengineering Research Center, Department of Orthopaedic Surgery, Newton-Wellesley Hospital, Newton, MA, USA.,Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Department of Orthopaedics, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Thomas Cha
- Orthopaedic Bioengineering Research Center, Department of Orthopaedic Surgery, Newton-Wellesley Hospital, Newton, MA, USA.,Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Guoan Li
- Orthopaedic Bioengineering Research Center, Department of Orthopaedic Surgery, Newton-Wellesley Hospital, Newton, MA, USA
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Lazzari ZT, Aria KM, Menger R. Neurosurgery and spinal adaptations in spaceflight: A literature review. Clin Neurol Neurosurg 2021; 207:106755. [PMID: 34126454 DOI: 10.1016/j.clineuro.2021.106755] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 06/02/2021] [Accepted: 06/03/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Spaceflight places astronauts in multiple environments capable of inducing pathological changes. Alterations in the spine have a significant impact on astronauts' health during and after spaceflight. Low back pain is an established and common intra-flight complaint. Intervertebral disc herniation occurs at higher rates in this population and poses significant morbidity. Morphological changes within intervertebral discs, vertebral bodies, and spinal postural muscles affect overall spine function and astronaut performance. There remains a paucity of research related to spaceflight-induced pathologies, and currently available reviews concern the central nervous system broadly while lacking emphasis on spinal function. OBJECTIVE Our aim was to review and summarize available data regarding changes in spinal health with exposure to spaceflight, especially focusing on effects of microgravity. The authors also present promising diagnostic and treatment approaches wherein the neurosurgeon could positively impact astronauts' health and post-flight outcomes. MATERIALS AND METHODS Articles included in this review were identified via search engine using MEDLINE, PubMed, Cochrane Review, Google Scholar, and references within other relevant articles. Search criteria included "spine and spaceflight", "vertebral column and spaceflight", "vertebral disc and spaceflight", and "muscle atrophy and spaceflight", with results limited to articles written in English from 1961 to 2020. References of selected articles were included as appropriate. RESULTS Fifty-six articles were included in this review. Compositional changes at the intervertebral discs, vertebral bone, and paraspinal muscles contribute to undesirable effects on astronaut spinal function in space and contribute to post-flight pathologies. Risk of intervertebral disc herniation increases, especially during post-flight recovery. Vertebral bone degeneration in microgravity may increase risk for herniation and fracture. Paraspinal muscle atrophy contributes to low back pain, poorer spine health, and reduced stability. CONCLUSION Anatomical changes in microgravity contribute to the development of spinal pathologies. Microgravity impacts sensory neurovestibular function, neuromuscular output, genetic expression, among other systems. Future developments in imaging and therapeutic interventions may better analyze these changes and offer targeted therapeutic interventions to decrease the burden of pain and other diseases of the spine in this population.
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Affiliation(s)
| | - Kevin M Aria
- University of South Alabama College of Medicine, Mobile, AL, USA.
| | - Richard Menger
- Department of Neurosurgery, University of South Alabama, Mobile, AL, USA; Department of Political Science, University of South Alabama, Mobile, AL, USA.
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42
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De Martino E, Hides J, Elliott JM, Hoggarth M, Zange J, Lindsay K, Debuse D, Winnard A, Beard D, Cook JA, Salomoni SE, Weber T, Scott J, Hodges PW, Caplan N. Lumbar muscle atrophy and increased relative intramuscular lipid concentration are not mitigated by daily artificial gravity after 60-day head-down tilt bed rest. J Appl Physiol (1985) 2021; 131:356-368. [PMID: 34080918 DOI: 10.1152/japplphysiol.00990.2020] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Exposure to axial unloading induces adaptations in paraspinal muscles, as shown after spaceflights. This study investigated whether daily exposure to artificial gravity (AG) mitigated lumbar spine flattening and muscle atrophy associated with 60-day head-down tilt (HDT) bed rest (Earth-based space analog). Twenty-four healthy individuals participated in the study: 8 received 30-min continuous AG; 8 received 6 × 5-min AG interspersed with rest periods; and 8 received no AG exposure (control group). Magnetic resonance imaging (MRI) of the lumbopelvic region was conducted at baseline (BDC) and at day 59 of HDT (HDT59). Longitudinal relaxation time (T1)-weighted images were used to assess morphology of the lumbar spine (spinal length, intervertebral disk angles, disk area) and volumes of the lumbar multifidus (LM), lumbar erector spinae (LES), quadratus lumborum (QL), and psoas major (PM) muscles from L1/L2 to L5/S1 vertebral levels. A chemical shift-based two-point lipid/water Dixon sequence was used to evaluate muscle composition. Results showed that spinal length and disk area increased (P < 0.05); intervertebral disk angles (P < 0.05) and muscle volumes of LM, LES, and QL reduced (P < 0.01); and lipid-to-water ratio for the LM and LES muscles increased (P < 0.01) after HDT59 in all groups. Neither of the AG protocols mitigated the lumbar spinae deconditioning induced by HDT bed rest. The increase in lipid-to-water ratio in LM and LES muscles indicates an increased relative intramuscular lipid concentration. Altered muscle composition in atrophied muscles may impair lumbar spine function after body unloading, which could increase injury risk to vulnerable soft tissues. This relationship needs further investigation.NEW & NOTEWORTHY This study presents novel insights into the morphological adaptations occurring in the lumbar spine after 60-day head-down bed rest and the potential role of artificial gravity (AG) to mitigate them. Results demonstrated no protective effect of AG protocols used in this study. In atrophied paraspinal muscles, the ratio of lipids versus intramuscular water increased in the postural lumbar muscles, which could impair muscle function during upright standing. These findings have relevance for future space explorations.
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Affiliation(s)
- Enrico De Martino
- Aerospace Medicine and Rehabilitation Laboratory, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, United Kingdom
| | - Julie Hides
- School of Allied Health Sciences, Griffith University, Nathan Campus, Brisbane, Queensland, Australia
| | - James M Elliott
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine Northwestern University, Chicago, Illinois.,Kolling Research Institute, Faculty of Medicine and Health, The University of Sydney and Northern Sydney Local Health District, Sydney, New South Wales, Australia
| | - Mark Hoggarth
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine Northwestern University, Chicago, Illinois.,Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, Illinois
| | - Jochen Zange
- Institute of Aerospace Medicine, German Aerospace Center (DLR), Cologne, Germany
| | - Kirsty Lindsay
- Aerospace Medicine and Rehabilitation Laboratory, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, United Kingdom
| | - Dorothée Debuse
- Aerospace Medicine and Rehabilitation Laboratory, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, United Kingdom
| | - Andrew Winnard
- Aerospace Medicine and Rehabilitation Laboratory, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, United Kingdom
| | - David Beard
- NIHR Oxford Biomedical Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - Jonathan A Cook
- NIHR Oxford Biomedical Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom.,Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - Sauro E Salomoni
- NHMRC Centre for Clinical Research Excellence in Spinal Pain, Injury and Health, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Tobias Weber
- European Astronaut Centre, Space Medicine Team (HRE-OM), European Space Agency (ESA), Cologne, Germany.,KBR GmbH, Cologne, Germany
| | - Jonathan Scott
- European Astronaut Centre, Space Medicine Team (HRE-OM), European Space Agency (ESA), Cologne, Germany.,KBR GmbH, Cologne, Germany
| | - Paul W Hodges
- NHMRC Centre for Clinical Research Excellence in Spinal Pain, Injury and Health, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Nick Caplan
- Aerospace Medicine and Rehabilitation Laboratory, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, United Kingdom
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Abstract
Space travel has grown during the past 2 decades, and is expected to surge in the future with the establishment of an American Space Force, businesses specializing in commercial space travel, and National Aeronautics and Space Administration's planned sustained presence on the moon. Accompanying this rise, treating physicians are bracing for a concomitant increase in space-related medical problems, including back pain. Back pain is highly prevalent in astronauts and space travelers, with most cases being transient and self-limiting (space adaptation back pain). Pathophysiologic changes that affect the spine occur during space travel and may be attributed to microgravity, rapid acceleration and deceleration, and increased radiation. These include a loss of spinal curvature, spinal muscle atrophy, a higher rate of disc herniation, decreased proteoglycan and collagen content in intervertebral discs, and a reduction in bone density that may predispose people to vertebral endplate fractures. In this article, the authors discuss epidemiology, pathophysiology, prevention, treatment, and future research.
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Pai S A, Zhang H, Ashjaee N, Wilson DR, Brown SH, Fels S, Street J, Oxland TR. Estimation and assessment of sagittal spinal curvature and thoracic muscle morphometry in different postures. Proc Inst Mech Eng H 2021; 235:883-896. [PMID: 33977818 DOI: 10.1177/09544119211014668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Spine models are typically developed from supine clinical imaging data, and hence clearly do not fully reflect postures that replicate subjects' clinical symptoms. Our objectives were to develop a method to: (i) estimate the subject-specific sagittal curvature of the whole spine in different postures from limited imaging data, (ii) obtain muscle lines-of-action in different postures and analyze the effect of posture on muscle fascicle length, and (iii) correct for cosine between the magnetic resonance imaging (MRI) scan plane and dominant fiber line-of-action for muscle parameters (cross-sectional area (CSA) and position). The thoracic spines of six healthy volunteers were scanned in four postures (supine, standing, flexion, and sitting) in an upright MRI. Geometry of the sagittal spine was approximated with a circular spline. A pipeline was developed to estimate spine geometry in different postures and was validated. The lines-of-action for two muscles, erector spinae (ES) and transversospinalis (TS) were obtained for every posture and hence muscle fascicle lengths were computed. A correction factor based on published literature was then computed and applied to the muscle parameters. The maximum registration error between the estimated spine geometry and MRI data was small (average RMSE∼1.2%). The muscle fascicle length increased (up to 20%) in flexion when compared to erect postures. The correction factor reduced muscle parameters (∼5% for ES and ∼25% for TS) when compared to raw MRI data. The proposed pipeline is a preliminary step in subject-specific modeling. Direction cosines of muscles could be used while improving the inputs of spine models.
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Affiliation(s)
- Anoosha Pai S
- School of Biomedical Engineering, University of British Columbia, Vancouver, BC, Canada
- ICORD, University of British Columbia, Vancouver, BC, Canada
| | - Honglin Zhang
- Centre for Hip Health and Mobility, University of British Columbia, Vancouver, BC, Canada
| | - Nima Ashjaee
- School of Biomedical Engineering, University of British Columbia, Vancouver, BC, Canada
- ICORD, University of British Columbia, Vancouver, BC, Canada
- Department of Electrical and Computer Engineering, University of British Columbia, Vancouver, BC, Canada
| | - David R Wilson
- ICORD, University of British Columbia, Vancouver, BC, Canada
- Centre for Hip Health and Mobility, University of British Columbia, Vancouver, BC, Canada
- Department of Orthopaedics, University of British Columbia, Vancouver, BC, Canada
| | - Stephen Hm Brown
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, ON, Canada
| | - Sidney Fels
- Department of Electrical and Computer Engineering, University of British Columbia, Vancouver, BC, Canada
| | - John Street
- ICORD, University of British Columbia, Vancouver, BC, Canada
- Department of Orthopaedics, University of British Columbia, Vancouver, BC, Canada
| | - Thomas R Oxland
- ICORD, University of British Columbia, Vancouver, BC, Canada
- Department of Orthopaedics, University of British Columbia, Vancouver, BC, Canada
- Department of Mechanical Engineering, University of British Columbia, Vancouver, BC, Canada
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The effects of exposure to microgravity and reconditioning of the lumbar multifidus and anterolateral abdominal muscles: implications for people with LBP. Spine J 2021; 21:477-491. [PMID: 32966906 DOI: 10.1016/j.spinee.2020.09.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 08/02/2020] [Accepted: 09/16/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT One of the primary changes in the neuromuscular system in response to microgravity is skeletal muscle atrophy, which occurs especially in muscles that maintain posture while being upright on Earth. Reduced size of paraspinal and abdominal muscles has been documented after spaceflight. Exercises are undertaken on the International Space Station (ISS) during and following space flight to remediate these effects. Understanding the adaptations which occur in trunk muscles in response to microgravity could inform the development of specific countermeasures, which may have applications for people with conditions on Earth such as low back pain (LBP). PURPOSE The aim of this study was to examine the changes in muscle size and function of the lumbar multifidus (MF) and anterolateral abdominal muscles (1) in response to exposure to 6 months of microgravity on the ISS and (2) in response to a 15-day reconditioning program on Earth. DESIGN Prospective longitudinal series. PATIENT SAMPLE Data were collected from five astronauts who undertook seven long-duration missions on the ISS. OUTCOME MEASURES For the MF muscle, measures included cross-sectional area (CSA) and linear measures to assess voluntary isometric contractions at vertebral levels L2 to L5. For the abdominal muscles, the thickness of the transversus abdominis (TrA), obliquus internus abdominis (IO) and obliquus externus abdominis (EO) muscles at rest and on contraction were measured. METHODS Ultrasound imaging of trunk muscles was conducted at four timepoints (preflight, postflight, mid-reconditioning, and post reconditioning). Data were analyzed using multilevel linear models to estimate the change in muscle parameters of interest across three time periods. RESULTS Beta-coefficients (estimates of the expected change in the measure across the specified time period, adjusted for the baseline measurement) indicated that the CSA of the MF muscles decreased significantly at all lumbar vertebral levels (except L2) in response to exposure to microgravity (L3=12.6%; L4=6.1%, L5=10.3%; p<.001), and CSAs at L3-L5 vertebral levels increased in the reconditioning period (p<.001). The thickness of the TrA decreased by 34.1% (p<.017), IO decreased by 15.4% (p=.04), and the combination of anterolateral abdominal muscles decreased by 16.2% (p<.001) between pre- and postflight assessment and increased (TrA<0.008; combined p=.035) during the postreconditioning period. Results showed decreased contraction of the MF muscles at the L2 (from 12.8% to 3.4%; p=.007) and L3 (from 12.2% to 5%; p=.032) vertebral levels following exposure to microgravity which increased (L2, p=.046) after the postreconditioning period. Comparison with preflight measures indicated that there were no residual changes in muscle size and function after the postreconditioning period, apart from CSA of MF at L2, which remained 15.3% larger than preflight values (p<.001). CONCLUSIONS In-flight exercise countermeasures mitigated, but did not completely prevent, changes in the size and function of the lumbar MF and anterolateral abdominal muscles. Many of the observed changes in size and control of the MF and abdominal muscles that occurred in response to prolonged exposure to microgravity paralleled those seen in people with LBP or exposed to prolonged bed rest on Earth. Daily individualized postflight reconditioning, which included both motor control training and weight-bearing exercises with an emphasis on retraining strength and endurance to re-establish normal postural alignment with respect to gravity, restored the decreased size and control of the MF (at the L3-L5 vertebral levels) and anterolateral abdominal muscles. Drawing parallels between changes which occur to the neuromuscular system in microgravity and which exercises best recover muscle size and function could help health professionals tailor improved interventions for terrestrial populations. Results suggested that the principles underpinning the exercises developed for astronauts following prolonged exposure to microgravity (emphasizing strength and endurance training to re-establish normal postural alignment and distribution of load with respect to gravity) can also be applied for people with chronic LBP, as the MF and anterolateral abdominal muscles were affected in similar ways in both populations. The results may also inform the development of new astronaut countermeasures targeting the MF and abdominal muscles.
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Pai S A, Zhang H, Street J, Wilson DR, Brown SHM, Oxland TR. Preliminary investigation of spinal level and postural effects on thoracic muscle morphology with upright open MRI. JOR Spine 2021; 4:e1139. [PMID: 33778411 PMCID: PMC7984016 DOI: 10.1002/jsp2.1139] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 12/29/2020] [Accepted: 01/17/2021] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE Spinal-muscle morphological differences between weight-bearing and supine postures have potential diagnostic, prognostic, and therapeutic applications. While the focus to date has been on cervical and lumbar regions, recent findings have associated spinal deformity with smaller paraspinal musculature in the thoracic region. We aim to quantitatively investigate the morphology of trapezius (TZ), erector spinae (ES) and transversospinalis (TS) muscles in upright postures with open upright MRI and also determine the effect of level and posture on the morphological measures. METHODS Six healthy volunteers (age 26 ± 6 years) were imaged (0.5 T MROpen, Paramed, Genoa, Italy) in four postures (supine, standing, standing with 30° flexion, and sitting). Two regions of the thorax, middle (T4-T5), and lower (T8-T9), were scanned separately for each posture. 2D muscle parameters such as cross-sectional area (CSA) and position (radius and angle) with respect to the vertebral body centroid were measured for the three muscles. Effect of spinal level and posture on muscle parameters was examined using 2-way repeated measures ANOVA separately for T4-T5 and T8-T9 regions. RESULTS The TZ CSA was smaller (40%, P = .0027) at T9 than at T8. The ES CSA was larger at T5 than at T4 (12%, P = .0048) and at T9 than at T8 (10%, P = .0018). TS CSA showed opposite trends at the two spinal regions with it being smaller (16%, P = .0047) at T5 than at T4 and larger (11%, P = .0009) at T9 than at T8. At T4-T5, the TZ CSA increased (up to 23%), and the ES and TS CSA decreased (up to 10%) in upright postures compared to supine. CONCLUSION Geometrical parameters that describe muscle morphology in the thorax change with level and posture. The increase in TZ CSA in upright postures could result from greater activation while upright. The decrease in ES CSA in flexed positions likely represents passive stretching compared to neutral posture.
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Affiliation(s)
- Anoosha Pai S
- School of Biomedical EngineeringUniversity of British ColumbiaVancouverCanada
- ICORDUniversity of British ColumbiaVancouverCanada
| | - Honglin Zhang
- Centre for Hip Health and MobilityUniversity of British ColumbiaVancouverCanada
| | - John Street
- ICORDUniversity of British ColumbiaVancouverCanada
- Department of OrthopaedicsUniversity of British ColumbiaVancouverCanada
| | - David R. Wilson
- ICORDUniversity of British ColumbiaVancouverCanada
- Centre for Hip Health and MobilityUniversity of British ColumbiaVancouverCanada
- Department of OrthopaedicsUniversity of British ColumbiaVancouverCanada
| | - Stephen H. M. Brown
- Department of Human Health and Nutritional SciencesUniversity of GuelphGuelphCanada
| | - Thomas R. Oxland
- ICORDUniversity of British ColumbiaVancouverCanada
- Department of OrthopaedicsUniversity of British ColumbiaVancouverCanada
- Department of Mechanical EngineeringUniversity of British ColumbiaVancouverCanada
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Trunk Skeletal Muscle Changes on CT with Long-Duration Spaceflight. Ann Biomed Eng 2021; 49:1257-1266. [PMID: 33604800 DOI: 10.1007/s10439-021-02745-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 02/02/2021] [Indexed: 12/25/2022]
Abstract
Astronauts exposed to microgravity for extended time are susceptible to trunk muscle atrophy, which may compromise strength and function on mission and after return. This study investigates changes in trunk skeletal muscle size and composition using computed tomography (CT) and dual-energy X-ray absorptiometry (DXA) among 16 crewmembers (1 female, 15 male) on 4-6 month missions. Muscle cross-sectional area and muscle attenuation were measured using abdominal CT scans at pre-flight, post-flight return, 1 year post-flight, and 2-4 years post-flight. Longitudinal muscle changes were analyzed using mixed models. In six crewmembers, CT and DXA data were used to calculate subject height-normalized skeletal muscle indices. Changes in these indices were analyzed using paired t-tests and compared by imaging modality using Pearson correlations. Trunk muscle area decreased at post-flight return (- 4.7 ± 1.1%, p < 0.001) and recovered to pre-flight values at 1-4 years post-flight. Muscle attenuation changes were not significant. Skeletal muscle index from CT decreased (- 5.2 ± 1.0%, p = 0.004) while appendicular skeletal muscle index from DXA did not change significantly. In summary, trunk muscle atrophies with long-duration microgravity exposure but recovers to pre-flight values within 1-4 years. The CT measures highlight size decreases not detected with DXA, emphasizing the importance of advanced imaging modalities in assessing muscle health with spaceflight.
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Salik E, Donat A, Ağaoğlu MH. Chiropractic Nimmo Receptor-Tonus Technique and McKenzie Self-Therapy Program in the Management of Adjacent Segment Disease: A Case Report. J Chiropr Med 2021; 19:249-259. [PMID: 33536862 DOI: 10.1016/j.jcm.2020.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 09/20/2019] [Accepted: 01/29/2020] [Indexed: 11/30/2022] Open
Abstract
Objective The objective of the present study objective was to describe adjacent segment disease (ASD) from a chiropractic management prospective and subsequently to stimulate further research into the chiropractic therapeutic effects on such cases and to contribute to chiropractic literature. Clinical Features A 44-year-old woman had a history of lumbar stabilization revision operation by pedicle screw fixation for spondylolisthesis. Her intractable back pain episodes, which were diagnosed as ASD, began shortly after this surgery. At presentation, she was taking pregabalin 75 mg 2 times a day for postoperative neuropathic pain without any pain relief. Clinical testing revealed myofascial tender points reproducing the pain. Intervention and Outcome After taking the case history and performing a physical examination, the patient was managed with chiropractic Nimmo receptor-tonus technique in combination with McKenzie exercises. Nimmo was applied by manually pressing on clinically relevant points for 5 to 15 seconds in 11 visits over 3 weeks. The patient by herself did McKenzie exercises 5 to 10 times a day for 10 to 12 repetitions over 2 months. After 3 weeks of therapy, visual analog scale and Oswestry Disability Index scores were improved. Furthermore, because of the amelioration of the patient's symptoms, her neurosurgeon successfully discontinued pregabalin 75 mg 2 times a day without negative consequences to care. Conclusion As far as the authors are aware, there is currently no published case of ASD care in chiropractic literature. Our rehabilitative management received a favorable response. It can be hypothesized that it offers a perspective that informs improved patient care.
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Affiliation(s)
- Emsal Salik
- Chiropractic Program, Health Sciences Institute, Bahcesehir University, Besiktas, Istanbul, Turkey
| | - Ali Donat
- Chiropractic Program, Health Sciences Institute, Bahcesehir University, Besiktas, Istanbul, Turkey
| | - Mustafa Hulisi Ağaoğlu
- Chiropractic Program, Health Sciences Institute, Bahcesehir University, Besiktas, Istanbul, Turkey
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Willey JS, Britten RA, Blaber E, Tahimic CG, Chancellor J, Mortreux M, Sanford LD, Kubik AJ, Delp MD, Mao XW. The individual and combined effects of spaceflight radiation and microgravity on biologic systems and functional outcomes. JOURNAL OF ENVIRONMENTAL SCIENCE AND HEALTH. PART C, TOXICOLOGY AND CARCINOGENESIS 2021; 39:129-179. [PMID: 33902391 PMCID: PMC8274610 DOI: 10.1080/26896583.2021.1885283] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Both microgravity and radiation exposure in the spaceflight environment have been identified as hazards to astronaut health and performance. Substantial study has been focused on understanding the biology and risks associated with prolonged exposure to microgravity, and the hazards presented by radiation from galactic cosmic rays (GCR) and solar particle events (SPEs) outside of low earth orbit (LEO). To date, the majority of the ground-based analogues (e.g., rodent or cell culture studies) that investigate the biology of and risks associated with spaceflight hazards will focus on an individual hazard in isolation. However, astronauts will face these challenges simultaneously Combined hazard studies are necessary for understanding the risks astronauts face as they travel outside of LEO, and are also critical for countermeasure development. The focus of this review is to describe biologic and functional outcomes from ground-based analogue models for microgravity and radiation, specifically highlighting the combined effects of radiation and reduced weight-bearing from rodent ground-based tail suspension via hind limb unloading (HLU) and partial weight-bearing (PWB) models, although in vitro and spaceflight results are discussed as appropriate. The review focuses on the skeletal, ocular, central nervous system (CNS), cardiovascular, and stem cells responses.
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Affiliation(s)
| | | | - Elizabeth Blaber
- Department of Biomedical Engineering, Rensselaer Polytechnic Institute
| | | | | | - Marie Mortreux
- Department of Neurology, Harvard Medical School, Beth Israel Deaconess Medical Center
| | - Larry D. Sanford
- Department of Radiation Oncology, Eastern Virginia Medical School
| | - Angela J. Kubik
- Department of Biomedical Engineering, Rensselaer Polytechnic Institute
| | - Michael D. Delp
- Department of Nutrition, Food and Exercise Sciences, Florida State University
| | - Xiao Wen Mao
- Division of Biomedical Engineering Sciences (BMES), Department of Basic Sciences, Loma Linda University
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Jones EJ, Kennett JE, Green DA. Spring-loaded body mass equivalent horizontal reactive countermovement jump ground contact and flight times, but not peak forces, are comparable to vertical jumping. J Biomech 2020; 116:110206. [PMID: 33485147 DOI: 10.1016/j.jbiomech.2020.110206] [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: 03/08/2020] [Revised: 11/21/2020] [Accepted: 12/14/2020] [Indexed: 11/16/2022]
Abstract
Horizontal (cylinder-based) sledge jumping has been shown to ameliorate multi-system deconditioning induced by long-term bed-rest. However, biomechanics differ from 1 g vertical jumping, in particular prolongation of ground contact times (GCT), reduction of peak force, rate of force development (RFD) (and presumably stretch shortening cycle [SSC] efficacy) and stiffness, whilst also requiring relatively complex equipment. Thus, we sought to determine if horizontal spring-loaded countermovement jumps were more analogous to vertical jumping. 9 healthy (5 female) subjects (27 ± 7yrs; 169.0 ± 5.3 cm; 63.6 ± 2.6 kg) performed 10 reactive countermovement jumps vertically, and horizontally (randomized) when lay on a spring-loaded carriage performed against loading (at lift-off) equivalent (±6%) to their body weight. Jump kinetics, kinematics and lower limb/trunk electromyographic activity were compared between conditions (paired t-tests). Mean flight and GCTs did not differ, however, peak jump height (p = 0.003; d = -0.961) was greater when jumping horizontally. In contrast, ground reaction forces (zGRF) during take-off (p < 0.001; d = 1.645) and landing (p = 0.002; d = 1.309), peak acceleration (p = 0.001; d = 1.988), leg stiffness (p = 0.001; d = 2.371) and RFD (p = 0.023; d = 1.255) were lower horizontally. Mean rectus femoris activity was lower during landing (p = 0.033; d = 0.691) when horizontal, but did not differ during either take-off or land-lift. Mean medial gastrocnemius activity was significantly (p = 0.018; d = 0.317) lower during horizontal take-off. Spring-loading (1 g at take-off) maintained short GCTs and flight times presumably maintaining muscle SSC efficacy in a manner that appears intuitive (in young active subjects), simple, robust and potentially compatible with spaceflight. Whether appropriate jump characteristics can be achieved in older subjects and in μg/hypogravity needs to be determined. However, greater jump height, lower peak zGRF, RFD and leg stiffness along with reduced lower limb and trunk muscle activity suggests that 1 g at take-off is insufficient to replicate vertical jump biomechanics. Thus, further investigation is warranted to optimize, and evaluate spring-loaded jumping as a gravity-independent multi-systems countermeasure on Earth, and in Space.
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Affiliation(s)
- E J Jones
- Centre of Human & Applied Physiological Sciences (CHAPS), King's College London, Faculty of Life Sciences & Medicine, Guy's Campus, London SE1 1UL, UK; Clinical, Metabolic and Molecular Physiology, MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, University of Nottingham, Nottingham, United Kingdom
| | - J E Kennett
- Physical Mind London, 135 High Street, Teddington, London TW11 8HH, UK
| | - D A Green
- Centre of Human & Applied Physiological Sciences (CHAPS), King's College London, Faculty of Life Sciences & Medicine, Guy's Campus, London SE1 1UL, UK; KBR, Wyle Laboratories GmbH, Albin-Koebis Strasse 4, 51174 Cologne, Germany; Space Medicine Team, HRE-OM, European Astronaut Centre, European Space Agency, Linder Höhe, Cologne 51147, Germany.
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