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Wareham DM, Fuller JT, Douglas TJ, Han CS, Hancock MJ. Swimming for low back pain: A scoping review. Musculoskelet Sci Pract 2024; 71:102926. [PMID: 38522227 DOI: 10.1016/j.msksp.2024.102926] [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: 11/28/2023] [Revised: 02/01/2024] [Accepted: 03/07/2024] [Indexed: 03/26/2024]
Abstract
BACKGROUND Guidelines recommend exercise for treatment of chronic low back pain and prevention, but the amount and quality of evidence for different exercise modes is highly variable. Swimming is commonly recommended by health professionals, but the extent and quality of research supporting its relationship with back pain is not clear. OBJECTIVES The aim of this scoping review was to map the extent, characteristics and findings of research investigating the relationship between swimming and low back pain. DESIGN Scoping review. METHOD Four electronic databases (MEDLINE, EMBASE, CINAHL, and SPORT Discus) were searched from inception to February 2023. We included primary studies and reviews that reported an association between swimming and low back pain. Hydrotherapy studies were excluded. RESULTS 3093 articles were identified, and 44 studies included. Only one randomised controlled trial and one longitudinal cohort study were included. Most studies were cross-sectional (37/44; 84.1%), included competitive athletes (23/39; 59.0%), and did not primarily focus on the association between swimming and low back pain in the aims (41/44; 93.2%). Instead, most data available were largely incidentally collected or a secondary outcome. The reported associations between swimming and low back pain were highly variable regardless of whether the comparison was to other sports (odds ratio: 0.17 to 17.92) or no sport (odds ratio: 0.54 to 3.01). CONCLUSION Most available literature investigating swimming and low back pain is cross-sectional in design. We did not identify any clear pattern of association between swimming and low back pain, based on the available literature.
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Affiliation(s)
- Deborah M Wareham
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Macquarie Park 2109, NSW, Australia.
| | - Joel T Fuller
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Macquarie Park 2109, NSW, Australia.
| | - Tayla J Douglas
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Macquarie Park 2109, NSW, Australia.
| | - Christopher S Han
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, Australia.
| | - Mark J Hancock
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Macquarie Park 2109, NSW, Australia.
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Hsu C, Genovese T, McInnis KC. Assessing the risk of lumbar degenerative disc disease associated with swimming: A systematic review. PM R 2024. [PMID: 38501332 DOI: 10.1002/pmrj.13138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 12/21/2023] [Accepted: 01/08/2024] [Indexed: 03/20/2024]
Abstract
OBJECTIVE The purpose of the current study is to synthesize the outcomes of investigations reporting the odds of lumbar degenerative disc disease (DDD) in competitive swimmers compared to controls. LITERATURE SURVEY PubMed, Embase, and Web of Science databases were searched according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines from inception until March 2023 to identify relevant studies evaluating the risk for lumbar DDD associated with swimming. METHODS Data in the current literature were synthesized for positive imaging findings of DDD at one or more lumbar level in swimmers compared to nonswimmers. Additionally, data regarding prevalence of lumbar disc degeneration and back pain in competitive swimmers were synthesized. SYNTHESIS Four studies were included in the final analysis. Study quality and risk of bias were deemed adequate. There was significant heterogeneity among studies (I2 = 0.74) regarding data collected, population of swimmers, sample size, and methods. Therefore, a meta-analysis was not conducted. The majority of the studies included in this study (three of four) reported that swimmers have increased odds of developing lumbar DDD. Additionally, secondary outcome analysis indicated that swimmers have a higher probability of developing moderate-to-severe back pain. CONCLUSION Competitive swimming appears to be associated with the presence of DDD on advanced imaging and moderate-to-severe back pain. These findings are limited by significant differences in study methodology in the included studies. Although swimming is conventionally considered a low-impact sport, elite swimmers risk developing lower back pain and disc pathology, possibly because training involves unique biomechanics with repetitive rotational and hyperextension/flexion of the spine. Further research investigating risk factors involving biomechanics of swimming on the spine may have important implications for stroke technique, injury prevention, and rehabilitation for swimmers.
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Affiliation(s)
- Connie Hsu
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, Massachusetts, USA
| | - Timothy Genovese
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, Massachusetts, USA
| | - Kelly C McInnis
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, Massachusetts, USA
- Division of Sports Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
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Koyama K, Nakazato K, Kubo Y, Gushiken K, Hatakeda Y, Seo K, Nakase T, Hiranuma K. Effects of Competition Level on the Prevalence and Incidence of Lumbar Disk Degeneration in Japanese Collegiate Gymnasts. Orthop J Sports Med 2022; 10:23259671221119439. [PMID: 36419478 PMCID: PMC9676327 DOI: 10.1177/23259671221119439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 05/16/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Lumbar disk degeneration (LDD) occurs frequently in athletes. Researchers have found that LDD occurs mainly in the lower disks (L4/L5 and L5/S1) in the general and athletic populations. However, a retrospective study showed a high prevalence of LDD in the upper lumbar disks (L1/L2), especially in elite gymnasts. Purpose: To investigate the effect of competition level on the prevalence and incidence of LDD in the upper lumbar disks (L1/L2). Study Design: Cross-sectional study; Level of evidence, 3; and cohort study; Level of evidence, 2. Methods: We conducted 2 studies to evaluate the effect of competition level on the prevalence and incidence of LDD in Japanese collegiate gymnasts. In study 1, a cross-sectional study of 298 collegiate gymnasts was conducted between 2011 and 2015. Competition levels were categorized as regional, national, and international, and T2-weighted magnetic resonance imaging (MRI) was used to evaluate LDD. Chi-square testing was applied to assess differences in the prevalence of LDD and spinal levels among the 3 competition levels. In study 2–-a prospective cohort study–-LDD progression and its related risk factors were investigated in 51 collegiate gymnasts. Baseline lumbar MRI scans and measurements of physical function (generalized joint laxity and finger-floor distance test) were performed in March 2014. Follow-up lumbar MRI scans were obtained 2 years later, in February 2016. Logistic regression analyses were performed to investigate the relationship between competition level and LDD progression. Results: In study 1, the prevalence of at least 1 degenerated disk in the regional, national, and international groups was 44.2% (19/43), 44.7% (98/219), and 52.8% (19/36), respectively (P = .655). The prevalence of LDD at L1/L2 in the international group was significantly higher than that in the other 2 groups (P = .018). In study 2, the presence of LDD at L1/L2 was associated significantly with international-level competition (adjusted odds ratio, 47.8; 95% CI, 2.75-830.50). Conclusion: In Japanese collegiate gymnasts, competing at the international level was found to be a risk factor for LDD at L1/L2.
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Affiliation(s)
- Koji Koyama
- Department of Judotherapy, Tokyo Ariake University of Medical and Health Sciences, Tokyo, Japan
| | - Koichi Nakazato
- Department of Exercise Physiology, Graduate School of Health and Sport Sciences, Nippon Sport Science University, Tokyo, Japan
| | - Yoshiaki Kubo
- Department of Judotherapy, Tokyo Ariake University of Medical and Health Sciences, Tokyo, Japan
| | - Koji Gushiken
- Sports Methodology (Gymnastic), Nippon Sport Science University, Tokyo, Japan
| | - Yoshiaki Hatakeda
- Sports Methodology (Gymnastic), Nippon Sport Science University, Tokyo, Japan
| | - Kyoko Seo
- Sports Methodology (Gymnastic), Nippon Sport Science University, Tokyo, Japan
| | - Takuya Nakase
- Sports Methodology (Gymnastic), Nippon Sport Science University, Tokyo, Japan
| | - Kenji Hiranuma
- Graduate School of Health and Sport Science, Nippon Sport Science University, Tokyo, Japan
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Byvaltsev VA, Kalinin AA, Shepelev VV, Pestryakov YY, Aliyev MA, Konovalov NA. [Results of minimally invasive lumbar fusion in professional athletes: a single-center retrospective study]. ZHURNAL VOPROSY NEĬROKHIRURGII IMENI N. N. BURDENKO 2021; 85:12-19. [PMID: 34463446 DOI: 10.17116/neiro20218504112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Professional athletes have a high basic level of physical fitness and significant motivation for returning to previous rhythm of functional activity within the shortest period after trauma without deterioration of baseline level of sportsmanship. Despite the well-presented results of lumbar spine fusion in general population, these data among professional athletes are not well understood. OBJECTIVE To analyze the results of minimally invasive lumbar fusion in professional athletes. MATERIAL AND METHODS A retrospective study included 27 athletes (19 men and 8 women) aged 29 (26; 34) years after minimally invasive lumbar spine decompression and fusion via anterior, lateral and posterior approaches. Total lumbar lordosis, degenerative changes in adjacent segment, area of multifidus muscle, perioperative complications and timing of sports rehabilitation were analyzed within 3-5 (mean 4) years after surgery. RESULTS We found an increase of total lumbar lordosis from 35.2° to 44.1° (p=0.02), no significant muscle atrophy (<30%) and degeneration of adjacent segment (p>0.05). There were 5 perioperative complications (18.5%). Mean period of sports rehabilitation was 14 (9; 17) weeks. One (3.7%) patient did not return to his previous sports career. CONCLUSION Minimally invasive short-segment lumbar interbody fusion in professional athletes is characterized by low risk of fixation element failure, no significant degeneration of adjacent level and postoperative muscle atrophy. This procedure ensures early rehabilitation and returning to sports.
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Affiliation(s)
- V A Byvaltsev
- Irkutsk State Medical University, Irkutsk, Russia.,Irkutsk Clinical Hospital "Russian Railways-Medicine", Irkutsk, Russia.,Irkutsk State Medical Academy of Postgraduate Education, Irkutsk, Russia
| | - A A Kalinin
- Irkutsk State Medical University, Irkutsk, Russia.,Irkutsk Clinical Hospital "Russian Railways-Medicine", Irkutsk, Russia
| | - V V Shepelev
- Irkutsk State Medical University, Irkutsk, Russia
| | | | - M A Aliyev
- Irkutsk State Medical University, Irkutsk, Russia
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Walter SS, Lorbeer R, Hefferman G, Schlett CL, Peters A, Rospleszcz S, Nikolaou K, Bamberg F, Notohamiprodjo M, Maurer E. Correlation between thoracolumbar disc degeneration and anatomical spinopelvic parameters in supine position on MRI. PLoS One 2021; 16:e0252385. [PMID: 34106962 PMCID: PMC8189447 DOI: 10.1371/journal.pone.0252385] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 05/15/2021] [Indexed: 11/18/2022] Open
Abstract
Objective This study aims to investigate the correlation between spinopelvic parameters in supine position (pelvic incidence (PI), sacral slope (SS), pelvic tilt (PT), lumbar lordosis (LL)), disc degeneration and herniation of the thoracolumbar spine, as well as cardiovascular risk factors and back pain in a southern German cohort from the general population. Methods This study is a cross-sectional, case–control study drawn from a prospective cohort of the “Cooperative Health Research in the Region of Augsburg/Kooperative Gesundheitsforschung in der Region Augsburg” study (KORA). In total, 374 participants (mean age 56.4 ± 9.2 years; 57.8% male) from the whole-body MRI cohort (FF4) were included. All participants underwent a standardized whole-body MRI on which disc degeneration of the thoracic and lumbar spine was evaluated using a sequence adapted Pfirrmann score. PI, PT, SS and LL were measured according to the description in the literature, using sagittal imaging. Furthermore, disc bulging and protrusion were assessed. Correlations were estimated by logistic regression models providing odds ratios. Results Mean PI was 54.0° ± 11.1°, PT 13.0° ± 5.8°, SS 40.2° ± 8.8° and LL 36.2° ± 9.6°. SS was greater in men (p<0.05) and lumbar lordosis in women (p<0.001). PT increased by 0.09° per age-year with rising age. Age was not associated with PI, SS and LL. Neither BMI, hypertension, cholesterol, lipid levels, nor physical activity were associated with PI, PT, SS or LL. Diabetes mellitus negatively correlated with SS (β = -4.19; 95%CI -7.31–1.06, p<0.01). Smaller spinopelvic parameters (PI, SS and LL) where significantly (p<0.05) correlated with an increased frequency of disc bulging, as well as a local clustering in the lumbar, but not the thoracic spine. Conclusion In conclusion, spinopelvic parameters, measured in supine position, are significantly correlated with disc bulging alone; there is no significant correlation between supine spinopelvic parameters and disc degeneration, back pain or cardiovascular risk factors.
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Affiliation(s)
- Sven S. Walter
- Department for Diagnostic and Interventional Radiology, Eberhard Karls University Tuebingen, University Hospital Tuebingen, Tübingen, Germany
| | - Roberto Lorbeer
- Department of Radiology, Ludwig-Maximilian-University Hospital Marchioninistraße, Munich, Germany
| | - Gerald Hefferman
- Brigham and Women’s Hospital, Department of Radiology and Harvard Medical School, Boston, MA, United States of America
| | - Christopher L. Schlett
- Department of Diagnostic and Interventional Radiology, Medical Center ‐ University of Freiburg, Freiburg, Germany
| | - Anette Peters
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center forEnvironmental Health, Neuherberg, Germany
- Medical Faculty, Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilians-Universität München, Munich, Germany
- German Center for Diabetes Research (DZD), Partner site Neuherberg, Neuherberg, Germany
| | - Susanne Rospleszcz
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center forEnvironmental Health, Neuherberg, Germany
- Medical Faculty, Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Konstantin Nikolaou
- Department for Diagnostic and Interventional Radiology, Eberhard Karls University Tuebingen, University Hospital Tuebingen, Tübingen, Germany
| | - Fabian Bamberg
- Department of Diagnostic and Interventional Radiology, Medical Center ‐ University of Freiburg, Freiburg, Germany
| | - Mike Notohamiprodjo
- Department for Diagnostic and Interventional Radiology, Eberhard Karls University Tuebingen, University Hospital Tuebingen, Tübingen, Germany
- Die Radiologie, Munich, Germany
- * E-mail:
| | - Elke Maurer
- Department for Trauma and Reconstructive Surgery, BG Unfallklinik Tuebingen, Eberhard Karls University Tuebingen, Tuebingen, Germany
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Clinical-Instrumental Results and Analysis of Functional Activity Restoration in Professional Athletes After Lumbar Total Disk Replacement. World Neurosurg 2021; 151:e1069-e1077. [PMID: 34052451 DOI: 10.1016/j.wneu.2021.05.066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 05/17/2021] [Accepted: 05/19/2021] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To analyze the clinical and biomechanical outcome of professional athletes after lumbar total disk replacement, with a focus on restoration of the functional activity. METHODS This nonrandomized retrospective single-center study included 11 professional athletes who underwent lumbar disc replacement surgery using the prosthesis M6-L (Spinal Kinetics, Schaffhausen, Switzerland). The average postoperative follow-up was 3.18 ± 1.14 years. The following outcomes were evaluated: intensity of pain in the lumbar spine and lower limbs, Oswestry Disability Index, Short-Form 36, complications, time of return to previous sports activity, range of movement, degree of lumbar lordosis, degenerative changes of the adjacent levels, and degree of heterotopic ossification. RESULTS The operated patients reported significant decrease of pain on visual analog scale (P < 0.001) as well as significant improvement of Oswestry Disability Index (P = 0.001) and Short-Form 36 (P < 0.001). For the duration of follow-up, the patients maintained segmental range of motion at L4-L5 (P = 0.04) and L5-S1 (P = 0.03) levels. There was also some statistically insignificant increase of global lumbar lordosis (P = 0.84). We did not identify any significant degeneration of the adjacent intervertebral disks (P > 0.05) or progression of the facet joint degenerative changes at the implantation level and in the adjacent segments (P > 0.05). One patient (9.1%) developed grade I heterotopic ossification 5 years after surgery and in 1 patient (9.1%), a lesion of superior hypogastric plexus was recorded. The average time of return to previous sports activity was 9.72 ± 3.03 weeks. CONCLUSIONS Total lumbar disc replacement using M6-L prosthesis in professional athletes made it possible to achieve statistically significant reduction of pain and facilitated early return to normal sports activities. In our opinion, preservation of movement of the operated lumbar segment can help to reduce the mechanical stress with beneficial impact on the rate of degeneration of the adjacent level.
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Castillo-Avila RG, González-Castro TB, Tovilla-Zárate CA, Juárez-Rojop IE, López-Narváez ML, Rodríguez-Pérez JM, Pérez-Hernández N. The role of TaqI, ApaI and BsmI polymorphisms of VDR gene in lumbar spine pathologies: systematic review and meta-analysis. 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; 30:2049-2059. [PMID: 34021784 DOI: 10.1007/s00586-021-06872-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 03/27/2021] [Accepted: 05/04/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE The objective of the present meta-analysis was to evaluate the association between TaqI (rs731236), ApaI (rs7975232) and BsmI (rs1544410) polymorphisms of the VDR gene and lumbar spine pathologies such as lumbar disc herniation and lumbar disc degeneration. BACKGROUND VDR gene polymorphisms have been reported to be associated with an increased risk of lumbar spine pathologies. MATERIALS AND METHODS A systematic search was performed up to February 2020 using PubMed, EBSCO and Web of Science databases. We used the keywords and combinations "lumbar disc degeneration," "lumbar disc herniation," "lumbar spine pathologies" and "VDR polymorphism." Subsequently, we performed a meta-analysis with the results of the included studies. RESULTS We found that the TaqI polymorphism was associated with an increased risk of developing lumbar spine pathologies (recessive model OR 1.25, 95% CI 1.01-1.54) and lumbar disc degeneration (allelic model OR 1.26, 95% CI 1.07-1.48; recessive model OR 1.34, 95% CI 1.06-1.69), but not with lumbar disc herniation. Additionally, ApaI was associated with an increased risk of developing lumbar spine pathologies (heterozygous model OR 1.45, 95% CI 1.06-1.98), but not with lumbar disc herniation or lumbar disc degeneration. CONCLUSIONS Our findings indicate that TaqI and ApaI polymorphisms of the VDR gene are important risk factors for developing lumbar spine pathologies. Moreover, the TaqI polymorphism is a risk factor for lumbar disc degeneration.
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Affiliation(s)
- Rosa Giannina Castillo-Avila
- División Académica de Ciencias de la Salud, Universidad Juárez Autónoma de Tabasco, Villahermosa, Tabasco, Mexico
| | - Thelma Beatriz González-Castro
- División Académica Multidisciplinaria de Jalpa de Méndez, Universidad Juárez Autónoma de Tabasco, Carretera estatal libre Villahermosa-Comalcalco km 27 s/n, Ranchería, 86205, Jalpa de Méndez, Tabasco, Mexico.
| | - Carlos Alfonso Tovilla-Zárate
- División Académica Multidisciplinaria de Comalcalco, Universidad Juárez Autónoma de Tabasco, Ranchería Sur, Cuarta Sección, 86650, Comalcalco, Tabasco, Mexico.
| | - Isela Esther Juárez-Rojop
- División Académica de Ciencias de la Salud, Universidad Juárez Autónoma de Tabasco, Villahermosa, Tabasco, Mexico
| | - María Lilia López-Narváez
- Hospital General de Yajalón "Dr. Manuel Velasco Siles", Secretaría de Salud. Yajalón, Yajalón, Chiapas, Mexico
| | | | - Nonanzit Pérez-Hernández
- Departamento de Biología Molecular, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
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Roller BL, Boutin RD, O'Gara TJ, Knio ZO, Jamaludin A, Tan J, Lenchik L. Accurate prediction of lumbar microdecompression level with an automated MRI grading system. Skeletal Radiol 2021; 50:69-78. [PMID: 32607805 DOI: 10.1007/s00256-020-03505-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 06/03/2020] [Accepted: 06/04/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Lumbar spine MRI interpretations have high variability reducing utility for surgical planning. This study evaluated a convolutional neural network (CNN) framework that generates automated MRI grading for its ability to predict the level that was surgically decompressed. MATERIALS AND METHODS Patients who had single-level decompression were retrospectively evaluated. Sagittal T2 images were processed by a CNN (SpineNet), which provided grading for the following: central canal stenosis, disc narrowing, disc degeneration, spondylolisthesis, upper/lower endplate morphologic changes, and upper/lower marrow changes. The grades were used to calculate an aggregate score. The variables and the aggregate score were analyzed for their ability to predict the surgical level. For each surgical level subgroup, the surgical level aggregate scores were compared with the non-surgical levels. RESULTS A total of 141 patients met the inclusion criteria (82 women, 59 men; mean age 64 years; age range 28-89 years). SpineNet did not identify central canal stenosis in 32 patients. Of the remaining 109, 96 (88%) patients had a decompression at the level of greatest stenosis. The higher stenotic grade was present only at the surgical level in 82/96 (85%) patients. The level with the highest aggregate score matched the surgical level in 103/141 (73%) patients and was unique to the surgical level in 91/103 (88%) patients. Overall, the highest aggregate score identified the surgical level in 91/141 (65%) patients. The aggregate MRI score mean was significantly higher for the L3-S1 surgical levels. CONCLUSION A previously developed CNN framework accurately predicts the level of microdecompression for degenerative spinal stenosis in most patients.
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Affiliation(s)
- Brandon L Roller
- Department of Radiology, Wake Forest School of Medicine, Medical Center Blvd., Winston Salem, NC, 27157, USA.
| | - Robert D Boutin
- Department of Radiology, Stanford University, Stanford, CA, USA
| | - Tadhg J O'Gara
- Department of Orthopaedic Surgery, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Ziyad O Knio
- Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Amir Jamaludin
- Department of Engineering Science, University of Oxford, Oxford, UK
| | - Josh Tan
- Department of Radiology, Wake Forest School of Medicine, Medical Center Blvd., Winston Salem, NC, 27157, USA
| | - Leon Lenchik
- Department of Radiology, Wake Forest School of Medicine, Medical Center Blvd., Winston Salem, NC, 27157, USA
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Maurer E, Klinger C, Lorbeer R, Rathmann W, Peters A, Schlett CL, Nikolaou K, Bamberg F, Notohamiprodjo M, Walter SS. Long-term effect of physical inactivity on thoracic and lumbar disc degeneration-an MRI-based analysis of 385 individuals from the general population. Spine J 2020; 20:1386-1396. [PMID: 32360761 DOI: 10.1016/j.spinee.2020.04.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Revised: 04/22/2020] [Accepted: 04/22/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT The correlation between physical inactivity, thoracolumbar disc degeneration, and back pain remains unclear. PURPOSE This study investigated the relationship between short- and long-term physical inactivity and degenerative changes of the thoracic and lumbar spine in a southern German cohort from the general population over a time period of 14 years. STUDY DESIGN/SETTING This study was designed as a cross-sectional case-control study, nested in a prospective cohort from the "Cooperative Health Research in the Region of Augsburg/Kooperative Gesundheitsforschung in der Region Augsburg" (KORA) study. PATIENT SAMPLE All participants in the population-based KORA study were assessed using a physical activity questionnaire to establish a baseline in 1999-2001 (exam 1), within an initial follow up questionnaire in 2006-2008 (exam 2), and a second follow-up questionnaire between 2013 and 2014 (exam 3). A subsample of this group (400 subjects) underwent full body MR scan performed on a 3T magnetic resonance imaging scanner current with exam 3. OUTCOME MEASURE Data regarding physical inactivity over a time period of 14 years and back pain, and quantification of thoracic and lumbar disc degeneration on magnetic resonance imaging. METHODS Quantification of thoracic and lumbar disc degeneration was performed using the Pfirrmann score. Physical activity was grouped as no physical activity, irregularly for 1 hour, regularly for 1 hour, or regularly for ≥2 hours. This was used to calculate another variable "physical inactivity," with the options of irregular activity ≤1 hour per week or regularly ≥1 hour. Physical labor, walking, and cycling activity were additionally investigated. Correlations between physical inactivity measurements and thoracic and lumbar disc degeneration were analyzed via linear regression models adjusted for age, sex, BMI, hypertension, diabetes, and back pain. RESULTS In total, 385 individuals (mean age: 56 years, SD ± 9.19; 58.2% male) were included in this study. Mean summed Pfirrmann score was 2.41 (SD ± 4.19) in the thoracic and 1.78 (SD ± 1.81) in the lumbar spine. The level of current exercise in our cohort varied with 113 (29.4%) subjects exercising regularly ≥2 hours per week, 118 (30.7%) regularly 1 hour per week, 57 (14%) irregularly for about 1 hour per week, and 97 (25.2%) stated not to exercise at exam 3. Disc degeneration was more apparent in those with irregular activity <1 hour compared to those with regular activity of ≥1 hour and more per week (p<.01) and in those with no activity compared to those with regular activity of ≥2 (p<.001) measured using exam 3. Less physical activity over a time period of 14 years correlated with an increase of disc degeneration of the thoracic and lumbar spine after adjustment for age, sex, BMI, hypertension and diabetes mellitus (p<.05). There was no statistically significant association between physical labor, walking activity, or cycling activity with disc degeneration. Additionally, no significant correlations between degree of disc degeneration (p=.990), degree of physical inactivity (p=.158), and back pain were observed. CONCLUSION Degree of physical inactivity as measured over a time period of 14 years demonstrated a strong correlation with disc degeneration of the thoracic and lumbar spine.
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Affiliation(s)
- Elke Maurer
- Department for Trauma and Reconstructive Surgery, BG Unfallklinik Tuebingen, Eberhard Karls University Tuebingen, Schnarrenbergstrasse 95, 72076 Tuebingen, Germany
| | - Christian Klinger
- Department for Diagnostic and Interventional Radiology, Eberhard Karls University Tuebingen, University Hospital Tuebingen, 72076 Tuebingen, Germany
| | - Roberto Lorbeer
- Department of Radiology, Ludwig-Maximilian-University Hospital, Marchioninistraße 15, 81377 Munich, Germany
| | - Wolfgang Rathmann
- Department of Biometry and Epidemiology, German Diabetes Center, Düsseldorf, Germany
| | - Annette Peters
- German Center for Cardiovascular Disease Research, Munich, Germany; Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany; Institute for Cardiovascular Prevention, Ludwig-Maximilian-University Hospital, Munich, Germany
| | - Christopher L Schlett
- Department of Diagnostic and Interventional Radiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Konstantin Nikolaou
- Department for Diagnostic and Interventional Radiology, Eberhard Karls University Tuebingen, University Hospital Tuebingen, 72076 Tuebingen, Germany
| | - Fabian Bamberg
- Department of Diagnostic and Interventional Radiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Mike Notohamiprodjo
- Department for Diagnostic and Interventional Radiology, Eberhard Karls University Tuebingen, University Hospital Tuebingen, 72076 Tuebingen, Germany; DIE RADIOLOGIE, Sonnenstrasse 17, 80331 Munich, Germany.
| | - Sven S Walter
- Department for Diagnostic and Interventional Radiology, Eberhard Karls University Tuebingen, University Hospital Tuebingen, 72076 Tuebingen, Germany
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Tang XM, Dai J, Sun HL. Upregulation of suppressor of cytokine signaling 3 ameliorates spinal degenerative disease in adolescents by mediating leptin and tumor necrosis factor-α levels. Exp Ther Med 2019; 18:2231-2237. [PMID: 31410173 DOI: 10.3892/etm.2019.7786] [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: 04/08/2018] [Accepted: 01/25/2019] [Indexed: 11/06/2022] Open
Abstract
Spinal degenerative changes may occur following the rapid growth observed in adolescents, causing a reduced quality of life. The suppressor of cytokine signaling (SOCS) is involved in various degenerative diseases. The current study recruited adolescents with spinal degenerative disease (SDD) to identify the effect of SOCS-3 on leptin and tumor necrosis factor-α (TNF-α) levels in this disorder. From January 2010 to January 2016, 120 adolescents (aged 14 to 25) were enrolled in the current study, with 68 diagnosed with SDD and the remaining 52 treated as controls. Nucleus pulposus cells (NPCs) were extracted and cultured in vitro. TNF-α levels in NPCs were determined using flow cytometry. Degenerative NPCs were then transfected with pCR3.1-SOCS-3 and ELISA was performed to determined TNF-α and leptin levels. RT-qPCR was performed to measure the mRNA level of SOCS-3 and leptin in NPCs and western blotting was utilized to detect the protein level of leptin and the extent of leptin receptor phosphorylation. The results revealed that TNF-α levels in degenerative NPCs were higher than those in normal NPCs. The overexpression of SOCS-3 reduced levels of TNF-α and leptin in degenerative NPCs. In addition, the upregulation of leptin increased SOCS-3 levels in a concentration-dependent manner. Furthermore, the expression of the leptin receptor and phosphorylated leptin receptor gradually decreased with increasing leptin concentrations and the level of phosphorylated leptin receptor negatively correlated with SOCS-3 expression. The inductive effect of leptin on the level of SOCS-3 and the inhibitory effect of SOCS-3 on the activity of leptin were identified. The current study demonstrated that SOCS-3 reduces leptin and TNF-α levels in degenerative NPCs from adolescents, indicating its potential role in the development of novel SDD therapies.
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Affiliation(s)
- Xiao-Ming Tang
- Department of Orthopedics, The Affiliated Huai'an No. 1 People's Hospital of Nanjing Medical University, Huai'an, Jiangsu 223300, P.R. China
| | - Jian Dai
- Department of Orthopedics, The Affiliated Huai'an No. 1 People's Hospital of Nanjing Medical University, Huai'an, Jiangsu 223300, P.R. China
| | - Hai-Lang Sun
- Department of Orthopedics, The Affiliated Huai'an No. 1 People's Hospital of Nanjing Medical University, Huai'an, Jiangsu 223300, P.R. China
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