What do astronauts and 80% of the world’s population have in common? A galactic back pain …!

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We are talking about that pain that affects, especially between 40 and 50 years, the column between the costal margin and the lower gluteal line. Back pain is, in fact, a pathology that continues to be among the most widespread according to data from the Global Burden Disease Study (2017): the study compared both the major causes of global disabilities over time and the data from 1990 and 2017.

The result? Low back pain maintains the podium in the causes of disability, with particular reference to countries with a high socio-demographic index (since it identifies where the country is located in terms of development by schooling, income and birth rate).

Consequently, there has been no improvement over time in the management capacity of this problem. Most cases still pose a challenge in terms of therapeutic management as their specific cause is unknown (George E. Ehrlich, Bulletin of the World Health Organization 2003; 81: 671-676).

Let’s go back to our spacemen. Because floating in space can be incredible, but unfortunately, half of the astronauts complain of back pain when they return, just like a good part of the rest of the population who pass their time on Earth.
Prolonged exposure to microgravity causes the muscles around the spine to relax and are less “trained” because they are not used. To put it like Luca Parmitano, one of the most famous Italian astronauts, “the spinal column in orbit seems to lengthen”.

In a recent study (Jeannie F. Bailey et al. 2018), the researchers evaluated some anatomical and functional parameters of the spine of some NASA astronauts before and after six months spent in orbit aboard the International Space Station and found that the prolonged exposure to the lack of gravity weakens the muscles that support the astronauts’ back.
“It has been seen that the atrophy of the muscles of the column rather than the protrusion of the intervertebral disc – explains Dr Francesca Di Felice, physician of Isico – is strongly associated with the reduction of lordosis (anterior curve of the column that allows a better distribution of the load to the lower limbs) and with the increase of the stiffness of the column and its weakening. This reduction in muscle strength increases back pain in astronauts once they return to Earth. It is easy to deduce the implications that these results also have for the deconditioned backs of sedentary subjects who live on Earth in gravity: what would happen to the laziest and most sluggish to physical activity would be superimposable to the anatomical and functional alterations recorded for experienced astronauts in a microgravity environment “.

Surgical Versus Nonsurgical Treatment for High-Grade Spondylolisthesis in Children and Adolescents: A Systematic Review and Meta-Analysis

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Xue X, Wei X, Li L, Medicine (Baltimore). 2016 Mar;95(11):e3070. doi: 10.1097/MD.0000000000003070

The optimal management of high-grade spondylolisthesis in children and adolescent is controversial. There is a paucity of literature regarding operatively or nonoperative management in this setting. To assessment of the current state of evidence regarding high-grade spondylolisthesis treatment with the goal of obtaining outcome comparisons in these patients managed either operatively or nonoperatively.

We performed a systematic literature search up to November 2014, using Medline, Embase, and The Cochrane Library.

The analysis and eligibility criteria were documented according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA-guidelines) and Cochrane Back Review Group editorial board.

We used the Newcastle-Ottawa quality assessment scale (NOS-scale) to assess the quality. Five observational studies were considered eligible for analysis based on the evaluation of 1596 identified papers.

The mean overall difference in the Scoliosis Research Society questionnaire 22 between the surgical and nonsurgical groups was not statistically significant (95% CI: -0.17 to 0.21, P = 0.84). The pooled mean difference in progression of slip between the surgical and nonsurgical groups was no significant difference (OR: 0.47, 95% CI: 0.12-1.81, P = 0.27, I = 0%). B

ecause of the preponderance of uncontrolled case series, low-quality evidence indicates that the quality of life and progression of slips was no significant difference between surgery and nonoperation group.

Nonoperative patients had no radiologic progression of their slip during the follow-up period.

Please find here the abstract of the article: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4839915/

Advantages and Disadvantages of Adult Spinal Deformity Surgery and its Impact on Health-related Quality of Life.

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Every year, the Scoliosis Study Group selects the best published papers on conservative spine treatment from the global scientific literature.
Here is the abstract from one of these papers.

Advantages and Disadvantages of Adult Spinal Deformity Surgery and its Impact on Health-related Quality of Life.

Oshida G, Boissiere L, Larrieu D, Bourghli A, Vital JM, Gille O, Pointillart V, Challier V, Mariey R, Pellise F, Vila-Casademunt A, Perez-Grueso FJ, Alanay A, Acaroglu E, Kleinstuck F, Obeid I
Spine (Phila Pa 1976). 2016 Jul 7.

STUDY DESIGN: Prospective multicenter study of adult spinal deformity (ASD) surgery.

OBJECTIVE: To clarify the impact of ASD surgery on each health-related quality of life (HRQOL) subclass/domain.

SUMMARY OF BACKGROUND DATA: For ASD patients, surgery offers superior radiological and HRQOL outcomes compared to non-operative care. However, HRQOL may be affected by surgical advantages related to corrective effects, yielding adequate spinopelvic alignment and stability or disadvantages because of long segment fusion. METHODS: The study included 170 consecutive ASD patients from a multicenter database with >2-year follow-up period. We analyzed each HRQOL domain/subclass [short form-36 items (SF-36), Oswestry Disability Index (ODI), Scoliosis Research Society-22 questionnaire (SRS-22)], and radiographic parameters preoperatively and at 1 and 2 years postoperatively. We divided the patients into two groups each based on lowest instrumented vertebra (LIV; above L5 or S1 to ilium) or surgeon-determined preoperative pathology (idiopathic or degenerative). Improvement rate (%) was calculated as follows: 100 x |pre.-post.|/preoperative points (%) (+, advantages; -, disadvantages).

RESULTS: The scores of all SF-36 and SRS-22 subclasses improved at 1 and 2 years after surgery, regardless of LIV location and preoperative pathology. However, personal care and lifting in ODI were not improved after 1 year. These disadvantages were correlated to sagittal modifiers of SRS-Schwab classification similar to other HRQOL. The degree of personal care disadvantage mainly depended on LIV location and preoperative pathology. Although personal care improved after 2 years postoperatively, no noticeable improvements in lifting were recorded.

CONCLUSION: HRQOL subclass analysis indicated two disadvantages of ASD surgery, which were correlated to sagittal radiographic measures. Fusion to the sacrum or ilium greatly restricted the ability to stretch or bend, leading to limited daily activities for at least 1 year postoperatively, although this effect may subside after another year. Consequently, spinal surgeons should note the impact of surgical treatment on each HRQOL domain and counsel patients on the implications of surgery.

Eurospine: a participant’s comment

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In September Isico attended the International Eurospine Congress in Barcelona. Dr. Francesca Di Felice presented a poster titled Adolescent idiopathic bracing success rates influenced by time in brace: Comparative effectiveness analysis of the BrAIST and ISICO cohorts, while Dr. Fabio Zaina delivered an oral presentation about the study, ISYQOL discriminates adolescents with spinal deformities subgroups better than the SRS-22 questionnaire.

The aim of Eurospine is to optimize patient care and prevention of spinal disorders, stimulating the exchange of knowledge and ideas in the field of research, prevention, and treatment of spine diseases. In recent years, the society, mostly represented by surgeons, has offered different surgical courses, but a novel development has occurred in Barcelona with the birth of Non-Surgical Interprofessional Courses: the EUROSPINE Diploma in Interprofessional Spine Care (EDISC). The non-surgical task force includes Dr. Fabio Zaina as responsible of the module on spinal deformities.

“We want to underline the great value in the field of research of Prof. Martin E. Schwab ‘s Medal Lecture at the conference: New therapies to repair the neuronal hardware and improve functional recovery after spinal cord injury,” says Dr. Di Felice. “Prof Schwab presented a clinical trial for anti-Nogo-A in acute spinal cord injury, promising in the rehabilitation of spinal cord injury (SCI). Nogo A is a suppressor of nerve fiber growth in the adult central nervous system (CNS); neutralization of Nogo-A by antibodies after CNS injury allows the enhancement of long-distance regeneration of injured fibers, the stimulation of compensatory fiber growth by speared systems, and a functional recovery.

An interesting topic has been the surgical symposium on Adolescent Spinal Deformities and Treatment Options in which the anterior surgery was debated. Anterior scoliosis correction and vertebral body tethering are examples of that: these techniques can be considered less invasive approaches compared to posterior surgery. The first one can also be used in curves over 65 degrees, stiff curves in mature adolescents and adults; the second one can be used in flexible curves less than 65 degrees in the growing spine”.