Stooped Posture Research Articles

369 Camptocormia in Parkinsons Disease: Systematic Review of Management Using Spine Surgery

INTRODUCTION: Postural instability or deformity manifests in a variety of ways for a Parkinson's disease (PD) patient, including the classical stooped posture, as well as antecollis, pisa syndrome, degenerative scoliosis, and a debilitating forward flexion of the trunk termed camptocormia. Camptocormia was first described in the midst of World War 1, where young soldiers were found to have a non-fixed forward-bent trunk attributed to the stress of battle. METHODS: PubMed was queried for studies involving spine surgery as treatment of PD-associated camptocormia. Studies that described nonsurgical management, deep brain stimulation (DBS), repetitive tran-spinal magnetic stimulation (rTSMS), or were descriptive in nature were excluded. RESULTS: The screening process resulted in 5 studies that reported on the use of spine surgery in PD-associated camptocormia. The total number of patients was 19, 12 of which experienced hardware failure warranting revision surgery (63.1%). Clinical and radiologic improvement was inconsistent. Patient outcomes were ultimately satisfactory, only after high reoperation and complication rates. CONCLUSIONS: Evidence for the feasibility of spine surgery as management for PD-associated camptocormia is lacking in the literature. In this particular patient population, these procedures carry a high risk of complications and subsequent revision operations, which may negatively affect long-term quality of life. In the absence of or resistance to conservative management, DBS, or rTSMS, spine surgery may be the only option for some patients. Continued investigation via longitudinal and large-scale studies is crucial in order to provide definitive recommendations and treatment algorithms for providers to adhere to.

Knowledge, Attitude, and Practices Towards Osteoporosis Among Adults in the United Arab Emirates (UAE) in 2023.

Osteoporosis, the silent epidemic, is defined as a systemic skeletal disease characterized by low mineral bone mass and micro-architectural deterioration of bone tissue. Osteoporosis is considered a burden to global economic, social, and health development. Osteoporosis exerts a substantial global influence, markedly influencing rates of illness and death on a broad scale. Clinical features of osteoporosis can include chronic back pain, loss of height, and a stooped posture, as well as an increased risk of fractures in the spine, hip, and wrist. Accurate identification and monitoring of these clinical features are essential for effective management and treatment of osteoporosis. This study aims to identify the knowledge, attitudes, and practices (KAP) of adults (over 18 years) about osteoporosis and identify relations between knowledge, attitudes, and practices with demographic data. Furthermore, to assess the risk factors and preventive measures for osteoporosis. Data from 446 responders were collected using a Google Forms questionnaire, including questions to assess knowledge, attitudes, and practice levels among adults 18 years and above in the United Arab Emirates (UAE). The collected data and statistical analysis were done through the IBM® SPSS® Statistics. Chi-Square was used in SPSS Statistics; the chi-square test was used for the relation between categorical variables, and P less than 0.05 was the cut-off level of significance. The research revealed that 41.9% of the participants had good knowledge, 38.8% had a positive attitude, and 45.3% had poor practices. The results also showed that there is a statistically significant correlation between gender and knowledge, attitudes, and practices. Our research demonstrates that there's a statistically significant correlation between gender variables with knowledge, attitudes, and practices. These findings have important implications in assessing the correlation between variables in our research that could be used to prevent osteoporosis further, target the specific demographic group, and provide the required education. Overall, our research contributes to a better understanding of the knowledge, attitude, and practices towards Osteoporosis among adults in the UAE and underscores the importance of further awareness in this area.

Impact of gender, posture and phase on back and lower extremity moments and muscle excitation during lifting task: a cross-sectional study.

Purpose: The aim of this work was to investigate and compare back and lower extremity joint moments and muscle excitation during stoop and squat postures by incorporating gender-based differences and analyzing lifting phases. Methods: 18 healthy adults (9 males and 9 females; age: 24.44 ± 4.96 years, body mass: 66.00 ± 12.10 kg, height: 170.11 ± 9.20 cm, lean body mass: 48.46 ± 7.66 kg) lifted an object 30% of their lean body mass using squat and stoop postures. Marker-based motion capture, force plate, and surface electromyography were synchronously used to acquire joint moments and muscle excitation. A 3-way mixed model analysis was performed to determine the effect of gender, posture, and phase on internal joint moments and muscle excitation of the lower back and extremities. Results: Significant differences were observed in the interaction of lifting posture and phase on lower extremity moments and excitation of rectus femoris and medial gastrocnemius. Individual effects of posture were significant for peak internal joint moments of the lower extremities only. Anterior lower extremity muscles showed significantly increased excitation during squat, whereas medial gastrocnemius was higher in stoop. Joint moments and muscle excitations were all higher during the lifting than the bending phase. Gender differences were found only in the peak lumbosacral sagittal plane moment and rectus femoris muscle excitation. Conclusions: The study identified significant variations in the joint moments and muscle excitation in lifting, influenced by gender, posture, and phase, highlighting its complex nature. Overall interactions were lacking, however individual effects were evident, necessitating larger future studies.

중년 비만 여성의 아바타 모델링을 위한 체형 연구

This study categorized and analyzed the body types of middle-aged obese women, aged 40-59, based on the characteristics of their shapes for the purpose of 3D avatar modeling. Data from 149 middle-aged obese women were utilized, as provided by the 'Size Korea 8th Body Measurement Survey,' consisting of 3D measurement data. Eleven body type factors were extracted. The data was analyzed through factor analysis and classified into four body types.Type 1 represents a curved body shape with pronounced curves, Type 2 is characterized by well-developed lower body and a stooped posture, Type 3 exhibits a straight body shape with minimal curves, and Type 4 features long legs and development of upper body with a leaning posture.

Analysis of abnormal posture in patients with Parkinson's disease using a computational model considering muscle tones.

Patients with Parkinson's disease (PD) exhibit distinct abnormal postures, including neck-down, stooped postures, and Pisa syndrome, collectively termed "abnormal posture" henceforth. In the previous study, when assuming an upright stance, patients with PD exhibit heightened instability in contrast to healthy individuals with disturbance, implying that abnormal postures serve as compensatory mechanisms to mitigate sway during static standing. However, limited studies have explored the relationship between abnormal posture and sway in the context of static standing. Increased muscle tone (i.e., constant muscle activity against the gravity) has been proposed as an underlying reason for abnormal postures. Therefore, this study aimed to investigate the following hypothesis: abnormal posture with increased muscle tone leads to a smaller sway compared with that in other postures, including normal upright standing, under the sway minimization criterion. To investigate the hypothesis, we assessed the sway in multiple postures, which is determined by joint angles, including cases with bended hip joints. Our approach involved conducting forward dynamics simulations using a computational model comprising a musculoskeletal model and a neural controller model. The neural controller model proposed integrates two types of control mechanisms: feedforward control (representing muscle tone as a vector) and feedback control using proprioceptive and vestibular sensory information. An optimization was performed to determine the posture of the musculoskeletal model and the accompanied parameters of the neural controller model for each of the given muscle tone vector to minimize sway. The optimized postures to minimize sway for the optimal muscle tone vector of patients with PD were compared to the actual postures observed in these patients. The results revealed that on average, the joint-angle differences between these postures was <4°, which was less than one-tenth of the typical joint range of motion. These results suggest that patients with PD exhibit less sway in the abnormal posture than in other postures. Thus, adopting an abnormal posture with increased muscle tone can potentially serve as a valid strategy for minimizing sway in patients with PD.

OA05 Cycling: a tool for cardiovascular exercise in patients with established ankylosing spondyloarthritis

OA05 Cycling: a tool for cardiovascular exercise in patients with established ankylosing spondyloarthritis

Effect of walking height on movement of individuals and crowds in a corridor

The safe and efficient evacuation of pedestrians in an emergency has been widely investigated in the past. Stooping is a common walking posture of pedestrians in evacuation. Understanding the basic laws of pedestrian movement with stoop posture is instructive for developing effective evacuation management in an emergency. However, the evacuation behaviors and movement characteristics of stooped pedestrians are still unclear. In this study, a series of experiments on individuals and crowds with different walking heights were conducted in an 18 m long corridor. It was found that a left-deflection phenomenon appears in the transition from upright walking to stooped walking, and the deflection angles of pedestrians decrease with increasing walking height. The influence of walking height on pedestrian velocity is revealed through the comparison of individual and crowd movement. Restricted walking height can promote the movement velocity of individuals at low speed levels, and weakens the velocity at high speed levels. In contrast to the individual, the velocities of crowds at different speed levels will be enhanced by restricted walking height. Generally, pedestrian movement is affected by the initial motivation, walking height and pedestrian density. Restricted walking height has an encouraging effect in the motivation of pedestrian movement but can increase the physical discomfort of pedestrians. Besides, crowd density has an inhibitory effect on pedestrian movement, and restricted walking height can alleviate high crowd density, implying that appropriate stoop movement can facilitate pedestrian traffic and evacuation to some extent.

Optimization of Subglottic View During Flexible Laryngoscopy With Patient Positioning.

Determine the ideal head position to optimize visualization of the subglottis using flexible laryngoscopy. Prospective cohort study. Outpatient multidisciplinary airway clinic at a tertiary care center. Patients presenting to a multidisciplinary airway clinic undergoing nasoendoscopic airway examination were enrolled. Three head positions were utilized to examine the subglottis during laryngoscopy: "sniffing,"chin tuck, and stooping positions. In-office reviewers and blinded clinician participants evaluated views of the airway based on Cormack-Lehane (CL) scale, airway grade (AG), and visual analog scale (VAS). Demographic data were obtained. Statistical analysis compared head positions and demographic data using Student's t test, analysis of variance, and Tukey's post hoc analysis. One hundred patients participated. No statistical differences existed amongin-clinic or blinded reviewers for the CL score in any head position (p = .35,.5, respectively). For both AG and VAS, flexed and stooping positions were rated higher than the sniffing positions by both in-clinic and blinded reviewers (p < .01 for all analyses), but there was no statistical difference between these two positions (p = .28,.18, respectively). There was an inverse correlation between age and scores for AGand VAS in the flexed position for both sets of reviewers (p = .02, <.01 respectively), and a higher body mass index was significantly associated with the need to perform tracheoscopy for full airway evaluation (p < .01). Both flexion and stoop postures can be implemented by an experienced endoscopist in awake, transnasal flexible laryngoscopy to enhance visualization of the subglottic airway.

Walking with a Mobile Phone: A Randomised Controlled Trial of Effects on Mood

It is now common to see pedestrians looking at their mobile phones while they are walking. Looking at a mobile phone can cause stooped posture, slower gait, and lack of attention to surroundings. Because these walking characteristics have been associated with negative affect, walking while looking at a mobile phone may have negative effects on mood. This study aimed to investigate whether walking while looking at a mobile phone had psychological effects. One hundred and twenty-five adults were randomised to walk in a park either with or without reading text on a mobile phone. Participants wore a fitness tracker to record pace and heart rate, and posture was calculated from video. Self-reported mood, affect, feelings of power, comfort, and connectedness with nature were assessed. The phone group walked significantly slower, with a more stooped posture, slower heart rate, and felt less comfortable than the phone-free group. The phone group experienced significant decreases in positive mood, affect, power, and connectedness with nature, as well as increases in negative mood, whereas the phone-free group experienced the opposite. There was no significant mediation effect of posture on mood; however, feeling connected with nature significantly mediated the effects of phone walking on mood. In conclusion, individuals experience better wellbeing when they pay attention to the environment rather than their phone while walking. More research is needed to investigate the effects of performing other activities on a mobile phone on mood while walking and in other settings.

HTLV-1-associated myelopathy/tropical spastic paraplegia with sporadic late-onset nemaline myopathy: a case report

BackgroundSporadic late onset nemaline myopathy (SLONM) is a muscle disorder characterized by the presence of nemaline rods in muscle fibers. SLONM has no known genetic cause but has been associated with monoclonal gammopathy of undetermined significance and with human immunodeficiency virus (HIV) infection. Human T-cell leukemia virus-1 (HTLV-1) is a known causative agent of adult T-cell leukemia/lymphoma and HTLV-1 associated myelopathy/tropical spastic paraplegia (HAM/TSP), a chronic inflammatory neurological disease. HTLV-1 has been reported to be implicated in inflammatory myopathies, as well as in HIV infection.; however, there have been no reports of an association between HTLV-1 infection and SLONM to date.Case presentationA 70-year-old Japanese woman presented with gait disturbance, lumbar kyphosis, and respiratory dysfunction. The diagnosis of HAM/TSP with SLONM was made based on characteristic clinical symptoms of HAM/TSP, such as spasticity in the lower extremities, and cerebrospinal fluid test results; and of SLONM, such as generalized head drooping, respiratory failure, and muscle biopsy results. Steroid treatment was initiated and improvement in her stooped posture was observed after 3 days of treatment.ConclusionThis is the first case report of SLONM combined with HTLV-1 infection. Further studies are needed to elucidate the relationship between retroviruses and muscle diseases.

Camera- and Viewpoint-Agnostic Evaluation of Axial Postural Abnormalities in People with Parkinson's Disease through Augmented Human Pose Estimation.

Axial postural abnormalities (aPA) are common features of Parkinson's disease (PD) and manifest in over 20% of patients during the course of the disease. aPA form a spectrum of functional trunk misalignment, ranging from a typical Parkinsonian stooped posture to progressively greater degrees of spine deviation. Current research has not yet led to a sufficient understanding of pathophysiology and management of aPA in PD, partially due to lack of agreement on validated, user-friendly, automatic tools for measuring and analysing the differences in the degree of aPA, according to patients' therapeutic conditions and tasks. In this context, human pose estimation (HPE) software based on deep learning could be a valid support as it automatically extrapolates spatial coordinates of the human skeleton keypoints from images or videos. Nevertheless, standard HPE platforms have two limitations that prevent their adoption in such a clinical practice. First, standard HPE keypoints are inconsistent with the keypoints needed to assess aPA (degrees and fulcrum). Second, aPA assessment either requires advanced RGB-D sensors or, when based on the processing of RGB images, they are most likely sensitive to the adopted camera and to the scene (e.g., sensor-subject distance, lighting, background-subject clothing contrast). This article presents a software that augments the human skeleton extrapolated by state-of-the-art HPE software from RGB pictures with exact bone points for posture evaluation through computer vision post-processing primitives. This article shows the software robustness and accuracy on the processing of 76 RGB images with different resolutions and sensor-subject distances from 55 PD patients with different degrees of anterior and lateral trunk flexion.

Prevalence of acute low back pain with risk of long-term disability and its correlates among medical students: A cross-sectional study.

Low back pain (LBP) is responsible for the highest number of years lived with disability globally. There is a paucity of data regarding the same among medical students. So, this study was planned to estimate the prevalence of acute LBP having a high propensity to develop into chronic one as well as to determine associated correlates among medical students. This cross-sectional study was conducted among 300 medical students at a tertiary hospital using an Acute Low Back Pain Screening Questionnaire (ALBPSQ) to identify individuals with LBP and having a high risk of developing a long-term disability. ALBPSQ is a 21-question-based biopsychosocial screening instrument for identifying patients at risk of chronicity. ALBPSQ scores have been found to be significantly associated with pain and functional disability. Descriptive statistics, bivariate analysis, and multiple binary logistic regression have been performed through SPSS-22 software. The prevalence of LBP having the propensity to develop into a long-term disability was found to be 14.3% (95% CI: 10.6-18.8). In bivariate analysis, higher age, no exercise, higher screen time, mental stress, studying in bed, abnormal posture, alcohol intake, tobacco use, positive family history, greater screen time per day, and more time spent in a sitting posture are significant with LBP. Stress ((adjusted odds ratio) AOR: 4.37, 95% CI: 1.79-10.68)), abnormally bent standing posture (AOR: 3.6, 95% CI: 1.3-10.6), and positive family of LBP (AOR: 3.6, 95% CI: 1.3-10.1) were found to be independent predictors of LBP among medical students. Among medical students, every 15 out of 100 have a low back problem with chances of long-term disability. These students require early intervention to avoid long-term disability. Abnormal stooping posture, psychological stress, and positive family history of low pain might independently lead to LBP.

Robust estimation of lumbar joint forces in symmetric and asymmetric lifting tasks via large-scale electromyography-driven musculoskeletal models

Low back joint compression forces have been linked to the development of chronic back pain. Back-support exoskeletons controllers based on low back compression force estimates could potentially reduce the incidence of chronic pain. However, progress has been hampered by the lack of robust and accurate methods for compression force estimation. Electromyography (EMG)-driven musculoskeletal models have been proposed to estimate lumbar compression forces. Nonetheless, they commonly underrepresented trunk musculoskeletal geometries or activation–contraction dynamics, preventing validation across large sets of conditions. Here, we develop and validate a subject-specific large-scale (238 muscle–tendon units) EMG-driven musculoskeletal model for the estimation of lumbosacral moments and compression forces, under eight box-lifting conditions. Ten participants performed symmetric and asymmetric box liftings under 5 and 15 kg weight conditions. EMG-driven model-based estimates of L5/S1 flexion–extension moments displayed high correlation, R2 (mean range: 0.88–0.94), and root mean squared errors between 0.21 and 0.38 Nm/kg, with respect to reference inverse dynamics moments. Model-derived muscle forces were utilized to compute lumbosacral compression forces, which reached eight times participants body weight in 15 kg liftings. For conditions involving stooped postures, model-based analyses revealed a predominant decrease in peak lumbar EMG amplitude during the lowering phase of liftings, which did not translate into a decrease in muscle–tendon forces. During eccentric contraction (box-lowering), our model employed the muscle force–velocity relationship to preserve muscle force despite significant EMG reduction. Our modeling methodology can inherently account for EMG-to-force non-linearities across subjects and lifting conditions, a crucial requirement for robust real-time control of back-support exoskeletons.

Ergonomic risk and physiological assessment of plogging activity

Plogging, an environment friendly trash workout is a combination of jogging with litter collection. People who are involved in the plogging carry a baggage for collecting the litter. Walking with a weight on one side causes the opposite side of the body to engage for stability and are also exposed to repetitive bending during the activity. The purpose of this study is to evaluate the postural and physiological aspects of plogging activity. Thirty six subjects performed the litter collection in stoop, semi-squat, full squat and lunge postures respectively. Postures were analyzed using Rapid Entire Body Assessment (REBA). Physiological aspects of plogging, as well as a comparison of physical activity assessment during jogging and plogging, were investigated using a Polar M430 optical heart rate monitor. Statistical analysis were performed using SPSS version 23. Mean±SD of full squat (5.13±0.59) and lunge (6.64±1.15) posture was found to have lesser risk score in comparison with the other two postures such as stoop (10.31±0.88) and semi-squat (8.11±1.40). Analysis from the Kruskal-Wallis and post hoc test showed that there is no significant interaction between the postures (p < 0.05). Paired Sample t-test showed that the energy expenditure for plogging and jogging are found to be similar (p > 0.05), but the fat percentages of calories burned is more in plogging (p < 0.05). Howerver plogging can be considered as a strenous activity as the % Cardiovascular strain of the activity had a mean value of (99.261% ). Ergonomic interventions are needed to play a vital role in minimizing the musculoskeletal related injuries and the physical strain of the task.

Camera Work

Camera Work

Complications after Spinal Surgery in Patients with Parkinson’s Disease

Background: Several studies have shown that spinal surgeries in patients who suffer from Parkinson’s Disease have a high rate of complications. These patients often need revision surgery. Objective: This is a retrospective study involving 21 patients with Parkinson’s Disease. This study aimed to examine the complications after spinal surgery. Methods: We studied 21 patients with Parkinson’s Disease retrospectively, who had undergone a previous operation by the same surgeon between 2004 to 2019. There were 11 females and 10 males. The mean age was 71.9 years (range, 52 to 85). However, the initial diagnosis and types of surgery were different. The mean time of follow-up for each patient was 3.6 years (ranging from 2 to 8 years). Results: Most of the patients had a post-operative complication within a period of three years. Τhe most common complication was kyphotic deformity and camptocormia. Twelve patients (57.1%) underwent revision surgery, and three patients (14.2%) denied treatment. In four patients (19.04%), kyphotic deformity or stooped posture remained. Only one patient (4.7%) presented with no complication in a follow-up of 8 years. Conclusion: Patients with Parkinson’s disease have a high rate of complications after spinal surgery and often need revision surgery. For this literature review, the overall number of patients was 502, and the mean revision rate was 43.6%. The surgeon must inform patients of possible complications, and a thorough post-operative observation must be implemented.

Advanced Physical Rehabilitation in Hairline Coccyx Fracture: A Case Report

Background: The fracturing of Coccyx is an injury normally caused by trauma. A fall on the buttocks can cause a coccyx fracture that may go radiographically unnoticed. There is substantial discomfort in the patient that can persist for months. Coccygectomy is suggested in cases that, after more than 2 months of conservative treatment, demonstrate coccydynia. There is little evidence available on the feasibility of this technique, though, and it is considered to have a high complication rate. As such, it requires other treatment techniques.Here, in order to effectively minimize coccydynia in a coccyx fracture patient, we report our experience using another conservative treatment option. The care consists largely of resting, physiotherapy and analgesics.&#x0D; Presenting Symptoms and Diagnosis: : A 21-year-old girl had increased pain i.e. coccydynia after a traffic accident( RTA) induced by coccyx fracture. She visited physiotherapy department with complaints of pain in coccyx area, tenderness, difficulty in mobility (pain while standing from sitting position) and difficulty in performing activities of daily living (ADL). Patient gives history of road traffic accident 2 months ago, a autorickshaw dashed the patient from behind. She went to orthopedic department where X-ray was performed and she diagnosed with hairline coccyx fracture. On inspection, patient was in pain, her NPRS score was 8. Her pain was aggravated by movements and relieved at rest. Patient came with slight stooping posture. On palpation we did found that the swelling and tenderness was present with tightness. Whereas on musculoskeletal assessment, we found that there was decreased range of motion, hypomobile joints, increased tone and muscle spasm.&#x0D; Therapeutic Intervention and Outcomes: Patient was on medical treatment and bed-rest, treated with the analgesic and use of ring cushion was advised. She was also advised to reduce the weight bearing on buttocks. Cross-strapping of buttocks was done. After the completion of bed-rest, her condition was improved but she was having pain and could not perform squatting activities and other activities of daily living. Physiotherapy treatment was planned for the same.&#x0D; Conclusion: Timely physiotherapy treatment is quite helpful to perform her everyday activities independently. This case study reveals the patient with hairline coccyx fracture experience full recovery after conservation management.

Embodiment: I sat, I felt, I performed – Posture effects on mood and cognitive performance

Previous embodiment findings indicate a relationship between physical posture and mood states, suggesting upright postures induce positive mood states. Findings also showed a relationship between moods and cognitive performance. While positive mood states were found to be related to increased processing speed, negative mood states were associated with higher processing accuracy in cognitive task performance. This implies that posture may affect the aforementioned sub-aspects of cognitive performance via mood states. Additionally, most studies on posture effects rely on explicit posture manipulation. With that in mind, our research explores the effects of implicitly manipulated postures on processing speed and accuracy and whether these effects are mediated by general mood. The results revealed that subjects in our sample (N = 82, M = 23.09years) who adopted an upright posture showed a more positive general mood (d = 0.50) and higher processing speed (d = 0.42) compared to those in stooped postures. Surprisingly, no differences in processing accuracy were found. There was no evidence of the proposed mediation in our data.

Measurement and Correction of Stooped Posture during Gait Using Wearable Sensors in Patients with Parkinsonism: A Preliminary Study.

Stooped posture, which is usually aggravated during walking, is one of the typical postural deformities in patients with parkinsonism. However, the degree of stooped posture is difficult to quantitatively measure during walking. Furthermore, continuous feedback on posture is also difficult to provide. The purpose of this study is to measure the degree of stooped posture during gait and to investigate whether vibration feedback from sensor modules can improve a patient’s posture. Parkinsonian patients with stooped posture were recruited for this study. Two wearable sensors with three-axis accelerometers were attached, one at the upper neck and the other just below the C7 spinous process of the patients. After being calibrated in the most upright posture, the sensors continuously recorded the sagittal angles at 20 Hz and averaged the data at every second during a 6 min walk test. In the control session, the patients walked with the sensors as usual. In the vibration session, sensory feedback was provided through vibrations from the neck sensor module when the sagittal angle exceeded a programmable threshold value. Data were collected and analyzed successfully in a total of 10 patients. The neck flexion and back flexion were slightly aggravated during gait, although the average change was <10° in most patients in both measurement sessions. Therefore, it was difficult to evaluate the effect of sensory feedback through vibration. However, some patients showed immediate response to the feedback and corrected their posture during gait. In conclusion, this preliminary study suggests that stooped posture could be quantitatively measured during gait by using wearable sensors in patients with parkinsonism. Sensory feedback through vibration from sensor modules may help in correcting posture during gait in selected patients.

The relationship between smoking and ankylosing spondylitis on some serum biomarkers

Ankylosing spondylitis (AS) is arthritis that affects the spine cause inflammatory stiffening of it. The disease affects both cartilaginous joints of the spine and the sacroiliac joints. Ossification of ligaments and spinal fusion with a typical stooped posture has been shown when disease was developed. Tobacco smoking consist of a complex mixture of various agents had many toxic effects so it has a negative influence on spinal activity, functional ability and mobility in AS. The pathogenesis of AS is imprecise and possible of several pro-inflammatory cytokine formation is leading to many pathogenic consequences. The liver responsible for releasing several types of acute phase proteins (APP) containing the fetuin- A (FA) as counter-regulatory mechanism. Vitamin D (VD) is very important for bone health, and has also been linked with immune function and protection against cancer. This study was designed to clarify the impact tobacco smoking on serum fetuin A, vitamin D and tumor necrosis factor alpha (TNF-α) levels in Iraqi male with ankylosing spondylitis. Cross- sectional study was done in Baghdad Teaching Hospital/ Medical City from April to August 2016. The number of both AS and volunteers are seventy-eight; their mean age were (36.53 ± 8.46) and (33.04 ± 9.74) years respectively. All of them were classified into four groups depending on healthy status and tobacco smoke. Blood sample was drawn from vein of each participant to determine the above serum biomarkers by ELISA. The result showed not significant variations in measuring hemoglobin (HGB) but significant increase of white blood cells (WBCs), platelets count and erythrocyte sedimentation rate (ESR){P values list > 0.05, < 0.05, < 0.05 and