Thoracic Spine Research Articles

Effects of seatback angles on passenger kinematics among the longitudinal braking scenario

With the development of autonomous vehicles and zero gravity seats, the passengers are more likely to sit in their preferred postures, such as the high reclined positions. This study aims to analyse the passenger kinematics under different seatback angles by volunteer experiments, which is beneficial for future smart restraint system development. For this study, four volunteers were selected to participate in the longitudinal braking experiments from 80 km/h to 0 km/h, and each volunteer repeated 3 times. Among the tests, three seatback angles (25°, 45°, and 60° from the vertical) were introduced, while the seat pan angles were the same. The seatbelt forces, as well as the volunteers’ motions were recorded among the experiments. The experimental results indicated that both head displacement and the first thoracic vertebrae (T1) displacement increased gradually with the increase of the seatback angle. The average T1 displacements for four volunteers under 25° seatback angle were between 180.2 mm to 245.5 mm, while the T1 displacements for 45° seatback angle and 60° seatback angle were between 291.4 mm to 374.3 and 366.2 mm to 444.5 mm respectively. Both shoulder belt force and lap belt force increased with the increase of seatback angle, except for the 60° case of No.1 volunteer, which might due to the muscle activation level difference. In this study, there was no significant correlation between the seatback inclination angle and the amount of seat belt outlet amount. The study is beneficial for active human model validation and future smart restraint system development.

A higher body mass index and increased syndesmophytes volume are associated with facet joints ankylosis on thoracic spine in patients with ankylosing spondylitis: a retrospective cohort study

ObjectiveTo investigate the association between syndesmophytes and facet joint (FJ) lesions in patients with ankylosing spondylitis (AS), and to identify clinical factors associated with FJ ankylosis (FJA) in thoracic segment.MethodsNinety-seven patients with AS who underwent thoracic spine computed tomography (CT) or chest CT and without completely thoracic spine fusion were included. FJ lesions were analyzed for the numbers and distribution of normal, ankylosis, erosions, joint-space narrowing, osteophytes, and subchondral sclerosis. The volume of vertebral syndesmophtes unit (VSU) and total thoracic syndesmophtes volume were separately calculated by Mimics software. Clinical factors associated with FJA were investigated using generalized estimation equation (GEE). The association between syndesmophtes volume and numbers of FJ structural lesions was analyzed using generalized additive mixed model (GAMM).Results2328 FJ and 1164 VSUs in thoracic spine were assessed. The majority FJ structural lesions were ankylosis (32.39%). FJA was more frequently seen in vertebrae with syndesmophytes formation (p < 0.001). GEE showed that patients with normal BMI (18.5–24.9 kg/m2) and high BMI (> 24.9 kg/m2) were more likely to have FJA in thoracic spine (odds rations [95% confidence interval]: 0.27(0.12–0.59), 1.45(1.03–8.57), respectively). GAMM showed that syndesmophytes volume increase the numbers of FJA (standard β = 0.009, p < 0.05) and decreased the numbers of normal FJ (standard β = -0.07, p < 0.01).ConclusionFJA was the most common FJ structural lesion in thoracic spine, and it increases linearly with syndesmophytes before the bridging syndesmophytes formed. A higher BMI (especially > 24.9 kg/m2) and increased syndesmophytes volume are associated with FJA in thoracic spine.

Evaluation of the RF depositions at 3T in routine clinical scans with respect to the SAR safety to improve efficiency of MRI utilization.

This study explores the potential for improving of 3T MRI utilization by assessing and tailoring RF exposure in routine clinical scans while complying to standard safety limit. Using two generic human body models, we evaluated pbSAR10g values at four landmark positions (knee, pelvis, thoracic spine, head) at different wbSAR levels. Specifically, weanalyzed local SAR10g in different operating modes and computed the maximum safety wbSAR, ensuring compliance with IEC limits. In normal operating mode, the RF power deposition reached wbSAR limit before the pbSAR10g limit. In the first level controlled operating mode, pbSAR10g limit is reached before the wbSAR limit in the knee, thoracic spine scanning scenarios, while the wbSAR limit is reached first in the pelvis scanning scenarios, making it the most potential-releasing (up to 33.33 %) scanning scenario. For head exposure, the head SAR10g limit is reached before the wbSAR limit, highlighting the necessity for strict SAR control. Moreover, we calculated the minimum allowable TR for common imaging sequences for reference. Different RF exposure setups are necessary to meet safety standards in various scenarios. By implementing careful RF exposure setups in routine clinical scans, the high potential capacity of 3T MRI can be fully released.

Chest wall muscle area, ventilatory efficiency and exercise capacity in systemic sclerosis.

To investigate the potential contribution of chest wall muscle area (CWMA) to the ventilatory efficiency and exercise capacity in patients with Systemic Sclerosis (SSc) without interstitial lung disease (ILD). Forty-four consecutive SSc patients [F = 37, median age 53.5years (IQR 43.5-58)] were examined using chest high-resolution computed tomography (HRCT), pulmonary function tests and cardiopulmonary exercise testing (CPET). The CWMA was evaluated at the level of the ninth thoracic vertebra on CT images by two independent evaluators blinded to the patient information. CPET parameters analyzed were maximum oxygen uptake (VO2 max) and VO2 at anaerobic threshold (VO2@AT); minute ventilation (VE); maximum tidal volume (VT). A statistically significant positive correlation was found between CWMA and maximum workload (r = 0.470, p < 0.01), VO2 max ml/min (r = 0.380, p < 0.01), VO2@AT (r = 0.343, p < 0.05), VE (r = 0.308, p < 0.05), VT (r = 0.410, p < 0.01) and VO2/heart rate (r = 0.399, p < 0.01). In multiple regression analysis, VO2 max (ml/min) was significantly associated with CWMA [β coefficient = 5.226 (95% CI 2.824, 7.628); p < 0.001], diffusing capacity for carbon monoxide (DLco) [β coefficient = 6.749 (95% CI 1.460, 12.039); p < 0.05] and body mass index (BMI) [β coefficient = 41.481 (95% CI 8.802, 74.161); p < 0.05]. In multiple regression analysis, maximum workload was significantly associated with CWMA [β coefficient = 0.490 (95% CI 0.289, 0.691); p < 0.001], DLco [β coefficient = 0.645 (95% CI 0.202, 1.088); p < 0.01] and BMI [β coefficient = 3.747 (95% CI 1.013, 6.842); p < 0.01]. In SSc-patients without ILD, CWMA represents an important variable in exercise capacity and can be evaluated by the mediastinal window available in the HRCT images required for lung disease staging.

Beef-on-dairy: current and potential meat quality of dairy-based beef production with culled Holstein cows and Danish Blue × Holstein crossbred calves

ABSTRACT This study characterizes rosé veal from 412 Danish Blue × Holstein heifer and bull calves and beef from 183 highly marbled culled Holstein dairy cows. Furthermore, it investigates the potential for breeding higher meat quality in dairy crossbreeds via genetic parameter estimation. Carcasses were split between the 5th and 6th thoracic vertebra and the meat quality of M. longissimus thoracis was evaluated for pH, color, cooking loss, Warner-Bratzler shear force (WBSF), and chemical intramuscular fat concentration (IMF%). Genetic parameters were estimated using an animal model. The crossbred bull calves outperformed heifers in carcass characteristics, while heifers were superior in redness, cooking loss, WBSF and IMF%. Heritability was significant for WBSF, cooking loss, and IMF%, indicating that meat quality can be improved through selective breeding. The meat quality of highly marbled Holstein cows did not vary across parities, highlighting them as an under-utilized potential source of high-quality beef from a beef-on-dairy system.

Suboptimal osteoporosis care in hospitalized patients: a retrospective analysis of vertebral compression fractures detected on computed tomography

Vertebral compression fractures (VCFs) are the most common osteoporotic fractures. Only 1/3 of patients with VCFs are clinically diagnosed. In our institution, the Fracture Liaison Service (FLS) was launched in 2017 to improve osteoporosis management for hospitalized patients. (1) To assess osteoporosis awareness among medical providers for emergency department (ED)/hospitalized patients aged 50 or greater; (2) To estimate the rate of FLS consults or referrals to primary care providers (FLS/PCP) by primary teams. A centralized radiology system was used to examine all thoracic and lumbar computed tomography (CT) scans conducted between June 1, 2017 and June 1, 2022. 449 studies were identified with the radiologic impression “compression fracture”. 182 studies were excluded after manual chart review. 267 hospitalizations/ED visits with lumbar and/or thoracic spine CT scans were included. Referrals to FLS (26) or PCP (27) were made in 53 cases (~ 20% of the total). In the ED subgroup (131 hospitalizations), only 17 patients had FLS/PCP referrals. The “compression fracture” was mentioned in 227 (85%) discharge notes (any part), while “osteoporosis” was mentioned in only 74 (28%) hospitalizations. A statistically significant difference was found between the two groups when “osteoporosis” was mentioned in the “assessment and plan” section (p = 0.02). Our data show that the overall osteoporosis care for affected patients is suboptimal. Medical providers often overlook the presence of osteoporosis, leading to a lack of consultation with the FLS of referral to PCPs for further evaluation and treatment.

The osteology of the lacertid genus Darevskia Arribas, 1999 (Squamata, Lacertidae)

A total of 230 cleared and alizarin stained and 136 radiographed specimens of Darevskia belonging to 47 nominal taxa (species, subspecies or singular clades) including the seven parthenogenetic ones and a triploid hybrid were studied. Sixteen osteological characters in all the tried species were analyzed. These characters by corporal regions were: skull characters: 1.—number of premaxillary teeth; 2.—number of maxillary teeth; 3.—number of dentary teeth; 4.—teeth morphology; 5.—presence of anterolateral process in the postfrontal bone; 6.—presence of anteromedial process in the postorbital bone; 7.—comparative lengths of the postorbital and postfrontal bones; 8.—overlap degree between the postorbital and the squamosal bones. Postcranial characters: 9.—existence of visible (ossified) ribs associated with the third presacral vertebrae; 10.—sternal/xiphisternal costal formula and presence of inscriptional ribs; 11.—number of presacral vertebrae; 12.—number of posterior dorsal vertebrae (short presacral ribs); 13.—presence and form of the sternal fontanelle; 14.—form of the clavicles (emarginated or marginated); 15.—interclavicle form; 16.—morphology of first autotomic vertebrae of the tail. Our goals were to characterize osteologically the different species of Darevskia, to contrast their relationships traced from osteological traits with the available genetic-derived phylogenies of the group, to compare the osteological characteristics of the parthenogenetic species with their bisexual parental species, and to comment on their parentage and character polarity. Finally, we aimed to search for osteological characteristics of the different groups within Darevskia, diagnosing them for the first time. The results, commented on by characters, are available in the main text, and taxa characteristics are easily consultable and condensed in Table 1. Osteological characteristics of Darevskia, together with available phylogenetic trees, have permitted us to define some new groups within Darevskia (raddei, chlorogaster, defilippi, and parvula new groups) (Appendix 3), which are reciprocally monophyletic and have diagnostic characteristics. All of them are diagnosed and named as subgenera to be used if necessary, instead of the partial, old and not always comprehensive groups.

Parameters and Biomechanics of Cervical Sagittal Balance: A Concise and Precise Review

Cervical spine is a vital component of the human spine and it is different from other components. It is the most mobile part of spine and it not only holds the head load but also maintains head balance while in motion. It also helps to balance the thoracic spine which is just contrary to it. Thoracic spine is a rigid structure and its natural curve is kyphotic unlike cervical spine. The equilibrium maintained by the cervical spine for head holding and balancing thoracic kyphosis is called cervical sagittal balance. Similarly, cervical spine also maintains the balance with lumbar spine and its lordosis. In fact, various components of the human spine are not individual parts from a function standpoint, they act simultaneously in a coordinated way to maintain the global balance so that human body remains in an equilibrium at any posture and position, this is what is called a sagittal balance. Cervical spine plays a vital role in maintaining the global balance of spine. Many parameters have been identified to understand cervical sagittal balance. Surgical planning based on maintenance of sagittal balance with the help of these parameters gives the best outcome. We hereby have tried to collect the maximum information about cervical sagittal balance which otherwise is not mentioned collectively elsewhere, and this will provide guidelines and surgical hints to a spinal surgeon.

Increased incidences of cervical ribs in deer indicate extinction risk

Mammals as a rule have seven cervical vertebrae, a number which remains remarkably conserved. Occasional deviations of this number are usually due to the presence of cervical ribs on the seventh vertebra, indicating a homeotic transformation from a cervical rib-less vertebra into a thoracic rib-bearing vertebra. These transformations are often associated with major congenital abnormalities or pediatric cancers (pleiotropic effects) that are, at least in humans, strongly selected against. Based on data from Late Pleistocene mammoths (Mammuthus primigenius) and woolly rhinoceroses (Coelodonta antiquitatis) from the North Sea, we hypothesized that high incidences of cervical ribs in declining populations are due to inbreeding and/or adverse conditions impacting early pregnancies. In this study, we investigated the incidence of cervical ribs in an extinct Late Pleistocene megaherbivore, giant deer (Megaloceros giganteus) from Ireland and in the extant highly inbred Père David deer (Elaphurus davidianus) and in twenty other extant species. We show that the incidence of cervical ribs is exceptionally high in both the Irish giant deer and the Père David deer and much higher than in extant outbred deer. Our data support the hypothesis that inbreeding and genetic drift increase the frequencies of maladaptive alleles in populations at risk of extinction. The high incidence of cervical ribs indicates a vulnerable condition, which may have contributed to the extinction of megaherbivore species in the Late Pleistocene. We argue that cervical rib frequency may be a good proxy for extinction risk in inbred populations.

Benefits of chest wall mobilization on respiratory efficiency and functional exercise capacity in people with severe chronic obstructive pulmonary disease (COPD): A randomized controlled trial.

Coexistence of chest wall hypomobility and lung hyperinflation compromises respiratory muscle function and respiratory efficiency in people with severe chronic obstructive pulmonary disease (COPD). This study aimed to investigate the effect of chest wall mobilization on functional exercise capacity, respiratory muscle activity and respiratory muscle tissue oxygen saturation for people with severe COPD. Thirty male adults (age: 75 ± 6) diagnosed with severe COPD completed a 6-week programme (twice/week) according to intervention randomization (chest wall mobilization group, CWMG, n = 15; control group, CG, n = 15). Both groups received standardized education and walking exercise, while CWMG also received chest wall and thoracic spine mobilization. Electromyography of the essential and accessory respiratory muscles and tissue oxygen saturation of the intercostal muscle (StO2, measured by near-infrared spectroscopy) during incremental cycle exercise test were measured and compared between the two groups at pre-programme, post-programme and 3-month follow-up. Patients in CWMG demonstrated a significant increase in exercise tolerance from <3 METS to 4-6 METS (p = 0.000) after intervention. A significant decrease in activity of scalene, sternocleidomastoids and intercostal muscle during exercise test (p < 0.01) was found in CWMG, as compared to CG. A significant decrease in StO2 (p < 0.05) and greater decline in the slope of oxygenation dissociation (p = 0.000) were seen in CWMG during exercise test. These positive results were maintained at 3-month follow-up in CWMG. Improvements in exercise tolerance, respiratory muscle efficiency and oxygenation extraction ability in CWMG suggest a potential clinical benefit of integrating chest wall and thoracic spine mobilization for rehabilitation of people with severe COPD.

Geometric target margin strategy of proton craniospinal irradiation for pediatric medulloblastoma.

In proton craniospinal irradiation (CSI) for skeletally immature pediatric patients, a treatment plan should be developed to ensure that the dose is uniformly delivered to all vertebrae, considering the effects on bone growth balance. The technical (t) clinical target volume (CTV) is conventionally set by manually expanding the CTV from the entire intracranial space and thecal sac, based on the physician's experience. However, there are differences in contouring methods among physicians. Therefore, we aimed to propose a new geometric target margin strategy. Nine pediatric patients with medulloblastoma who underwent proton CSI were enrolled. We measured the following water equivalent lengths for each vertebra in each patient: body surface to the dorsal spinal canal, vertebral limbus, ventral spinal canal and spinous processes. A simulated tCTV (stCTV) was created by assigning geometric margins to the spinal canal using the measurement results such that the vertebral limb and dose distribution coincided with a margin assigned to account for the uncertainty of the proton beam range. The stCTV with a growth factor (correlation between body surface area and age) and tCTV were compared and evaluated. The median values of each index for cervical, thoracic and lumber spine were: the Hausdorff distance, 9.14, 9.84 and 9.77mm; mean distance-to-agreement, 3.26, 2.65 and 2.64mm; Dice coefficient, 0.84, 0.81 and 0.82 and Jaccard coefficient, 0.50, 0.60 and 0.62, respectively. The geometric target margin setting method used in this study was useful for creating an stCTV to ensure consistent and uniform planning.

Application of ultrasonic bone scalpel system for laminectomy and posterior longitudinal ligament ossification block release combined with dekyphosis orthopedic surgery in treatment of multisegmental thoracic ossification of posterior longitudinal ligament

To explore the safety and effectiveness of multisegmental thoracic ossification of posterior longitudinal ligament (T-OPLL) treated by laminectomy, posterior longitudinal ligament ossification block release combined with dekyphosis orthopedic surgery using ultrasonic bone scalpel system. The clinical data of 8 patients with multisegmental T-OPLL treated with laminectomy, posterior longitudinal ligament ossification block release combined with dekyphosis orthopedic surgery using ultrasonic bone scalpel system between January 2020 and April 2023 was retrospectively analyzed. There were 3 males and 5 females; the age ranged from 41 to 67 years, with a mean of 57.1 years. The disease duration ranged from 3 to 74 months, with a mean of 33.4 months. Symptoms were progressive numbness and weakness of both lower limbs, unsteady walking, chest and back pain in 3 cases, and urinary and bowel dysfunction in 5 cases; 7 cases showed increased muscle strength of the lower limbs, hyperreflexia of the tendons, and a positive Babinski sign, and 1 case showed decreased muscle strength of the lower limbs, decreased skin sensation, decreased knee and Achilles tendon reflexes, and a negative pathologic sign. Multisegmental posterior longitudinal ligament ossification of thoracic spine was found in 8 cases, with 4-8 segments of ossification, and in 5 cases with multisegmental ossification of the ligamentum flavum. The preoperative Japanese Orthopaedic Association (JOA) thoracic spinal function score was 4.3±0.9, the visual analogue scale (VAS) score was 6.9±1.0, and the the kyphotic Cobb angle of the stenosis segment was (34.62±10.76)°. The operation time, intraoperative blood loss, and complications were recorded. VAS score was used to evaluate the back pain, JOA score was used to evaluate the thoracic spinal cord function and the JOA improvement rate was calculated, and the kyphotic Cobb angle of the stenosis segment was measured and the Cobb angle improvement rate was calculated. The operation time ranged from 210 to 340 minutes, with a mean of 271.62 minutes; intraoperative blood loss ranged from 900 to 2 100 mL, with a mean of 1 458.75 mL; the number of resected vertebral plates ranged from 4 to 8, with a mean of 6.1; dural tears and cerebrospinal fluid leakage occurred in 3 cases, and the incisions healed by first intention. All 8 cases were followed up 12-26 months, with a mean of 18.3 months. There was no complication such as loosening of internal fixator, breakage of screws and rods, and no significant progress of ossification. At last follow-up, the VAS score was 1.4±0.7, the JOA thoracic spinal function score was 9.8±0.7, and the the kyphotic Cobb angle of the stenosis segment was (22.12±8.28)°, all of which significantly improved when compared with preoperative ones ( t=11.887, P<0.001; t=13.015, P<0.001; t=7.395, P<0.001). The JOA improvement rate was 81.06%±10.93%, of which 5 cases were rated as excellent and 3 cases as good; the Cobb angle improvement rate was 36.51%±14.20%. Laminectomy, posterior longitudinal ligament ossification block release combined with dekyphosis orthopedic surgery using ultrasonic bone scalpel system is a safe, effective, and simple method for the treatment of multisegmental T-OPLL, which is a feasible option.

The individualization of estimation of changes in the reaction of the cardiovascular system to the procedure of manual therapy of the thoracic spine in men with a vertebral thoracalgia in the sanatorium-resort treatment’ course

The individualization of estimation of changes in the reaction of the cardiovascular system to the procedure of manual therapy of the thoracic spine in men with a vertebral thoracalgia in the sanatorium-resort treatment’ course

Pruritus: An Overlooked Symptom of Spinal Tumors

Background Chronic itch is often associated with pain due to its complex nature. Neuropathic pruritus is defined as a debilitating form of chronic itching, about which not much is known to date. This condition may develop as a result of various neurological events and is associated with damage to the somatosensory nervous system, accounting for approximately 10% of chronic itching cases. Syringomyelia, transverse myelitis, radiculopathies, thoracic spine masses, brain tumors, strokes, and abscesses are among the conditions associated with neuropathic itching to date. Case presentation A 65-year-old female patient, with no known diseases and no regular medication usage, presented with a complaint of itching that had been ongoing for the past two years. Itching initially started in approximately five cm areas on the bilateral below-knee flexor surfaces. The patient, whose complaints persisted, was referred to the internal medicine outpatient clinic by dermatology. On physical examination, erythematous excoriated papules were observed in the areas affected by itching. The patient's blood sugar, liver and kidney function tests, complete blood count, erythrocyte sedimentation rate, thyroid function tests, urinalysis, stool parasitology were all normal or negative. The patient reported a sensation of coldness in the same area, was referred to neurosurgery to investigate the etiology of possible neuropathic itching. The patient's spinal imaging, revealed a spinal mass. She underwent surgery performed by a neurosurgeon, during which the spinal mass was completely removed. She reported that her itching had completely disappeared post-operatively. Conclusions The concept of itching as a variant of pain is not very new. Any damage occurring in the central nervous system or peripheral nervous system that affects the neurons responsible for transmitting and processing itch can lead to neuropathic itching. Focusing on spinal cord pathologies, any condition that damages the spinal cord may cause itching, depending on the level of damage. In cases of itching with dermatomal localization, where pain, hot or cold sensations, and paroxysmal itching are present, additional imaging methods or investigations for etiology should be performed.

Evolution of Video Assisted Thoracoscopic Surgery for Thoracic Disc Herniation: Towards Biportal Thoracoscopic Approach

This work aims to describe the evolution of the VATS approach from a multiportal access to a biportal access for thoracic herniated disc surgery. Thoracic disc herniation remains a challenging pathology for spine surgeons. Video-Assisted Thoracoscopic Surgery (VATS) of the thoracic spine was described in the 90s and represented an important technical leap by including minimally invasive options for thoracic pathology. Nowadays, VATS in thoracic surgery tends to evolve towards an even less invasive technique, from a multiportal approach to a biportal one. We describe the adoption of this approach for our spinal pathology in three patients. We use a two-port VATS. The largest (approximately 5 cm) with an Alexis retractor ® and a second port (1.5 cm) just for the camera. The three patients started walking in less than 24 hours, and none suffered any complications related to the approach. All of them reported tolerable pain at the surgical site. Changing our previous VATS system from 3 to 5 ports was relatively easy regarding the surgical technique. This access allows the surgeon to manipulate the instrumentation confidently, and the camera does not fog up as often. Extracting a piece of rib is unnecessary, and theoretically, we only manipulate one or at most two intercostal nerves, so the patient's recovery is favorable.

Preoperative prediction of early mortality after surgery for spinal metastases.

The objective of this study was to provide a convenient preoperative prediction of the risk of early postoperative mortality. This retrospective study included patients who underwent surgery for spinal metastasis at our hospital between 2009 and 2021. Preoperative blood test data of all patients were collected, and the survival time was calculated by dividing the blood data. A multivariate analysis was conducted using a Cox proportional hazards model to identify prognostic factors. The study population included 83 patients (average: 64.5years), 22 of whom died within 3 months. The most common lesion was the thoracic spine, and incomplete paralysis was observed in 57 patients. The surgical methods included posterior implant fixation (n=17), posterior decompression (n=31), and posterior decompression with fixation (n=35). In the univariate analysis, the presence of abnormal values was significantly associated with postoperative survival in six preoperative blood collection items (hemoglobin, C-reactive protein, albumin, white blood cell, gamma-glutamyl transpeptidase, and lactate dehydrogenase). In a multivariate analysis, four test items (hemoglobin, C-reactive protein, white blood cell, and lactate dehydrogenase) were identified as independent prognostic factors.Comparing cases with ≥3 abnormal values among the above four items (high-risk group; n=23) and those with ≤2 (low-risk group; n=60), there was a significant difference in survival time. In addition, it was possible to predict cases of early death within 3months after surgery with 73% sensitivity and 89% specificity. The study showed that four preoperative blood test abnormalities (hemoglobin, C-reactive protein white blood cell, and lactate dehydrogenase) indicated the possibility of early death within 3months after surgery.

The vicious cycle of frailty and pain: a two-sided causal relationship revealed.

The decline in physiological functions in the older people is frequently accompanied with pain and frailty, yet the causal connection between frailty and pain remains uncertain. In this study, we utilized a two-sample Mendelian randomization (MR) approach to investigate the potential causal association between frailty and pain. Two-sample bidirectional MR was conducted using summary data from genome-wide association studies to examine the potential causal relationship between frailty (defined by the frailty index and frailty phenotype) and pain. Summary genome wide association statistics were extracted from populations of European ancestry. We also investigated the causal relationship between frailty and site-specific pain, including joint pain, limb pain, thoracic spine pain and low back pain. Causal effects were estimated using the inverse variance weighting method. Sensitivity analyses were performed to validate the robustness of the results. Genetic predisposition to frailty was associated with an increased risk of pain (frailty phenotype odds ratio [OR]: 1.73; P = 3.54 × 10-6, frailty index OR: 1.36; P = 2.43 × 10-4). Meanwhile, individuals with a genetic inclination toward pain had a higher risk of developing frailty. Regarding site-specific pain, genetic prediction of the frailty phenotype increased the occurrence risk of joint pain, limb pain and low back pain. Reverse MR analysis further showed that limb pain and low back pain were associated with an increased risk of frailty occurrence. This study presented evidence supporting a bidirectional causal relationship between frailty and pain. We highlighted the significance of addressing pain to prevent frailty and recommend the inclusion of pain assessment in the evaluation system for frailty.

Effect of thoracic spine mobilization on pain and lumbar mobility in patients with lumbosacral radiculopathy: A randomized controlled trial

Effect of thoracic spine mobilization on pain and lumbar mobility in patients with lumbosacral radiculopathy: A randomized controlled trial

Investigating the Difference Between Thoracic Kyphosis and its Mobility in Community-Dwelling Older Men and Women

Introduction: The amount of thoracic kyphosis and its mobility may be affected by gender in older adults. This study investigates gender differences in thoracic kyphosis and thoracic spine mobility in healthy older adults. Materials and Methods: In this cross-sectional study, 36 participants among which 21 were female and 15 were male with an age range of 65-80 years participated. The amount of thoracic spine kyphosis was measured in a relaxed standing position and the position of maximum correction of thoracic kyphosis using a flexible ruler between the spinous processes of T12 and C7. The difference between the thoracic kyphosis of the relaxed state and the condition of the maximum correction is used to determine the degree of thoracic spine mobility. Finally, men and women were compared in terms of thoracic kyphosis and thoracic spine mobility. The student t-test was employed to compare kyphosis and spinal mobility between men and women, and the paired student t-test was used to compare kyphosis angle in a relaxed posture and maximum kyphosis correction status. Meanwhile, the Pearson test was utilized to evaluate the relationship between variables. Results: Although there was no statistically significant difference in the mean thoracic kyphosis of relaxation (P=0.13) and maximal correction (P=0.18) status of healthy old men and women, there was a significant positive relationship between the rate of kyphosis angle and the amount of mobility of thoracic kyphosis (P=0.003; r=0.48). Conclusion: There is no difference in the degree of kyphosis and thoracic spine mobility in older men and women. In addition, people with more thoracic kyphosis had more spinal mobility.

The effect of visual cues at different heights on sit-to-stand movements in people with and without low back pain

BackgroundInvestigating movement strategies that can be utilized to avoid pain-provocation could enhance the management of low back pain episodes. ObjectiveTo assess the effect of visual cues at different heights on the kinematics of sit-to-stand movements, as well as perceived difficulty and pain levels. DesignCross-over design comparing individuals with low back pain to healthy controls. Methods26 asymptomatic controls and 15 individuals with chronic, recurrent low back pain performed 5 sets of 5 sit-to-stand movements. High, middle, and low visual cues were used during sets 2–4. Spinal sagittal plane range of motion, peak spinal flexion and extension angles, and trunk centre of mass velocity were obtained from kinematic data. ResultsThe low cue led to significantly more head and lumbar spine flexion, while the high cue led to significantly more head and thoracic spine extension and increased thoracic spine range of motion. The low back pain group demonstrated a significantly lower vertical trunk centre of mass velocity than the control group during the high cue trials. There was a significant association between higher perceived difficulty scores and lower trunk centre of mass velocity for the low back pain group. Pain scores were not significantly different between cue conditions. ConclusionVisual cues can be used to temporarily change the spinal kinematics of sit-to-stand movements in people with and without low back pain. This could be helpful in clinical practice to encourage more, or less, movement in specific spinal regions, and avoid pain provocation to facilitate functional rehabilitation.