Low Back Pain During and After Spaceflight: A Systematic Review with Meta-Analysis

Guillermo Ceniza-Bordallo,1,* Eric Zimmermann,2,* Marie Vigouroux,2 Kacper Niburski,3 Maryse Fortin,4 Jean Ouellet,5– 7 Juan Pablo Cata,8,9 Pablo M Ingelmo2,7,10,11 1Department of Radiology, Rehabilitation and Physiotherapy, Faculty of Nursing, Physiotherapy, and Podiatry, University Complutense of Madrid, Madrid, Spain; 2Edwards Family Interdisciplinary Center for Complex Pain, Montreal Children’s Hospital, Montreal, QC, Canada; 3Department of Anesthesia, University of British Columbia, Vancouver, BC, Canada; 4Department of Health, Kinesiology & Applied Physiology, Concordia University, Montreal, QC, Canada; 5Department of Paediatric Surgery & Surgery, McGill University Health Centre, Montreal, QC, Canada; 6Department of Scoliosis & Spine Surgery, Shriner’s Hospital for Children, Montreal, QC, Canada; 7Alan Edwards Centre for Research on Pain, McGill University, Montreal, QC, Canada; 8Department of Anesthesia and Perioperative Medicine, the University of Texas – MD Anderson Cancer Center, Houston, TX, USA; 9Anesthesiology and Surgical Oncology Research Group, Houston, TX, USA; 10Department of Anesthesia. McGill University, Montreal, Canada; 11Research Institute, McGill University Health Center, Montreal, Canada*These authors contributed equally to this workCorrespondence: Guillermo Ceniza-Bordallo, Email [email protected]: Space flights can produce physiological changes in the spine, leading to the development of acute and chronic pain in passengers. However, there is a lack of comprehensive literature exploring physiological spine changes and acute and chronic pain in space passengers (astronauts and animals). The first aim of this study was to identify the physiological changes experienced by passengers (humans and animals) after space flight. The second aim was to identify the incidence of low back pain during and after space flight. This systematic review was conducted following PRISMA guidelines and was pre-registered in PROSPERO (ID 451144). We included Randomized Controlled Trials or longitudinal studies in humans and animals, and the variables must be assessed either in-flight or post-flight. We conducted a literature search in major databases combining the keywords: Pain; Space; Low Back Pain; Astronauts; Spine Changes; Microgravity; Physiological Changes; Humans; Animals. Risk of bias and quality of studies were analyzed, and the level of evidence was assessed using the GRADE system. After duplicates were removed, 115 abstracts were screened by two reviewers, and finally, 11 articles were included in this review. The evidence indicates that astronauts experience muscle atrophy in the lumbar multifidus with a moderate to large effect, especially in the L4-L5 and L5-S1 segments. Space flights also decrease the range of motion with a moderate effect, along with disc herniations and disc dehydration. 77% of astronauts experience pain during spaceflight, and 47% develop acute pain after spaceflight. Chronic pain was reported by 33% of the astronauts. After space flights, astronauts suffer from lumbar muscle atrophy, reduced range of motion, disc herniations, and disc dehydration, with a high incidence of both acute and chronic pain.Plain Language Summary: Space travel affects the spine and can cause both immediate and long-term pain. Our study aimed to understand what changes happen in the spine during and after space travel and how often these changes lead to low back pain.Why was the study done?We wanted to investigate the specific spinal changes and the frequency of low back pain in both astronauts and animals exposed to space travel. This is important because understanding these effects can help improve health interventions for space travelers.What did the researchers do?We reviewed studies that examined spine changes and pain in humans and animals during and after space flights. We used a systematic approach to find relevant research, following strict guidelines and assessing the quality of each study.What did the researchers find?Astronauts often experience muscle loss in the lower back, particularly in the lumbar spine.Space travel reduces the spine’s range of motion.There is a significant occurrence of disc herniations and disc dehydration.77% of astronauts report pain during space flights.47% experience acute pain after returning to Earth.33% suffer from chronic pain post-mission.What do these results mean?Our findings show that space travel can lead to serious spinal issues and a high risk of pain. These results highlight the need for better health strategies to protect astronauts during and after their missions. Understanding these effects is crucial for developing effective interventions and ensuring the well-being of space travelers.Keywords: chronic low back pain, space flight, physiological changes, microgravit

Anaesthesia and airway management in mucopolysaccharidosis

Abstract This paper provides a detailed overview and dis-cussion of anaesthesia in patients with mucopolysacchari-dosis (MPS), the evaluation of risk factors in these patients and their anaesthetic management, including emergency airway issues. MPS represents a group of rare lysosomal storage disorders associated with an array of clinical mani-festations. The high prevalence of airway obstruction and restrictive pulmonary disease in combination with cardio-vascular manifestations poses a high anaesthetic risk to these patients. Typical anaesthetic problems include airway obstruction after induction or extubation, intubation diffi-culties or failure [can’t intubate, can’t ventilate (CICV)], possible emergency tracheostomy and cardiovascular and cervical spine issues. Because of the high anaesthetic risk, the benefits of a procedure in patients with MPS shoul

Detrimental Effects of Space Flight on the Lumbar Spine May Be Correlated to Baseline Degeneration: Insights From an Advanced MR Imaging Study

Rakan Bokhari,1 Daniel G Bisson,2 Maryse Fortin,3 Marie Vigouroux,4 Juan Pablo Cata,5,6 Ken-Pin Hwang,7 Melissa M Chen,8 Guillermo Ceniza-Bordallo,9 Jean A Ouellet,2,10 Pablo M Ingelmo3,10,11 1Division of Neurosurgery, Department of Surgery, College of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia; 2Department of Pediatric Orthopedics, McGill University, Montreal, QC, Canada; 3Department of Health, Kinesiology & Applied Physiology, Concordia University, Montreal, QC, Canada; 4Edwards Family Interdisciplinary Center for Complex Pain, Montreal Children’s Hospital, Montreal, QC, Canada; 5Department of Anesthesia and Perioperative Medicine, The University of Texas – MD Anderson Cancer Center, Houston, TX, USA; 6Anesthesiology and Surgical Oncology Research Group, Houston, TX, USA; 7Department of Imaging Physics, The University of Texas – MD Anderson Cancer Center, Houston, TX, USA; 8Department of Neuroradiology, The University of Texas – MD Anderson Cancer Center, Houston, TX, USA; 9Department of Radiology, Rehabilitation and Physiotherapy, Faculty of Nursing, Physiotherapy, and Podiatry, University Complutense of Madrid, Madrid, Spain; 10Alan Edwards Centre for Research on Pain, McGill University, Montreal, QC, Canada; 11Research Institute, McGill University Health Center, Montreal, QC, CanadaCorrespondence: Guillermo Ceniza-Bordallo, Email [email protected]: Pain in lower back is a common condition reported by astronauts, both during and after space missions. Investigating the alterations in the spine and the mechanisms driving these changes is essential for a deeper understanding of how microgravity impacts the human spine. This knowledge could also open pathways for therapeutic or preventive interventions. Nevertheless, there is a limited evidence regarding changes in intervertebral discs (IVDs) due to space travel.Materials and Methods: In this study, 2 astronauts were enrolled in a space travel. Before the space flight, a lower back magnetic resonance imaging (MRI) scan was performed. We repeated an MRI instantly after 17-days space travel, and again 3 months after landing. The water content and glycosaminoglycan (GAGs) levels in the lumbar IVDs were evaluated using DIXON water-only phase imaging and T1rho MRI sequences. Additionally, alterations in the size and quality of the paraspinal muscles (PSMs), including fatty infiltration, were examined.Results: Varied alterations were observed in the IVDs and PSMs of both astronauts. One astronaut experienced a reduction in water and GAGs content, while the other showed an increase. These changes in the IVDs following spaceflight appeared to be linked to the degree of baseline degeneration. Regarding the PSMs, differences in size and fatty infiltration also varied between the two astronauts. Notably, these changes had not stabilized by the final follow-up at 3 months.Conclusion: Our findings offer initial evidence indicating that even brief exposures to microgravity might be linked to biochemical alterations in IVDs and changes in the quality of PSMs, which could continue evolving for more than 3 months after returning from space.Keywords: MRI, neuroimaging, spaceflight, spine, low back pai

Markers of Tissue Deterioration and Pain on Earth and in Space

Madalina Patron,1,2,* Mattias Neset,1,2,* Mariia Mielkozorova,2,* Daniel G Bisson,1,3,* Marie Vigouroux,4 Juan Pablo Cata,5,6 Pablo M Ingelmo,4,7,8 Jean A Ouellet,1,3 Lisbet Haglund,1,3,* Svetlana V Komarova1,2,* 1Shriners Hospital for Children, Montreal, Canada; 2Faculty of Dental Medicine and Oral Health Sciences, McGill University, Montreal, Canada; 3Orthopaedic Research Laboratory, Department of Surgery, McGill University, Montreal, Canada; 4Edwards Family Interdisciplinary Center for Complex Pain, Montreal Children’s Hospital, Montreal, QC, Canada; 5Department of Anesthesia and Perioperative Medicine, The University of Texas – MD Anderson Cancer Center, Houston, TX, USA; 6Anesthesiology and Surgical Oncology Research Group, Houston, TX, USA; 7Alan Edwards Centre for Research on Pain, McGill University, Montreal, QC, Canada; 8Research Institute, McGill University Health Center, Montreal, Canada*These authors contributed equally to this workCorrespondence: Svetlana V Komarova, Shriners Hospital for Children, 1003 Decarie Boulevard, Montreal, Quebec, H4A 0A9, Canada, Tel +1 514 282-7153, Email [email protected]: Pain is an understudied physiological effect of spaceflight. Changes in inflammatory and tissue degradation markers are often associated with painful conditions. Our aim was to evaluate the changes in markers associated with tissue deterioration after a short-term spaceflight.Patients and Methods: Plasma levels of markers for systemic inflammation and tissue degeneration markers were assessed in two astronauts before and within 24 h after the 17-day Axiom Space AX-1 mission.Results: After the spaceflight, C-reactive protein (CRP) was reduced in both astronauts, while INFγ, GM-CSF, TNFα, BDNF, and all measured interleukins were consistently increased. Chemokines demonstrated variable changes, with consistent positive changes in CCL3, 4, 8, 22 and CXCL8, 9, 10, and consistent negative change in CCL8. Markers associated with tissue degradation and bone turnover demonstrated consistent increases in MMP1, MMP13, NTX and OPG, and consistent decreases in MMP3 and MMP9.Conclusion: Spaceflight induced changes in the markers of systemic inflammation, tissue deterioration, and bone resorption in two astronauts after a short, 17-day, which were often consistent with those observed in painful conditions on Earth. However, some differences, such as a consistent decrease in CRP, were noted. All records for the effect of space travel on human health are critical for improving our understanding of the effect of this unique environment on humans.Keywords: spaceflight, astronaut, cytokine, interleukin, chemokine, bone turnove

Evaluation of peritoneal endometriosis treatment using intralesional acetylsalicylic acid injection in rabbits

PURPOSE: To investigate the efficacy of intralesional 20% aspirin injection for treatment of experimental peritoneal endometriosis. Methods: Peritoneal endometriosis was experimentally induced in forty adult nulligravid female rabbits. On day 30 post-endometriosis induction, rabbits were randomly divided to assess early (10 days) and late (20 days) effects of intralesional injection of physiological saline solution (control groups) in comparison to intralesional injection of 20% bicarbonate aspirin solution (experimental groups) as follows: control group 1 (10 days, n=10); control group 2 (20 days, n=10); experimental group 3 (10 days, n=10); experimental group 4 (20 days, n=10). Resected tissues, including endometriosis foci, were qualitatively (general morphology and signs of inflammatory cells infiltrate, necrosis and apoptosis) and quantitatively (remaining endometriosis area) assessed by histopathological analysis. Results: Extensive necrosis, hemorrhage, apoptosis, and fibrosis were observed in the experimental groups 3 and 4. Groups 1 and 2 presented typical endometrial tissue cysts, respectively. Groups 3 and 4 showed sparse endometrial tissue foci and no endometrial tissue, respectively. Quantitative analysis revealed that aspirin-treated groups 3 and 4 had significantly (p<0.05) smaller remaining endometriosis area, compared to control groups 1 and 2. Conclusion: Intralesional 20% aspirin injection caused total destruction of peritoneal endometriosis foci in rabbits

Acute postoperative opioid consumption trajectories and long-term outcomes in pediatric patients after spine surgery

Mandy MJ Li,1,2 Don Daniel Ocay,2,3 Alisson R Teles,2,4 Pablo M Ingelmo,5,6 Jean A Ouellet,1&ndash;2,7 M Gabrielle Pag&eacute;,8,9 Catherine E Ferland2,4&ndash;6,101Faculty of Medicine, McGill University, Montreal, Quebec, Canada; 2Department of Clinical Research, Shriners Hospitals for Children-Canada, Montreal, Quebec, Canada; 3Department of Experimental Surgery, McGill University, Montreal, Quebec, Canada; 4Integrated Program in Neurosciences, McGill University, Montreal, Quebec, Canada; 5Chronic Pain Services, Montreal Children&rsquo;s Hospital, Montreal, Quebec, Canada; 6Department of Anesthesia, McGill University, Montreal, Quebec, Canada; 7Division of Orthopaedic Surgery, McGill University, Montreal, Quebec, Canada; 8D&eacute;partement d&rsquo;anesth&eacute;siologie, Universit&eacute; de Montr&eacute;al, Montreal, Quebec, Canada; 9Carrefour de l&rsquo;innovation et de l&rsquo;&eacute;valuation en sant&eacute;, Centre de recherche du Centre hospitalier de l&rsquo;Universit&eacute; de Montr&eacute;al (CRCHUM), Montreal, Quebec, Canada; 10Child Health and Human Development Research Axis, Research Institute-McGill University Health Centre, Montreal, Quebec, CanadaBackground: The days following surgery are a critical period where the use of opioids predicts long-term outcomes in adults. It is currently unknown as to whether opioid consumption throughout the acute postoperative period is associated with long-term outcomes in pediatric patients. The aims of this study were to characterize opioid consumption trajectories in the acute postoperative period, identify predictors of trajectory membership and determine associations between opioid consumption trajectories and long-term patient outcomes.Materials and methods: Medication use, pain and mental health status were assessed at baseline in adolescents with idiopathic scoliosis who were scheduled for spinal fusion surgery. Cumulative 6-hr opioid consumption was recorded for up to 5 days after spinal surgery. At 6 months after surgery, medication use, pain and functional activity were evaluated. Growth mixture modeling was used to identify opioid trajectories.Results: One hundred and six patients were included in the study. Mean cumulative 6-hr opioid consumption in the acute postoperative period was 13.23&plusmn;5.20 mg/kg. The model with the best fit contained 5 acute postoperative trajectories and a quadratic term (AIC =6703.26, BIC =6767.19). Two types of patient behaviors were identified: high opioid consumers (trajectories 4 and 5) and low opioid consumers (trajectories 1, 2 and 3). Intraoperative intrathecal morphine dose was a predictor of trajectory membership (p=0.0498). Opioid consumption during the acute postoperative period was not significantly associated with pain, functional activity or pain medication use at 6 months after surgery.Conclusion: In pediatric patients, intraoperative intrathecal morphine dose predicts opioid consumption in the acute postoperative period. Importantly, opioid consumption during this period does not affect long-term outcomes in pediatric patients after a spine surgery.Keywords: opioids, pediatrics, postsurgical pain, trajectories, adolescent idiopathic scoliosis, spinal fusion surger