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We read the article titled “Influence of body position and axial load on spinal stiffness in healthy young adults” by Häusler et al. [1] with immense interest and congratulate authors for their immense effort to study, write and conclude on a subject less pondered into. However, there were certain facts and observation which need further discussion and elaboration:
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There are very limited exclusion criteria in this study like history of backache, infections, fractures, etc. Various other important spinal conditions like asymptomatic inflammatory spondyloarthropathies, asymptomatic congenital disorders (block vertebrae, hemivertebrae) may influence the spinal stiffness.
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What about the subjects having preexisting disorders of the hip and knee as they have significant impact on the spine biomechanics? Similarly preexisting respiratory and abdominal disorders significantly affect the spinal stiffness [2, 3].
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Before commenting on the spinal stiffness in various body positions and axial loading, was the coronal and the sagittal balance of the recruits standardized as this could alter the spine biomechanics and muscle recruitment.
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Was any radiology (X-rays, CT, MRI, etc.) sought before labelling the subjects as normal as they could reveal some important parameters affecting the spine biomechanics and stiffness?
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Was any linear association found between the spinal stiffness and the percentage of additional axial loading? Why only 50% of the additional axial load was chosen? What if the additional axial load is less or more than 50% ? Further study is warranted to address these questions.
References
Häusler M, Hofstetter L, Schweinhardt P, Swanenburg J (2020) Influence of body position and axial load on spinal stiffness in healthy young adults. Eur Spine J 29(3):455–461
Hodges PW, Eriksson AE, Shirley D, Gandevia SC (2005) Intra-abdominal pressure increases stiffness of the lumbar spine. J Biomech 38:1873–1880
Shirley D, Hodges PW, Eriksson AE, Gandevia SC (2003) Spinal stiffness changes throughout the respiratory cycle. J Appl Physiol 95:1467–1475. https://doi.org/10.1152/japplphysiol.00939.2002
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Kumar, V., Salaria, A.K. & Kumar, N. Letter to the Editor concerning “Influence of body position and axial load on spinal stiffness in healthy young adults” by Häusler M, et al. (Eur Spine J; [2020]: doi:10.1007/s00586-019-06254-0). Eur Spine J 29, 1777 (2020). https://doi.org/10.1007/s00586-020-06437-0
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DOI: https://doi.org/10.1007/s00586-020-06437-0