Disc herniations in astronauts: What causes them, and what does it tell us about herniation on earth?

Daniel L Belavy, Michael Adams, Helena Brisby, Barbara Cagnie, Lieven Danneels, Jeremy Fairbank, Alan R Hargens, Stefan Judex, Richard A Scheuring, Roope Sovelius, Jill Urban, Jaap H van Dieën, Hans-Joachim Wilke

Journal: European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society 2016;25(1):144-154

PMID: 25893331

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Abstract

PURPOSE

Recent work showed an increased risk of cervical and lumbar intervertebral disc (IVD) herniations in astronauts. The European Space Agency asked the authors to advise on the underlying pathophysiology of this increased risk, to identify predisposing factors and possible interventions and to suggest research priorities.

METHODS

The authors performed a narrative literature review of the possible mechanisms, and conducted a survey within the team to prioritize research and prevention approaches.

RESULTS AND CONCLUSIONS

Based on literature review the most likely cause for lumbar IVD herniations was concluded to be swelling of the IVD in the unloaded condition during spaceflight. For the cervical IVDs, the knowledge base is too limited to postulate a likely mechanism or recommend approaches for prevention. Basic research on the impact of (un)loading on the cervical IVD and translational research is needed. The highest priority prevention approach for the lumbar spine was post-flight care avoiding activities involving spinal flexion, followed by passive spinal loading in spaceflight and exercises to reduce IVD hyper-hydration post-flight.

Address: Center of Muscle and Bone Research, Charité University Medicine Berlin, Hindenburgdamm 30, 12203, Berlin, Germany. [email protected].; Centre for Physical Activity and Nutrition Research, School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Highway, Burwood, VIC, 3125, Australia. [email protected].; Centre for Comparative and Clinical Anatomy, University of Bristol, Southwell Street, Bristol, BS2 8EJ, UK.; Department of Orthopedics, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Gothenborg, Sweden.; Department of Orthopedics, Sahlgrenska University Hospital, Gothenborg, Sweden.; Department of Rehabiliation Sciences and Physiotherapy, Ghent University, De Pintelaan 185 3B3, 9000, Ghent, Belgium.; Nuffield Orthopaedic Centre, Headington, Oxford University Hospitals NHS Trust, Oxford, OX3 7HE, UK.; Department of Orthopaedic Surgery, University of California, San Diego, San Diego, CA, 92103-8894, USA.; Bioengineering Building, Stony Brook University, Stony Brook, NY, 11794-5281, USA.; Johnson Space Center, 2101 NASA Parkway SD4, Houston, TX, 77058, USA.; Centre for Military Medicine, Satakunta Air Command, PO.Box 1000, 33961, Pirkkala, Finland.; Department of Physiology, Anatomy and Genetics, Oxford University, Le Gros Clark Building, South Parks Road, Oxford, OX1 3QX, UK.; Faculty of Human Movement Sciences, MOVE Research Institute Amsterdam, VU University Amsterdam, van der Boechorststraat 9, Amsterdam, 1081 BT, The Netherlands.; Institute of Orthopaedic Research and Biomechanics, University of Ulm, Helmholtzstrasse 14, 89081, Ulm, Germany.

DOI: 10.1007/s00586-015-3917-y

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MeSH Terms: Astronauts, Cervical Vertebrae, Humans, Intervertebral Disc Displacement, Lumbar Vertebrae, Risk Factors, Space Flight