FOR 5177: The Dynamics of the Spine: Mechanics, Morphology and Motion towards a comprehensive Diagnosis of Low Back Pain

随着越来越多的患者遭受或需要手术或非手术治疗，下腰痛(LBP)给社会带来了巨大的社会和经济负担。目前LBP临床治疗的成功率差异很大，表明对疾病发生、发展和治疗调节的基本机制缺乏基本了解。提高对LBP机制的理解将产生合格的患者分层，并形成个性化治疗方法的基本基础。目前，临床应用保守或手术干预的决定是基于身体病史、静态图像(X光、CT、MRI)所观察到的潜在脊柱病理以及简短的体格检查。这样的快照分析很少代表患者在日常生活中的自然姿势，完全忽略了脊柱活动和负荷的动态，通常也没有考虑心理社会环境。因此，它们不能充分描述组织退化、局部炎症和疼痛的潜在过程。到目前为止，还没有一个国际指南包含力学、形态和运动方面的发病机制。拟议的研究小组汇集了骨科医生、影像专家、生物力学专家、计算机建模专家、疼痛专家、健康心理学家和材料和培训科学家，以揭示脊柱形状和几何(形态学)、体力活动和脊柱-骨盆运动学(运动)和腰椎负荷(力学)如何与LBP相互联系和联系。总之，我们假设，了解这些3M之间的相互关系将使新的途径能够开发作为个性化治疗基础的功能化患者分层策略。最初，我们将在不同的慢性LBP队列中描述这些相互关系，这些队列有或没有接受多模式疼痛治疗的形态和/或功能障碍，或者保守治疗失败和开出手术处方的患者。将按年龄组和性别分析患者队列和额外的无症状对照，以解决患者多样性问题。对大小动物模型的活体研究和数学建模将补充这些研究，以加强对LBP的机制理解。从长远来看，我们的目标是将这种对3MS和LBP动态相互作用的更机械性的理解转变为对预后诊断、更具体的患者分层和考虑LBP患者个体活动和适应能力的个性化治疗策略的更深刻的功能理解。

Low back pain (LBP) represents an overwhelming social and economic burden to society with a constantly increasing number of patients suffering and requiring surgical or non-surgical treatment. The success rates of current clinical treatments for LBP vary considerably, indicating a lack of basic understanding of the underlying mechanisms of disease onset, progression and therapeutic modulation. Improving the mechanistic understanding of LBP will give rise to qualified patient stratification and form an essential basis for personalized therapeutic approaches. Currently, the clinical decision to apply conservative or surgical interventions is based on physical history, underlying spinal pathology observed in static images (X-ray, CT, MRI) and a short physical examination. Such snapshot analyses rarely represent the natural postures of patients during daily life, completely neglect the dynamics of spinal mobility and loading and usually do not consider psycho-social circumstances. Thus, they do not sufficiently characterize the underlying processes of tissue degeneration, local inflammation and pain. To date, none of the international guidelines incorporate pathogenesis with regards to mechanics, morphology and motion.The proposed Research Unit brings together orthopedic surgeons, imaging specialists, biomechanics experts, computer modelers, pain experts, health psychologists, and material and training scientists to reveal how spinal shape and geometry (MORPHOLOGY), physical activity and spino-pelvic kinematics (MOTION) and lumbar spinal loading (MECHANICS) are interlinked and associated with LBP. Together, we hypothesize that understanding the interrelations between these 3Ms will enable new avenues to develop strategies for functionalized patient stratification as basis to a personalized treatment. Initially, we will characterize these interrelations in different chronic LBP cohorts with and without morphologic and/or functional impairments undergoing multimodal pain management or in whom conservative treatments have failed and who are prescribed to surgery. Both patient cohorts and additional asymptomatic controls will be analyzed per age groups and both sexes to address patient diversity. In vivo investigations in large and small animal models and mathematical modeling will complement these studies to enhance a mechanistic understanding of LBP. In the long term, we aim to transfer this more mechanistic understanding on the dynamic interplay of the 3Ms and LBP to a more profound functional understanding towards a prognostic diagnostic, a more specific patient stratification and personalized treatment strategies that considers the individual mobility and adaptation capability of LBP patients.