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

FOR 5177：脊柱动力学：腰痛综合诊断的力学、形态学和运动

• 批准号: 439742772
• 金额: --
• 依托单位: Julius Wolff Institut für Biomechanik und Muskuloskeletale Regeneration (CVK)
• 依托单位国家: 德国
• 项目类别: Research Units
• 资助国家: 德国
• 项目状态: 未结题
• 来源: https://gepris.dfg.de/gepris/projekt/439742772?language=en
• 关键词: 5177; Dynamics; Spine; Mechanics; Morphology

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.

腰痛（LBP）代表了社会压倒性的社会和经济负担，遭受的患者数量不断增加，需要手术或非手术治疗。当前LBP临床治疗的成功率差异很大，表明对疾病发作，进展和治疗调节的潜在机制缺乏基本的了解。提高对LBP的机械理解将导致合格的患者分层，并为个性化治疗方法构成重要的基础。目前，应用保守或手术干预措施的临床决定基于物理病史，这是在静态图像（X射线，CT，MRI）中观察到的脊柱病理学的基础，并进行了短暂的体格检查。这种快照分析很少代表日常生活中患者的自然姿势，完全忽略了脊柱迁移和负载的动态，通常不考虑心理社会环境。因此，它们没有充分表征组织变性，局部炎症和疼痛的基本过程。 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 （力学）是相互联系的，并与LBP相关。我们共同假设理解这些3MS之间的相互关系将使新的途径能够制定功能化患者分层作为个性化治疗的基础。最初，我们将在有或没有形态学和/或功能障碍的不同慢性LBP队列中表征这些相互关系，经历了多模式疼痛管理或保守治疗失败并在手术处方处方的情况下。每个年龄段的患者队列和其他无症状对照都将分析，以解决患者多样性。大型动物模型和数学模型中的体内研究将补充这些研究，以增强对LBP的机械理解。从长远来看，我们旨在将对3MS和LBP的动态相互作用的更机械理解转移到对预后诊断的更深刻的功能理解，一种更具体的患者分层和个性化的治疗策略，这些治疗策略认为LBP患者的个人移动性和适应能力。