Coordination Funds

协调基金

• 批准号: 464342547
• 负责人: Professor Dr. Hendrik Schmidt
• 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/464342547?language=en
• 关键词: Coordination; Funds

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.

下背痛（LBP）代表了社会的巨大社会和经济负担，不断增加的患者数量需要手术或非手术治疗。目前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重要基础。目前，应用保守或手术干预的临床决策是基于病史、静态图像（X线、CT、MRI）中观察到的潜在脊柱病理学和短期体格检查。这种快照分析很少代表患者在日常生活中的自然姿势，完全忽略了脊柱运动和负荷的动态，通常不考虑心理社会情况。因此，它们不能充分表征组织变性、局部炎症和疼痛的潜在过程。迄今为止，没有一个国际指南将力学、形态学和运动方面的发病机制纳入其中。拟议的研究单位汇集了整形外科医生、影像学专家、生物力学专家、计算机建模师、疼痛专家、健康心理学家以及材料和培训科学家，以揭示脊柱形状和几何结构如何影响脊柱的运动。（形态学）、体力活动和脊柱-骨盆运动学（运动）以及腰椎负荷（力学）相互关联，并与LBP相关。总之，我们假设，了解这些3 M之间的相互关系，将使新的途径，以制定战略的功能化患者分层的基础上，个性化治疗。最初，我们将在不同的慢性LBP队列中描述这些相互关系，有或没有形态和/或功能障碍，接受多模式疼痛管理，或保守治疗失败，并规定手术。将按照年龄组和两种性别分析两个患者队列和其他无症状对照，以解决患者多样性。大型和小型动物模型的体内研究和数学建模将补充这些研究，以提高对LBP机制的理解。从长远来看，我们的目标是将这种对3 M和LBP动态相互作用的更机械的理解转移到对预后诊断的更深刻的功能理解，更具体的患者分层和个性化的治疗策略，考虑LBP患者的个体流动性和适应能力。