Spinal facet joints: biomechanical evaluation for improved interventions

在英国，每5个成年人中就有4个在人生的某个阶段遭受背部疼痛的折磨，每年的治疗费用超过10亿英镑，英国经济每年花费100亿英镑。当需要外科手术时（例如发生事故或脊柱异常），金标准是脊柱融合术，这是一种旨在阻止受影响脊柱区域运动的侵入性干预。脊柱融合术的一个主要问题是它会增加脊柱其他部位的压力，尤其是小的软骨关节，称为关节面。即使在一个健康的人身上，这些方面也经常恶化，但这很少引起任何症状。然而，在脊柱融合术后，病情恶化可能会加剧，并产生新的症状和长期疼痛。目前迫切需要确定融合效果最好的患者类型和手术方法；为了改进设备，使这种加速退化的情况发生得更少。患者之间的初始恶化程度差异很大，目前缺乏在测试融合装置时考虑这些大差异的生物力学证据。为了解决这些问题，这笔拨款将开发新的测试方法和工具，将实验室模拟与计算机建模相结合。这些方法将用于预测融合装置在不同程度的关节突退化时一系列参数的力学性能变化。这将使不同的干预措施与不同患者的特征相匹配。此外，证明测试方法准确性的过程将涉及在不同劣化程度下进行测试。这些测试的结果将有助于更好地了解关节突退化如何影响脊柱的生物力学功能。这些知识将有可能为开发其他更有效的脊柱治疗方法提供信息，并且开发的新方法也可以应用于身体的其他关节。

In the UK, four out of five adults suffer from back pain at some point in their life, the treatment of which costs the NHS over a billion per year and the UK economy £10 billion per year. When a surgical option is required (for example after an accident or because of abnormalities in the spine), the gold standard is spinal fusion, an invasive intervention designed to stop the motion of the affected spinal area. One of the main issues with spinal fusion is that it increases the stress on other area in the spine, in particular on small cartilaginous joints called the facets. Even in a healthy person, the facets are often deteriorated but this rarely cause any symptoms. After spinal fusion however, the deterioration can increase and create new symptoms and long term pain for one in four patients.There is an urgent need to define the type of patients and procedures for which fusion works best; and to improve devices so that this accelerated deterioration of the facets happens less often. The levels of initial deterioration between patients differs greatly and there is currently a lack of biomechanical evidence that takes into account these large variations when testing fusion devices. To tackle these issues, this grant will develop novel testing methods and tools combining laboratory simulation with computer modelling. These methods will be used to predict the variation in the mechanical performance of a series of parameters in fusion devices at various levels of facet deterioration. This will enable the different interventions to be matched to different patient's characteristics. In addition, the process of proving the accuracy of the testing methods will involve conducting tests at different levels of deterioration. The results from these tests will provide a greater understanding of how facet deterioration affects the biomechanical function of the spine. This knowledge will have the potential to inform the development of other more effective treatments for the spine and the new methods developed can also be applied to other joints in the body.