权益分类	功能权益	普通用户	{{item.name}}会员
{{category.name}}	{{benefitItem.name}}

Evaluating adjacent segment biomechanics after ACDF or TDR surgery in cervical spondylosis patients.

评估颈椎病患者 ACDF 或 TDR 手术后邻近节段的生物力学。

基本信息

批准号：
9759737
负责人：
Thomas D Cha
金额：
$ 6.38万
依托单位：
MASSACHUSETTS GENERAL HOSPITAL
依托单位国家：
美国
项目类别：
财政年份：
2018
资助国家：
美国
起止时间：
2018-08-15 至 2021-08-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9759737
关键词：
Age Aging Anatomy Animal Model Anterior Articular Range of Motion Attention Basic Science Biochemical Biological Factors Biomechanics Cadaver Categories Cervical Cervical Radiculopathies Cervical spine Clinical Clinical Research Complement 5a Computer Simulation Data Degenerative Disorder Development Devices Diagnostic radiologic examination Disease Early Diagnosis Etiology Facet joint structure Follow-Up Studies Gait Goals Health Care Costs Heart Iatrogenesis Imaging Techniques Knowledge Lead Longitudinal Studies Longitudinal prospective study Magnetic Resonance Imaging Measures Methods Motion Natural History Neck Neck Pain Operative Surgical Procedures Outcome Outcome Measure Pain Pathology Patient Care Patient Outcomes Assessments Patient-Focused Outcomes Patients Physicians Population Postoperative Period Predisposition Prevalence Randomized Randomized Clinical Trials Relaxation Repeat Surgery Reporting Research Research Proposals Risk Scientist Specimen Spinal Cord Spinal Cord Diseases Spondylosis Symptoms Syndrome Time Vertebral column Weight-Bearing state age related base career control trial experience follow-up improved in vivo indexing innovation insight inter-individual variation kinematics next generation operation outcome forecast preservation randomized trial sex spine bone structure symptom treatment

项目摘要

Summary Cervical spondylosis refers to age related degenerative changes in the upper region of the spinal column. Symptoms caused by this degeneration can be classified into axial neck pain, cervical radiculopathy and cervical myelopathy (syndrome of long tract findings from spinal cord involvement). Lifetime prevalence of axial neck pain is approximately 66%, with 5% of the population experiencing disabling pain at any given time. One of the most commonly prescribed treatments for cervical degenerative disorders is anterior cervical discectomy and fusion (ACDF). However, radiographic follow-up studies reveal that as many as 90% of treated patients develop progressive adjacent segment disease (ASD) with up to 25.6% requiring reoperation at an adjacent segment due to symptomatic ASD. Concern for ASD has been the rationale for developing total disc replacement (TDR) through preserving index level motion capability. However, recent mid to long term randomized trials reported similar clinical outcomes and post-operative re-operation rate at adjacent segments when comparing ACDF and TDR patient groups. Whether adjacent segment degeneration is an effect of surgery (ACDF or TDR) or merely represents the natural development of the disease remains unknown. Etiology of ASD is multifactorial and research has shown that altered adjacent level biomechanics following surgery could be a contributing factor. Although many imaging techniques have been used to research in-vivo cervical spine motion, few data have been reported on the changes in kinematics and arthrokinematics in spondylosis patients before and after ACDF or TDR surgery during dynamic, functional and weightbearing activities. Specifically, no other study has investigated patients before and after ACDF or TDR with age and sex matched asymptomatic controls to account for patient specific factors and to separate age-related degeneration. Understanding the biomechanical factors that can increase the risk for ASD is necessary to improve reoperation rate due to symptomatic ASD. This study is based on the hypothesis that the altered adjacent segment biomechanics after cervical surgery are strongly associated with the development of post-operative adjacent segment degeneration. Firstly, we will determine kinematics (i.e. 6DOF range of motion) and arthrokinematics (i.e. disc deformation and facet joint motion) in the adjacent segments in spondylosis patients before and after a C5-6 ACDF or TDR. Kinematics and arthrokinematics at adjacent segments (C2-C3, C3-C4, C4-C5 and C6-C7) in 10 ACDF and 10 TDR patients during functional activities (dynamic gait and full range of motion of the neck) before surgery and 18 months after surgery will be measured. Secondly, we will determine the relationship between the changes in biomechanics (kinematics, arthrokinematics) and biochemical composition (T1ρ and T2 relaxation values) in the spondylosis patients before and after an ACDF or TDR. This longitudinal, prospective study will provide pilot data for an in-depth understanding of the biomechanical component of cervical spine ASD after undergoing an ACDF or a TDR surgery. If our hypothesis is confirmed then this study will help clinicians predict symptomatic degeneration earlier and improve reoperation rate by showing whether ACDF or TDR is better at reducing symptomatic ASD. Alternatively, if no association between biomechanical and biochemical composition (T1ρ and T2 mapping sequences) is found, then this study will show that biological factors are the main drivers of ASD and increased attention should be placed on patient specific anatomy and pathology. This pilot data will be used to develop a R01 randomized clinical trial research proposal that can thoroughly isolate the biomechanical component of ASD by taking iatrogenic and patient specific anatomy in consideration and using a larger patient group with longer follow-up times. As a physician- scientist, it is my career goal to improve patient care through innovative translational basic science research and this research is at the heart of that goal.

总结颈椎病是指与年龄相关的脊柱上部区域的退行性变化。由这种变性引起的症状可分为轴性颈痛、颈神经根病和颈神经痛。脊髓病（脊髓受累的长束综合征）。中轴颈的终生患病率疼痛约占66%，5%的人群在任何给定时间经历致残性疼痛。之一颈椎退行性疾病的最常用处方治疗是颈椎前路椎间盘切除术，融合（ACDF）。然而，放射学随访研究显示，多达90%的治疗患者发生进行性相邻节段疾病（ASD），高达25.6%的患者需要在相邻节段再次手术因为有症状的ASD对ASD的关注一直是开发全椎间盘置换术（TDR）的基本原理通过保留索引级运动能力。然而，最近的中长期随机试验报告说，当比较ACDF时，相邻节段的临床结局和术后再手术率相似， TDR患者组。相邻节段退变是否是手术（ACDF或TDR）的影响，代表疾病的自然发展仍然未知。 ASD的病因是多因素的，研究表明，相邻节段生物力学的改变可能是一个原因虽然许多成像技术已被用于研究在体内颈椎运动，很少有关于运动学和关节运动学变化的数据报道在ACDF或TDR手术前后，颈椎病患者在动力、功能和承重期间活动具体而言，没有其他研究调查了ACDF或TDR前后患者的年龄和性别匹配无症状对照，以解释患者的特定因素，并分离年龄相关的变性。了解可能增加ASD风险的生物力学因素对改善再次手术是必要的由于症状性ASD的发生率。这项研究是基于这样一个假设，即颈椎骨折后邻近节段的生物力学改变手术与术后相邻节段退变的发展密切相关。第一、我们将确定运动学（即6DOF运动范围）和关节运动学（即椎间盘变形和关节面关节运动）在相邻节段的颈椎病患者之前和之后C5-6 ACDF或TDR。运动学 10例ACDF和10例TDR患者相邻节段（C2-C3、C3-C4、C4-C5和C6-C7）的关节运动学在术前和术后18个月的功能活动期间（动态步态和颈部全范围活动）手术将被测量。其次，我们将确定生物力学变化之间的关系（运动学，关节运动学）和生化组成（T1ρ和T2松弛值）在椎关节强硬 ACDF或TDR前后的患者。这项纵向前瞻性研究将为深入了解颈椎ASD在接受ACDF或TDR手术后的生物力学成分。如果我们的假设证实，那么这项研究将有助于临床医生更早地预测有症状的退行性变，并改善再次手术通过显示ACDF或TDR在减少症状性ASD方面是否更好，或者，如果没有关联生物力学和生物化学成分（T1ρ和T2映射序列）之间的关系，将表明生物因素是ASD的主要驱动因素，应增加对患者的关注具体解剖学和病理学。该试验数据将用于开展R 01随机临床试验研究提出了一种可以通过将医源性和患者性ASD的生物力学成分彻底分离的建议，考虑特定的解剖结构，并使用更大的患者组和更长的随访时间。作为一名医生- 作为一名科学家，我的职业目标是通过创新的转化基础科学研究来改善患者护理，这项研究是这一目标的核心。