Three dimensional in vivo movement of cervical vertebrae during functional loadin

描述（由申请人提供）： 颈椎前路融合手术可有效恢复功能并减轻因退行性脊柱疾病引起的疼痛。然而，邻近融合颈椎的运动节段的退化（邻近节段疾病）是患者和外科医生关注的问题。已经提出，机械因素，包括施加到相邻运动节段的过度应力，驱动相邻节段疾病的进展。通过在各种功能负荷任务中收集体内数据，可以最好地了解与相邻节段疾病相关的这些力学因素。我们建议使用一种独特的双平面放射成像系统来研究颈椎融合对相邻节段运动的影响，该系统能够表征功能负荷期间的体内运动。当受试者进行颈椎屈曲/伸展、侧弯和轴向旋转运动时，双平面X线摄影系统将以每秒50帧的速度收集X线数据。将使用动态RSA技术（基于微珠的跟踪）和经验证的无标记技术（基于模型的跟踪）准确测量三维骨运动。颈椎前路融合术受试者将在术后（术后6-9个月和24个月）进行两次运动测试，以评估整体椎体运动（骨运动学）的变化和椎体终板之间相对运动（关节运动学）随时间的变化。运动过程中的数据收集将使我们能够量化整个运动范围内颈椎的动态稳定性/不稳定性。椎体终板的关节运动学测量将使我们能够推断在功能载荷期间施加于椎间盘的机械载荷条件（压缩、剪切、扭转）。将融合受试者的椎体运动与无症状、年龄匹配的对照受试者的椎体运动进行比较。这项研究将首次记录无症状受试者和前路融合患者颈椎的精确、三维、体内运动。本研究的第一个目的是确定在体内功能负荷期间区分无症状受试者和单节段前路融合患者的特定运动学和关节运动学测量值。第二个目的是确定融合患者随着时间的推移颈椎运动学和关节运动学的变化。最后，融合组运动学和关节运动学的变化将与患者结局调查结果和退行性椎间盘疾病/脊柱不稳定的标准临床指标相关，以便将异常椎体运动与患者症状和临床结果相关。从这项研究中获得的知识可能会改善退行性脊柱疾病患者的诊断和治疗。 公共卫生关系： 据报道，16%（Ishihara，2004）至25%（Hilibrand，1999）的患者接受手术以缓解退行性脊柱疾病，术后10年内出现新发疾病。手术后脊柱的异常运动可能会增加脊柱相邻部分的压力，并导致进一步的脊柱退化。该项目旨在确定可能与脊柱手术后退行性脊柱疾病相关的异常颈骨运动。

DESCRIPTION (provided by applicant): Project Summary Anterior cervical fusion surgery effectively restores function and alleviates pain due to degenerative spine disease. However, the degeneration of motion segments adjacent to the fused cervical vertebrae (adjacent segment disease) is a concern for patients and surgeons. It has been proposed that mechanical factors, including excessive stress applied to adjacent motion segments, drive the progression of adjacent segment disease. Improved understanding of these mechanical factors associated with adjacent segment disease can best be obtained through collecting data in vivo during a variety of functional loading tasks. We propose to study the effects of cervical fusion on adjacent segment motion using a unique biplane radiographic imaging system capable of characterizing in vivo motion during functional loading. The biplane radiographic system will collect x-ray data at 50 frames per second as subjects perform cervical flexion/extension, lateral bending and axial rotation movements. Three-dimensional bone motion will be accurately measured using both a dynamic RSA technique (bead-based tracking) and a validated markerless technique (model-based tracking). Anterior cervical fusion subjects will perform movement tests two times following surgery (6-9 months and 24 months post-surgery) to assess changes in overall vertebral motion (bone kinematics) and changes in relative motion between vertebral endplates (arthrokinematics) over time. Data collection during movement will allow us to quantify the dynamic stability/instability of the cervical spine throughout the range of motion. Arthrokinematic measurements of vertebral endplates will allow us to infer mechanical loading conditions applied to intervertebral discs (compression, shear, torsion) during functional loading. Fusion subject's vertebral movements will be compared to asymptomatic, age-matched control subject's vertebral movements. The proposed study will be the first to record precise, three-dimensional, in vivo movement of cervical vertebrae in asymptomatic subjects and anterior fusion patients. The first aim of the study is to identify specific kinematic and arthrokinematic measurements that differentiate between asymptomatic subjects and single- level anterior fusion patients during in vivo functional loading. The second aim is to identify changes in cervical vertebrae kinematics and arthrokinematics over time in the fusion patients. Finally, changes in fusion group kinematics and arthrokinematics will be correlated with patient outcome survey results and standard clinical measures of degenerative disc disease/spinal instability in order to relate abnormal vertebral movement to patient symptoms and clinical findings. Knowledge acquired from this study may lead to improved diagnosis and treatment for patients afflicted with degenerative spine disease. PUBLIC HEALTH RELAVANCE: Project Narrative It has been reported that between 16% (Ishihara, 2004) and 25% (Hilibrand, 1999) of patients who have surgery to alleviate degenerative spine disease have new disease within 10 years of the operation. Abnormal spine movement following surgery may increase stress on adjacent portions of the spine and cause further spine degeneration. This project aims to identify abnormal neck bone movement that may be associated with degenerative spine disease following spine surgery.