Metastatic Spine Tumors: Minimally Invasive Fracture Risk Analysis and Treatment

转移性脊柱肿瘤：微创骨折风险分析和治疗

• 批准号: 7599113
• 负责人: Lichun Lu
• 金额: $ 47.69万
• 依托单位: MAYO CLINIC ROCHESTER
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-04-01 至 2013-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7599113
• 关键词: Abbreviations; Achievement; Activities of Daily Living; Address; Affect; Applications Grants; Biocompatible Materials; Braces-Orthopedic appliances; Cadaver; Carrying Capacities; Clinical; Data; Defect; Development; Diagnosis; Diagnostic; Disease; Disseminated Malignant Neoplasm; Evaluation; Excision; Failure; Family; Fracture; Goals; Home environment; Image Analysis; In Vitro; Injectable; Injury; Length of Stay; Life; Malignant Neoplasms; Mechanics; Methodology; Methods; Modeling; Nature; Neoplasm Metastasis; Nerve compression syndrome; Neurologic; Operative Surgical Procedures; Pain; Paralysed; Pathologic; Patient Care; Patients; Physiological; Positioning Attribute; Property; Recommendation; Recovery; Rehabilitation therapy; Research; Residual state; Risk; Scanning; Shapes; Sheep; Sorting - Cell Movement; Spinal; Spinal Cord; Spinal Fractures; Spinal nerve structure; System; Techniques; Temperature; Time; Tissues; Translations; Tumor Tissue; Validation; Vertebral column; Weight-Bearing state; X-Ray Computed Tomography; base; bone strength; clinical practice; computer program; computerized; density; design; experience; heat injury; in vivo; indexing; minimally invasive; novel; polymerization; pre-clinical; programs; public health relevance; reconstitution; reconstruction; spine bone structure; theories; tumor; validation studies

DESCRIPTION (provided by applicant): The identification of cancer metastases to the bony vertebral column obligates the treating clinician to make a surgical decision. The consequences of that decision for the patient are significant whether the recommendation is for surgical or non-surgical treatment. If the spine is deemed unstable and at risk for fracture, then the patient will undergo a major spinal operation, and will often spend much of their remaining life recuperating from it. Conversely, the patient whose spine is deemed stable and receives non-surgical treatment risks fracture and possible paralysis if the stability analysis was incorrect. In addition, the metastatic disease usually progresses, and the stability analysis must be repeated at intervals throughout the disease course. The spinal stability decision is empirical and can be inaccurate, even when done by experienced spinal clinicians. This proposal addresses both the stability decision and, for those patients deemed at risk for fracture, the nature of the treatment. Aim 1 describes the development of an automated program that analyzes spinal computerized tomography scans, and calculates the residual load carrying capacity of the affected vertebra. Aim 2 optimizes novel injectable materials to restore the load carrying capacity of the vertebra in a minimally invasive manner, thus decreasing time in recovery and rehabilitation from major spine surgery. Successful achievement of this aim would offer an alternative to open surgery for many of these patients, thus decreasing their rehabilitation time and increasing their family time. Aim 3 addresses validation of both the automated spinal stability analysis and the minimally invasive spinal reconstruction. These in vitro and in vivo Aim 3 preclinical validation studies are requisite steps to position both the Aim 1 automated diagnostic methodology and the Aim 2 minimally invasive surgical treatment methodology closer to the goal of translation to clinical practice. Public Health Relevance Statement (provided by applicant): The computerized spinal stability assessment, for patients who have cancer that has spread to their spine, will offer more accurate diagnosis of the need for spine surgery to the patients, and with a much greater likelihood that the patients and their families can get the evaluation done near their home, saving them time, expense, and inconvenience. The recommendation for non-surgical treatment will be made with increased assurance that the risk of a spine fracture is low. Those patients, who do need surgery, will often chose minimally invasive surgical techniques that will shorten their hospital stay and allow them to return home to their families.

描述（由申请人提供）：确定癌症转移至骨性脊柱后，治疗临床医生有义务做出手术决定。无论建议是手术治疗还是非手术治疗，该决定对患者的影响都是重大的。如果脊柱被认为不稳定并且有骨折的风险，那么患者将接受一次大型脊柱手术，并且通常会花费大部分的余生来恢复。相反，如果稳定性分析不正确，脊柱被认为稳定并接受非手术治疗的患者就有骨折和可能瘫痪的风险。此外，转移性疾病通常会进展，并且在整个病程中必须每隔一定时间重复进行稳定性分析。脊柱稳定性决策是凭经验做出的，即使是由经验丰富的脊柱临床医生做出的，也可能不准确。该提案既涉及稳定性决策，又涉及那些被认为有骨折风险的患者的治疗性质。目标 1 描述了一种自动化程序的开发，该程序可分析脊柱计算机断层扫描，并计算受影响椎骨的残余承载能力。目标 2 优化新型可注射材料，以微创方式恢复椎骨的承载能力，从而减少大型脊柱手术的恢复和康复时间。成功实现这一目标将为许多此类患者提供开放手术的替代方案，从而减少他们的康复时间并增加他们的家庭时间。目标 3 解决了自动脊柱稳定性分析和微创脊柱重建的验证问题。这些体外和体内 Aim 3 临床前验证研究是使 Aim 1 自动诊断方法和 Aim 2 微创手术治疗方法更接近转化为临床实践的目标的必要步骤。 公共卫生相关性声明（由申请人提供）：对于癌症已扩散到脊柱的患者，计算机化的脊柱稳定性评估将为患者提供更准确的脊柱手术需求诊断，并且患者及其家人更有可能在家附近完成评估，从而节省时间、费用和不便。建议进行非手术治疗，以确保脊柱骨折的风险较低。那些确实需要手术的患者通常会选择微创手术技术，以缩短住院时间并让他们回家与家人团聚。