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Analysis of the rib construct for treatment of early-onset spinal deformity with hyperkyphosis

肋骨结构治疗早发性脊柱后凸畸形的分析

基本信息

批准号：
10251070
负责人：
Daniel James Bonthius
金额：
$ 4.6万
依托单位：
MEDICAL UNIVERSITY OF SOUTH CAROLINA
依托单位国家：
美国
项目类别：
财政年份：
2020
资助国家：
美国
起止时间：
2020-07-09 至 2022-07-08
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10251070
关键词：
Adolescent Anatomy Animal Model Animals Anterior Biological Biomechanics Biomedical Engineering Bone Tissue Cadaver Chest Child Childhood Chondrocytes Chondrogenesis Clinical Data Complication Computer Models Deformity Development Device or Instrument Development Early treatment Effectiveness Elements Engineering Epiphysial cartilage Failure Family suidae Fatigue Fellowship Fostering Gene Proteins Grant Growth Histologic Human Hyperkyphosis Implant Institution Kyphosis deformity of spine Label Laboratories Lateral Measures Mechanics Medical Medical Device Methods Modeling Motion Operative Surgical Procedures Orthopedics Osteogenesis Outcome Patients Performance Periodicity Prosthesis Reporting Research Retrospective Studies Rod Safety Science Scientist Secondary to Series Spinal Spinal Curvatures Stress Structure Surgeon Techniques Testing Time Tissues Titanium Torsion Training Vertebral column Work density doctoral student early childhood early onset experience instrument instrumentation interest microCT models and simulation multidisciplinary novel programs rib bone structure sample fixation scoliosis soft tissue spine bone structure standard care success vertebra body

项目摘要

Project Summary/Abstract Early-onset spinal deformity (EOSD) is a common affliction of early childhood in which the spine curves abnormally. This spinal curvature can induce debilitating deformity and secondary medical problems. Thus, EOSD is an important pediatric problem. Spinal deformity in the lateral direction is scoliosis, while deformity in the anterior direction is kyphosis. EOSD can be treated with surgery. There are two widely-used growth-sparing surgical methods for EOSD: 1) growing rods and 2) VEPTR (Vertical Expandable Prosthetic Titanium Rib). These methods provide some immediate correction of spinal deformity by realigning vertebral bodies, and they may provide additional gradual correction of the deformity via growth modulation of the spine over time. However, the presence of hyperkyphosis complicates the surgical treatment of EOSD, as currently available growth-sparing instrumentation does not provide ideal control of the deformity in the sagittal plane. Furthermore, hyperkyphosis increases mechanical failure rates in the existing surgical approaches. Thus, a new surgical method of treating hyperkyphosis is needed. We are developing a novel method, called the “rib construct,” which utilizes a series of laminar hooks to anchor extendable rods to the ribs. The merits of the rib construct have been validated anecdotally in a small series of patients and with ex vivo biomechanical testing at our institution. However, to date, there have been no large animal studies that have examined the performance and mechanism of the rib construct for correcting hyperkyphosis under controlled laboratory conditions. The central hypothesis of this proposal is that the rib construct will correct hyperkyphosis in a pediatric porcine animal model. Aim 1 will assess the ability of the rib construct to correct hyperkyphosis via growth modulation in a pediatric porcine animal model. We will implant the rib construct in juvenile pigs with hyperkyphosis and assess its ability to correct the curvature, compared to standard treatment with pedicle screws. Aim 2 will evaluate the biological mechanism of spinal growth modulation with the rib construct at the tissue and cellular level. We will examine the biological mechanism by which the rib construct works by quantifying chondrocyte number and density and by measuring changes in marker genes and proteins related to chondrogenesis and osteogenesis. Aim 3 will evaluate the biomechanics of the rib construct. Utilizing a computer model simulation program, we will analyze the stress and strain distributions on the instrumentation, bone, and soft tissues, then compare them to those of conventional surgical approaches. We will validate these findings by conducting normal pull-out force, bending, and torsional biomechanical testing on human and porcine cadaver spines. Finally, we will report our clinical data on the use of the rib construct in a retrospective study of human patients. Success in this project could revolutionize the treatment of children with EOSD. By providing training in orthopedic research, basic biological & engineering science, and translational medical device development, this fellowship will foster the development of the trainee into a unique orthopedic academic clinician/scientist.

项目总结/文摘