Metastatic Spine Tumors: Minimally Invasive Fracture Risk Analysis and Treatment - Master

转移性脊柱肿瘤：微创骨折风险分析和治疗 - 硕士

• 批准号: 10585673
• 负责人: Lichun Lu
• 金额: $ 41.44万
• 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 2028-01-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10585673
• 关键词: Activities of Daily Living; Address; Affect; Biocompatible Materials; Biomechanics; Biomimetics; Bone Cements; Cadaver; Calibration; Caring; Cauda Equina; Cementation; Chemicals; Chemistry; Clinic; Clinical; Communities; Complex; Counseling; Data; Decision Making; Defect; Development; Disease; Disseminated Malignant Neoplasm; Elements; Evaluation; Exercise; Failure; Family; Finite Element Analysis; Formulation; Fracture; Future; Grant; Home; Household; Human; Hydrogels; Injectable; Institution; Intervertebral disc structure; Length of Stay; Link; Lytic; Malignant Neoplasms; Mechanics; Methodology; Methods; Modeling; Motion; Nature; Neoplasm Metastasis; Nervous System Trauma; Network-based; Operative Surgical Procedures; Outcome Study; Pain; Paralysed; Patient Care; Patients; Periosteum; Physiological; Polymers; Prevention; Procedures; Process; Protocols documentation; Recommendation; Recovery; Rehabilitation therapy; Reproducibility; Research; Residual state; Retrospective cohort; Risk; Robotics; Scanning; Spinal; Spinal Fractures; Spinal Neoplasms; Spinal nerve structure; Spine surgery; Stretching; Surgical Oncology; System; Techniques; Testing; Time; Vertebral column; Weight-Bearing state; Work; X-Ray Computed Tomography; base; biomaterial compatibility; bone; catalyst; clinical implementation; clinical translation; clinically relevant; computerized; crosslink; fracture risk; grandchild; high risk; improved; indexing; kinematics; mechanical properties; minimally invasive; neural; novel; operation; poly(propylene fumarate); prevent; programs; prophylactic; quantitative computerized tomography based finite element analysis; reconstitution; reconstruction; risk prediction; spinal cord compression; spine bone structure; tumor; vertebra body; virtual; virtual assessment

Project Summary/Abstract The identification of cancer metastases to the bony vertebral column obligates the treating clinician to make a surgical decision. Current spinal stability decision-making is empirical, qualitative, and can be inaccurate. The consequences of that decision for the patient, however, are significant. If the spine is deemed at risk for fracture, then the patient will undergo a major spinal operation. Conversely, the patient whose spine is deemed stable risks fracture and possible paralysis if the analysis was incorrect. This research program addresses both the stability decision and the nature of the treatment. In this renewal application, we will continue our efforts to develop non-invasive, quantitative, and reliable methods to predict the fracture risk of vertebrae with metastatic cancer under physiologically relevant loading conditions, and to optimize minimally invasive techniques using novel biomaterials to reconstitute the load bearing capacity of an affected vertebra. In Aim 1, we propose a novel injectable polymer network that can be self-crosslinked via catalyst-free click chemistry into “click” organic-inorganic nanohybrid (click-ON) bone cement. Compared to our previous injectable system, the novel cement has improved biocompatibility, injectability, and crosslinking efficiency. In Aim 2, we will investigate the efficacy of the optimized click-ON bone cement to both prevent impending fractures and treat existing fractures in cadaveric models using the clinical vertebroplasty and kyphoplasty procedures, respectively (Aim 2a). Intact lumbar spines (L1-S1), spines with simulated lytic defects, and spines with biomaterial augmentation will be tested under accurate and biomimetic loading conditions using a novel robotic testing system. Our previously developed quantitative computerized tomography based finite element analysis (QCT/FEA) models will be expanded to include both kinematic motion evaluation and fracture risk prediction under physiological loading and boundary conditions and validated using the experimental results (Aim 2b). In Aim 3, We will develop a phantom-less calibration technique to account for the effects of QCT protocols on QCT/FEA results (Aim 3a). Using the powerful AnalyzeMD platform, we will implement an automated process to further advance the FEA technique for time efficiency and reproducibility (Aim 3b). We will apply the comprehensive QCT/FEA models in a retrospective cohort of spine metastasis patients and assess the virtual reconstruction using the click-ON bone cement as a first step towards clinical translation. The QCT/FEA technique developed in this work takes into consideration both the quality and quantity of bone and the degeneration status of the intervertebral discs. This technique allows the clinician to counsel her/his patient regarding activities of daily living that can be performed with a low risk of spinal fracture. Our future plans are to expand the clinical implementation of the spinal FEA analysis at Mayo Clinic. We will add FEA evaluation results in our discussion with the patients regarding our recommendations for their care. We will study the outcome results of those recommendations, adjust the decision parameters as necessary, and then extend the analysis to additional institutions.

项目摘要/摘要 鉴定癌症转移到骨椎骨的义务使治疗临床义务使 手术决定。当前的脊柱稳定性决策是经验，定性的，并且可能不准确。 然而，该决定对患者的后果很大。如果脊柱被认为有风险 断裂，然后患者将进行主要的脊柱手术。相反，脊柱被认为是 如果分析不正确，稳定的风险骨折和可能的麻痹。该研究计划都解决了 稳定决策和治疗的性质。在此续签应用中，我们将继续努力 开发非侵入性，定量和可靠的方法，以预测转移性的椎骨骨折风险 在物理相关的负载条件下进行癌症，并使用微创技术优化 新型生物材料重建受影响的椎骨的负载能力。在AIM 1中，我们建议 可以通过无催化剂单击化学的新型可注射聚合物网络，可以自我链接到“ click” 有机无机纳米杂交（点击）骨水泥。与我们以前的可注射系统相比 水泥具有提高的生物相容性，注射性和交联效率。在AIM 2中，我们将调查 优化的点击骨水泥的功效可以防止即将发生的裂缝和治疗现有骨折 在使用临床椎体成形术和脑膜成形术程序的尸体模型中（AIM 2A）。完好无损的 腰椎（L1-S1），具有模拟裂解缺陷的棘突，具有生物材料增强的棘是 使用新型的机器人测试系统在准确和仿生的载荷条件下进行测试。我们以前 开发的基于定量计算机层析成像的有限元分析（QCT/FEA）模型将是 扩展到包括运动运动评估和物理负荷下的断裂风险预测 和边界条件，并使用实验结果验证（AIM 2B）。在AIM 3中，我们将开发一个 无幻象的校准技术来说明QCT方案对QCT/FEA结果的影响（AIM 3A）。 使用功能强大的分析平台，我们将实施一个自动化过程，以进一步推进FEA 时间效率和可重复性的技术（AIM 3B）。我们将应用全面的QCT/FEA模型 在回顾性脊柱转移患者的队列中，并使用点击键评估虚拟重建 骨水泥是迈向临床翻译的第一步。这项工作中开发的QCT/FEA技术需要 考虑到骨骼的质量和数量以及椎间盘的变性状态。 这种技术使临床可以为她/他的患者提供有关日常生活活动的建议 以低脊髓骨折的风险进行。我们未来的计划是扩大 梅奥诊所的脊柱FEA分析。我们将在与患者的讨论中添加FEA评估结果 关于我们的护理建议。我们将研究这些建议的结果， 根据需要调整决策参数，然后将分析扩展到其他机构。