In-vivo Lumbar Disc Deformation

体内腰椎间盘变形

• 批准号: 7990064
• 负责人: GUOAN LI
• 金额: $ 27.88万
• 依托单位: MASSACHUSETTS GENERAL HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-07-01 至 2012-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7990064
• 关键词: Adult; Anatomic Models; Anatomy; Animal Model; Anterior; Applications Grants; Biomechanics; Cervical spine; Chest; Computers; Data; Data Reporting; Development; Disease; Failure; Female; Figs - dietary; Fluoroscopy; Follow-Up Studies; Future; Goals; Guidelines; Healed; Human; Human body; Image; Imaging Techniques; Implant; Intervertebral disc structure; Investigation; Knowledge; Life; Low Back Pain; Lumbar Disc Degenerative Disorder; Magnetic Resonance Imaging; Measures; Mechanics; Methods; Modality; Modeling; Motion; Operative Surgical Procedures; Patients; Physiological; Population; Postoperative Period; Process; Recruitment Activity; Reporting; Research; Review Literature; Role; Scanning; Secondary to; Spinal Diseases; System; Techniques; Time; Tissue Engineering; United States; Vertebral column; Weight Lifting; Weight-Bearing state; base; coccyx; cost; design; experience; healing; human subject; in vivo; insight; instrumentation; intervertebral disk degeneration; kinematics; lumbar vertebra bone structure; male; pressure; prevent; public health relevance; sacrum; spine bone structure; tomography; treatment strategy

DESCRIPTION (provided by applicant): Degenerative Disc Disease (DDD) of the lumbar spine is accompanied with structural failure of the disc. Seventy-five percent (75%) of all adults will experience lower back pain (LBP) secondary to DDD in the lumbar spine at some point in their lifetime.1,2 Fusion of the involved motion segments is currently of the most common surgical treatment of severe DDD.3-5 However, radiographic follow-up studies (from as early as one year following surgery) have revealed that as many as 80% of patients may develop progressive degeneration in the adjacent vertebral segments regardless of the method of fusion.6-9 Altered vertebral kinematics and intra-disc pressure have been generally assumed to be important biomechanical factors leading to the degenerative development 10,11. Therefore, a quantitative knowledge of the in-vivo vertebral motion and disc deformation in normal human spines and in pathological spines before and after fusion surgery is instrumental to reveal the biomechanical factors accompanied with DDD development process. However, a literature review revealed that there is no data reported on the intervertebral disc deformation in living human subjects. Recently, we have developed a combined dual fluoroscopic image system (DFIS) and MRI based modeling technique to measure in-vivo human intervertebral disc deformation under weightbearing conditions. In this exploratory R21 proposal, the overall goal is to determine the vertebral motion and intervertebral disc deformation during dynamic human body activities using the combined DFIS and MRI technique. Firstly, we will compare intervertebral disc deformation (compressive and shear) of the lumbar spines (L1-2, L2-3, L3-4 and L4-5) of normal subjects and patients with severe DDD before fusion surgery during dynamic symmetric and asymmetric weight-lifting activities. Secondly, we will accurately quantify and compare the compressive and shear deformation of the lumbar intervertebral discs of the DDD patients after surgical fusion with those measured before surgery and those of normal subjects during the same activities. The proposed research will be the first attempt to quantitatively determine in-vivo vertebral motion and lumbar intervertebral disc deformation in normal subjects and patients with severe DDD under functional dynamic loading conditions. The data will quantify the effect of DDD and surgical fusion of the DDD segment on the vertebral motion and deformation of the intervertebral disc along the dynamic lumbar spine motion path. Therefore, this research will provide guidelines for the improvement of current surgical modalities for the treatment of DDD patients so that post-operative degeneration of adjacent segments can be prevented. The data can also be invaluable for establishing objective functions for designing future disc replacement implants, dynamic stabilization systems, spine biologics or tissue engineered products that can accommodate physiological intervertebral disc deformation. PUBLIC HEALTH RELEVANCE: This proposed project will investigate the compressive and shear deformation of human lumbar intervertebral discs during dynamic weight-lifting activities. It will also determine the effect of surgical fusion of diseased L5-S1 disc on lumbar disc deformation at the adjacent vertebral levels. The obtained knowledge will not only provide insight into the disease process but will also be useful for improvement of treatment strategies.

描述（由申请人提供）：腰椎的退化性椎间盘疾病（DDD）伴随着椎间盘的结构衰竭。所有成年人中，百分之七十五（75％）将经历腰椎腰椎继发于DDD的下背痛（LBP）。1,2相关运动段的融合是目前最常见的手术治疗的严重DDD.3-5。无论融合方法如何，邻近的椎骨片段。6-9改变的椎运动学改变和盘内压力通常被认为是重要的生物力学因子，导致退化性发育10,11。因此，在融合手术前后，对体内椎骨运动和椎间盘变形的定量知识对揭示伴随DDD发育过程的生物力学因子具有重要作用。但是，文献综述表明，没有关于活着的人类受试者椎间盘变形的数据。最近，我们开发了一种组合的双重荧光图像系统（DFIS）和基于MRI的建模技术，以测量体重体重条件下的体内椎间盘椎间盘变形。在此探索性R21提案中，总体目标是使用联合DFI和MRI技术在动态人体活动期间确定椎骨运动和椎间盘变形。首先，我们将比较正常受试者的腰椎（L1-2，L2-3，L3-4和L4-5）的腰椎椎间盘变形（压缩和剪切）和在动态对称和非对称重量增加活动期间进行融合手术前进行严重DDD的患者。其次，我们将准确地量化和比较手术融合后DDD患者腰椎椎间盘的压缩和剪切变形与手术前测量的椎间盘以及在同一活动中正常受试者的压缩椎间盘。拟议的研究将是定量确定正常受试者的体内椎骨运动和腰椎椎间盘变形的尝试，在功能动态载荷条件下患有严重DDD的患者。数据将量化DDD段的DDD和手术融合的影响对沿动态腰椎运动路径沿椎间盘的椎骨运动和变形。因此，这项研究将为DDD患者治疗当前手术方式的改善提供指南，以便可以防止相邻细分的术后变性。这些数据也可以是建立目标功能，用于设计未来的椎间盘置换植入物，动态稳定系统，脊柱生物制剂或组织工程产品，以适应生理椎间盘椎间盘变形。 公共卫生相关性：这个拟议的项目将调查动态体重活动期间人类腰椎椎间盘的压缩和剪切变形。它还将确定患病L5-S1椎间盘的手术融合对相邻椎骨水平上腰椎椎间盘变形的影响。获得的知识不仅将提供对疾病过程的见解，而且还将有助于改善治疗策略。