FOR 5177: The Dynamics of the Spine: Mechanics, Morphology and Motion towards a comprehensive Diagnosis of Low Back Pain

腰痛（LBP）是一个巨大的社会和经济负担，患者人数不断增加，需要手术或非手术治疗。目前临床治疗LBP的成功率差异很大，这表明对疾病发病、进展和治疗调节的潜在机制缺乏基本的了解。提高对腰痛的机制理解将有助于对患者进行合格的分层，并为个性化治疗方法提供必要的基础。目前，临床决定采用保守或手术干预是基于身体病史，在静态图像（x射线，CT， MRI）中观察到的潜在脊柱病理和简短的体格检查。这种快照分析很少代表患者在日常生活中的自然姿势，完全忽视了脊柱运动和负荷的动态，通常不考虑心理社会环境。因此，它们不能充分表征组织变性、局部炎症和疼痛的潜在过程。迄今为止，没有一项国际指南将发病机制与力学、形态学和运动结合起来。拟议的研究单位汇集了骨科医生，成像专家，生物力学专家，计算机建模专家，疼痛专家，健康心理学家，以及材料和训练科学家，以揭示脊柱形状和几何形状（形态学），身体活动和脊柱-骨盆运动学（运动）以及腰椎负荷（力学）是如何相互联系并与LBP相关的。综上所述，我们假设理解这些3m之间的相互关系将为制定功能化患者分层策略提供新的途径，作为个性化治疗的基础。首先，我们将在不同的慢性腰痛队列中描述这些相互关系，这些队列有或没有形态学和/或功能损伤，接受多模式疼痛管理，或保守治疗失败，并规定手术治疗。将按年龄组和性别分析患者队列和其他无症状对照，以解决患者多样性问题。大型和小型动物模型的体内研究和数学建模将补充这些研究，以增强对腰痛的机制理解。从长远来看，我们的目标是将这种对3m和LBP动态相互作用的更机械的理解转化为对预后诊断、更具体的患者分层和个性化治疗策略的更深刻的功能理解，这些治疗策略考虑了LBP患者的个体活动能力和适应能力。

Low back pain (LBP) represents an overwhelming social and economic burden to society with a constantly increasing number of patients suffering and requiring surgical or non-surgical treatment. The success rates of current clinical treatments for LBP vary considerably, indicating a lack of basic understanding of the underlying mechanisms of disease onset, progression and therapeutic modulation. Improving the mechanistic understanding of LBP will give rise to qualified patient stratification and form an essential basis for personalized therapeutic approaches. Currently, the clinical decision to apply conservative or surgical interventions is based on physical history, underlying spinal pathology observed in static images (X-ray, CT, MRI) and a short physical examination. Such snapshot analyses rarely represent the natural postures of patients during daily life, completely neglect the dynamics of spinal mobility and loading and usually do not consider psycho-social circumstances. Thus, they do not sufficiently characterize the underlying processes of tissue degeneration, local inflammation and pain. To date, none of the international guidelines incorporate pathogenesis with regards to mechanics, morphology and motion.The proposed Research Unit brings together orthopedic surgeons, imaging specialists, biomechanics experts, computer modelers, pain experts, health psychologists, and material and training scientists to reveal how spinal shape and geometry (MORPHOLOGY), physical activity and spino-pelvic kinematics (MOTION) and lumbar spinal loading (MECHANICS) are interlinked and associated with LBP. Together, we hypothesize that understanding the interrelations between these 3Ms will enable new avenues to develop strategies for functionalized patient stratification as basis to a personalized treatment. Initially, we will characterize these interrelations in different chronic LBP cohorts with and without morphologic and/or functional impairments undergoing multimodal pain management or in whom conservative treatments have failed and who are prescribed to surgery. Both patient cohorts and additional asymptomatic controls will be analyzed per age groups and both sexes to address patient diversity. In vivo investigations in large and small animal models and mathematical modeling will complement these studies to enhance a mechanistic understanding of LBP. In the long term, we aim to transfer this more mechanistic understanding on the dynamic interplay of the 3Ms and LBP to a more profound functional understanding towards a prognostic diagnostic, a more specific patient stratification and personalized treatment strategies that considers the individual mobility and adaptation capability of LBP patients.