Spinal facet joints: biomechanical evaluation for improved interventions

在英国，五分之四的成年人在生活中的某个时候患有背痛，NHS每年的治疗费用超过10亿英镑，英国经济每年100亿英镑。当需要手术选择时（例如在事故后或由于脊柱异常），黄金标准是脊柱融合，这是一种旨在阻止受影响脊柱区域运动的侵入性干预。脊柱融合的主要问题之一是它增加了脊柱其他区域的应力，特别是称为小关节面的小软骨关节。即使在一个健康的人，方面往往恶化，但这很少会引起任何症状。然而，脊柱融合后，恶化可能会增加，并产生新的症状和长期疼痛的四分之一的患者，有一个迫切需要确定的类型的患者和程序的融合工作最好的，并改善设备，使这种加速恶化的小关节发生的频率较低。患者之间的初始恶化程度差异很大，目前缺乏生物力学证据，在测试融合器时考虑到这些大的变化。为了解决这些问题，这笔赠款将开发新的测试方法和工具，结合实验室模拟和计算机建模。这些方法将被用来预测在不同程度的小关节面退化的融合器中的一系列参数的机械性能的变化。这将使不同的干预措施能够与不同患者的特征相匹配。此外，证明测试方法准确性的过程将涉及在不同的退化程度上进行测试。这些测试的结果将有助于更好地了解小关节退化如何影响脊柱的生物力学功能。这些知识将有可能为开发其他更有效的脊柱治疗方法提供信息，并且开发的新方法也可以应用于身体的其他关节。

In the UK, four out of five adults suffer from back pain at some point in their life, the treatment of which costs the NHS over a billion per year and the UK economy £10 billion per year. When a surgical option is required (for example after an accident or because of abnormalities in the spine), the gold standard is spinal fusion, an invasive intervention designed to stop the motion of the affected spinal area. One of the main issues with spinal fusion is that it increases the stress on other area in the spine, in particular on small cartilaginous joints called the facets. Even in a healthy person, the facets are often deteriorated but this rarely cause any symptoms. After spinal fusion however, the deterioration can increase and create new symptoms and long term pain for one in four patients.There is an urgent need to define the type of patients and procedures for which fusion works best; and to improve devices so that this accelerated deterioration of the facets happens less often. The levels of initial deterioration between patients differs greatly and there is currently a lack of biomechanical evidence that takes into account these large variations when testing fusion devices. To tackle these issues, this grant will develop novel testing methods and tools combining laboratory simulation with computer modelling. These methods will be used to predict the variation in the mechanical performance of a series of parameters in fusion devices at various levels of facet deterioration. This will enable the different interventions to be matched to different patient's characteristics. In addition, the process of proving the accuracy of the testing methods will involve conducting tests at different levels of deterioration. The results from these tests will provide a greater understanding of how facet deterioration affects the biomechanical function of the spine. This knowledge will have the potential to inform the development of other more effective treatments for the spine and the new methods developed can also be applied to other joints in the body.