Metastatic Spine Tumors: Minimally Invasive Fracture Risk Analysis and Treatment

转移性脊柱肿瘤：微创骨折风险分析和治疗

• 批准号: 7796565
• 负责人: Lichun Lu
• 金额: $ 41.49万
• 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 2013-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7796565
• 关键词: Abbreviations; Achievement; Activities of Daily Living; Address; Affect; Applications Grants; Biocompatible Materials; Braces-Orthopedic appliances; Cadaver; Carrying Capacities; Clinical; Data; Defect; Development; Diagnosis; Diagnostic; Disease; Disseminated Malignant Neoplasm; Evaluation; Excision; Failure; Family; Fracture; Goals; Home environment; Image Analysis; In Vitro; Injectable; Injury; Length of Stay; Life; Malignant Neoplasms; Mechanics; Methodology; Methods; Modeling; Nature; Neoplasm Metastasis; Nerve compression syndrome; Neurologic; Operative Surgical Procedures; Pain; Paralysed; Pathologic; Patient Care; Patients; Physiological; Positioning Attribute; Property; Recommendation; Recovery; Rehabilitation therapy; Research; Residual state; Risk; Scanning; Shapes; Sheep; Sorting - Cell Movement; Spinal; Spinal Cord; Spinal Fractures; Spinal nerve structure; System; Techniques; Temperature; Time; Tissues; Translations; Tumor Tissue; Validation; Vertebral column; Weight-Bearing state; X-Ray Computed Tomography; base; bone strength; clinical practice; computer program; computerized; density; design; experience; heat injury; in vivo; indexing; minimally invasive; novel; operation; polymerization; pre-clinical; programs; public health relevance; reconstitution; reconstruction; spine bone structure; theories; tumor; validation studies

DESCRIPTION (provided by applicant): The identification of cancer metastases to the bony vertebral column obligates the treating clinician to make a surgical decision. The consequences of that decision for the patient are significant whether the recommendation is for surgical or non-surgical treatment. If the spine is deemed unstable and at risk for fracture, then the patient will undergo a major spinal operation, and will often spend much of their remaining life recuperating from it. Conversely, the patient whose spine is deemed stable and receives non-surgical treatment risks fracture and possible paralysis if the stability analysis was incorrect. In addition, the metastatic disease usually progresses, and the stability analysis must be repeated at intervals throughout the disease course. The spinal stability decision is empirical and can be inaccurate, even when done by experienced spinal clinicians. This proposal addresses both the stability decision and, for those patients deemed at risk for fracture, the nature of the treatment. Aim 1 describes the development of an automated program that analyzes spinal computerized tomography scans, and calculates the residual load carrying capacity of the affected vertebra. Aim 2 optimizes novel injectable materials to restore the load carrying capacity of the vertebra in a minimally invasive manner, thus decreasing time in recovery and rehabilitation from major spine surgery. Successful achievement of this aim would offer an alternative to open surgery for many of these patients, thus decreasing their rehabilitation time and increasing their family time. Aim 3 addresses validation of both the automated spinal stability analysis and the minimally invasive spinal reconstruction. These in vitro and in vivo Aim 3 preclinical validation studies are requisite steps to position both the Aim 1 automated diagnostic methodology and the Aim 2 minimally invasive surgical treatment methodology closer to the goal of translation to clinical practice. Public Health Relevance Statement (provided by applicant): The computerized spinal stability assessment, for patients who have cancer that has spread to their spine, will offer more accurate diagnosis of the need for spine surgery to the patients, and with a much greater likelihood that the patients and their families can get the evaluation done near their home, saving them time, expense, and inconvenience. The recommendation for non-surgical treatment will be made with increased assurance that the risk of a spine fracture is low. Those patients, who do need surgery, will often chose minimally invasive surgical techniques that will shorten their hospital stay and allow them to return home to their families.

描述（由申请人提供）：鉴定对骨椎骨的癌症转移剂义务治疗临床医生做出手术决定。该决定对患者的后果是重要的，无论该建议是针对外科手术还是非手术治疗的建议。如果脊柱被认为是不稳定的，并且有骨折的风险，那么患者将进行主要的脊柱手术，并且经常将其剩余的大部分寿命从中度过。相反，如果稳定性分析不正确，则视为脊柱被认为稳定并接受非手术治疗风险的患者。此外，转移性疾病通常会进展，并且必须在整个疾病过程中以间隔重复稳定性分析。脊柱稳定性决策是经验性的，即使是经验丰富的脊柱临床医生，也可能是不准确的。该提案既解决稳定决定，也解决了那些被认为有骨折风险的患者。 AIM 1描述了一个自动化程序的开发，该程序分析了脊柱计算机断层扫描，并计算受影响的椎骨的残余负载能力。 AIM 2优化了新型的可注射材料，以微创方式恢复椎骨的承载能力，从而减少了主要脊柱手术的恢复和康复时间。成功实现这一目标将为许多患者提供开放手术的替代方法，从而减少了他们的康复时间并增加了家庭时间。 AIM 3解决了自动脊柱稳定性分析和微创脊柱重建的验证。这些在体外和体内目标3临床前验证研究是定位AIM 1自动诊断方法和目标2微创手术治疗方法的必要步骤。 公共卫生相关性陈述（由申请人提供）：针对患有脊椎的癌症的患者进行计算机化的脊柱稳定性评估，将为患者提供更准确的诊断，并有更大的可能性，患者及其家人可以在家附近进行评估，以节省他们的时间，节省他们的时间，费用和不便。通过越来越多的保证脊柱骨折的风险很低，对非手术治疗的建议将提出。那些确实需要手术的患者通常会选择微创的手术技术，以缩短住院并允许他们返回家人。