Impact of Global and Regional Sagittal Malalignment on Cervical Spine Mechanics

全球和区域矢状面错位对颈椎力学的影响

• 批准号: 8781179
• 负责人: Avinash G. Patwardhan
• 金额: --
• 依托单位: EDWARD HINES JR VA HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-06-01 至 2018-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8781179
• 关键词: Activities of Daily Living; Affect; Analgesics; Analysis of Variance; Ankylosing spondylitis; Anterior; Automobile Driving; Bone Transplantation; Caring; Cervical; Cervical spine; Chest; Chiropractor; Clinical; Clinical Research; Clinical Treatment; Current Procedural Terminology Codes; Data; Deformity; Deterioration; Development; Diagnostic; Dimensions; Disease; Elements; Equation; Equilibrium; Event; Facet joint structure; Goals; Head; Head and neck structure; Health; Human; ICD-9; Intervention; Intervertebral disc structure; Kinetics; Kyphosis deformity of spine; Laboratories; Laminectomy; Ligaments; Link; Literature; Lordosis; Manuals; Measures; Mechanics; Medical Care Team; Methodology; Mission; Modeling; Monitor; Motion; Muscle; Muscle Fatigue; Muscle relaxants; Neck; Neck Pain; Neurologic; Neurologic Deficit; Operative Surgical Procedures; Outcome; Pain; Patient Care; Patients; Physical Medicine; Physical Rehabilitation; Physicians; Physiological; Positioning Attribute; Posture; Procedures; Regression Analysis; Relative (related person); Research; Rheumatoid Arthritis; Secondary to; Severities; Shoulder; Specimen; Stress; Surgeon; Symptoms; Testing; Translations; Trauma; Vertebral column; Veterans; Work; base; clinical practice; clinically relevant; cost effective; design; disability; dorsal column; functional disability; gaze; health related quality of life; horizontal gaze; improved; kinematics; member; muscle stress; neoplastic; novel; orthotics; patient population; public health relevance; reconstruction; research study; response; soft tissue; spine bone structure; treatment planning

DESCRIPTION (provided by applicant): Purpose: A physiologic sagittal alignment of the cervical spine, including the ability to maintain level gaze, is essential to maintaining functionality during activities of daily living. Consequenty, cervical sagittal malalignment has been linked to disability and poor health-related quality of lif scores due to disabling symptoms of neck pain and neurological deficit. The goal of this study is to establish the link between radiographic or clinical measures of sagittal malalignment and objective measures of cervical pathomechanics. Hypotheses: The long-term goal of our research is to understand the mechanisms responsible for cervical malalignment-related symptoms of neck pain, muscle fatigue, and neurological deficit so as to improve treatment rationale. Our central hypothesis is that in the presence of cervical sagittal malalignment, the compensatory realignment of cervical segments that is necessary in order to maintain horizontal gaze will: (1) increase force demands on posterior muscles to maintain the head-neck posture in equilibrium and cause increased loading of disc & facet joints; and (2) adversely affect the foraminal and canal spaces. The hypothesis is based on our preliminary studies using a novel laboratory model of cervical sagittal imbalance that allows assessment of the effects of the independent variables on cervical spine postural and kinetic responses. Specific Aims: (1) For each combination of the independent variables of sagittal malalignment, measure the compensatory angular and translational repositioning of each cervical vertebra such that horizontal gaze is maintained, and the forces and moments that are needed to maintain the head-neck posture in equilibrium. (2) Analyze the effects of experimentally simulated sagittal malalignments on foraminal and canal spaces using CT-based specimen-specific models and kinematic data collected in Aim 1. (3) Analyze effects of simulated sagittal malalignments on stresses in bony and soft tissues of the cervical spine using CT-based specimen- specific finite element models (FEM), and the kinematic and kinetic boundary conditions quantified in Aim 1. Research Plan: We will use a combination of (1) experimental studies on human cadaveric cervical spine specimens, (2) CT-based specimen-specific kinematic models, and (3) CT-based specimen-specific finite element models, to achieve our goals. Experiments on 55 fresh human cadaveric cervical spine specimens (occiput-T1) will simulate a variety of clinically relevant sagittal malalignments. Experimentally measured quantities, namely, compensatory vertebral motions, and kinematic and kinetic boundary conditions at the ends of the specimen, will serve as inputs to the specimen-specific kinematic and FE models to assess the effects of each sagittal malalignment on canal & foramen dimensions and facet loading. The three study- components together will define cervical spine mechanics in terms of the following outcome variables: Kinetic: loading of muscles and stresses in facets & discs, with implications to muscle fatigue, disc & facet degeneration, and neck pain; and Geometric: foraminal and canal spaces, with implications to neurologic deterioration. Statistical Analysis: Each of the 55 specimens will be tested for different combinations of the four independent variables that define sagittal malalignment, giving adequate (>80%) power for assessing the effects of the main variables and their interactions. Discrete values of the outcome variables for the intact spine and also for the different cases of simulated fusions will be analyzed using the repeated measures ANOVA. Multivariate regression analyses will be performed to assess the relative importance of independent variables in influencing the outcome and arrive at predictive equations relating dependent & independent variables. Significance: The results of this study will provide a rational basis for bringing objectivity to the present day subjective paradigms for treatment of cervical imbalance. Results will be of immediate benefit to all health care team-members who manage patients with neck pain, whether conservatively (physicians, physical therapists, chiropractors), or those who perform invasive interventions (surgeons).

描述（由申请人提供）： 目的：颈椎的生理矢状对齐，包括维持水平注视的能力，对于维持日常生活活动期间的功能至关重要。因此，由于颈部疼痛和神经系统缺陷的残疾症状，颈矢状症与残疾和健康相关的LIF分数质量差有关。这项研究的目的是建立矢状差异或宫颈病原机械的客观度量之间的射线照相或临床措施之间的联系。假设：我们研究的长期目标是了解负责颈部疼痛，肌肉疲劳和神经功能不足的症状的机制，以改善治疗原理。我们的中心假设是，在存在宫颈矢状疾病的情况下，为了维持水平凝视而需要的宫颈段的补偿性重新对准将是：（1）增加对后肌的力需求，以维持平衡状态的头颈姿势，并导致盘式和方面关节的负载增加； （2）不利影响孔和运河空间。该假设基于我们的初步研究，使用了颈矢状失衡的新实验室模型，该模型允许评估自变量对颈椎姿势和动力学反应的影响。具体目的：（1）对于矢状差异的独立变量的每种组合，测量每个颈椎椎骨的代偿角度和翻译重新定位，以使水平凝视保持水平，以及保持平衡中头颈姿势所需的力和力矩。 （2）使用基于CT的特异性模型以及AIM 1收集的基于CT的特异性模型以及在AIM 1中收集的基础图1分析实验模拟的矢状疾病对孔和运河空间的影响。在AIM 1。研究计划中：我们将使用（1）对人尸体颈椎标本，（2）基于CT的标本特异性运动学模型的实验研究以及（3）基于CT的标本特异性有限元模型来实现我们的目标。对55个新鲜人尸体颈椎标本（枕骨T1）进行实验将模拟各种临床相关的矢状疾病。实验测量的数量，即代偿性椎骨运动，以及样品末端的运动学和动力学边界条件，将作为对试样特异性运动学和FE模型的输入，以评估每个10SAGITTAL MALALIGNMENT对运河和有孔尺寸和刻面负载的影响。这三个研究组成部分将通过以下结果变量来定义颈椎力学：动力学：方面和椎间盘中的肌肉和压力的负载，对肌肉疲劳，椎间盘和圆盘变性和颈部疼痛有影响；和几何：前孔和运河空间，对神经系统恶化有影响。统计分析：55个样品中的每个标本中的每一个都将测试定义矢状差异的四个独立变量的不同组合，从而为评估主要变量及其相互作用的影响提供足够的（> 80％）的功率。完整脊柱的结果变量的离散值以及模拟融合的不同情况的离散值将使用重复测量方差分析分析。将进行多元回归分析，以评估自变量在影响结果中的相对重要性，并到达有关相关和自变量的预测方程。意义：这项研究的结果将为当今的主观范例提供宫颈不平衡的主观范例的客观性提供合理的基础。对于所有管理颈部疼痛患者的医疗团队，无论是保守的（医师，物理治疗师，脊医）还是进行侵入性干预措施（外科医生）的所有医疗保健团队的结果。