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

• Subject Area: Medicine
• Term: since 2021
• Project identifier: Deutsche Forschungsgemeinschaft (DFG) - Project number 439742772

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.

• DFG Programme: Research Units
• International Connection: Iran

Projects

• Articulated, statistical 3D shape and bone density model of the human spine for research in clinical biomechanics as well as for individualized diagnosis and therapy planning in orthopaedics (Applicant Zachow, Stefan )
• Coordination Funds (Applicant Schmidt, Hendrik )
• Correlation between lumbar spinal performance and clinical outcomes after spine treatment in LBP patients (Applicant Arampatzis, Ph.D., Adamantios )
• Dynamics of posture, shape, and motion of asymptomatic subjects and LBP patients in daily life activities (Applicants Pumberger, Matthias ;  Schmidt, Hendrik )
• In vivo mechanical loading and tissue adaptation in vertebrae: Inflammation, pain and opioid effects (Applicants Celik, Ph.D., Melih Özgür ;  Duda, Georg )
• Influence of local tissue injuries, repair and degeneration on spinal Morphology, Mechanics and Motion in a large animal model (Applicants Checa Esteban, Ph.D., Sara ;  Reitmaier, Sandra )
• Musculoskeletal simulations towards a subject-specific spino-pelvic load transfer prediction (Applicant Schmidt, Hendrik )
• Physical activity and psychosocial characteristics of asymptomatic subjects and low back pain patients in real life (Applicant Fleig, Lena )

• Spokesperson: Professor Dr. Hendrik Schmidt