2014-15 CDMI Projects

 

Basic Science

Screening perilacunar remodeling to identify novel therapies to improve bone quality

We will establish a Perilacunar Remodeling (PLR) Screening Facility that will integrate and streamline
a suite of histologic, molecular, and radiographic analyses to provide the service of  a comprehensive
analysis of osteocyte-mediated bone
remodeling to understand the effect of therapeutic agents on
bone quality.

 

Principal Invesitigator: Tamara Alliston, PhD

Trainee: Tristan Fowler

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Biomechanics

Alternations in segmental stability with differing lumbar interbody cages, including expandable cages and fusion techniques: An in vitro and finite element investigation

Our goals are to undertake a cadaver study and a finite element model study to investigate the effects of various surgical procedures, cage designs, and shapes on the construct stability.  
Some of these aspects will be pursued in a cadaver model and
remaining in an experimentally validated finite element model of the ligamentous L1-S1 spine.

 

Principal Invesitgator: Vijay Goel, PhD

Trainee: Sushil Sudershan

Biomechanical evaluation of the pullout strength of two S1 broken pedicle screw revision techniques: An in vitro study

The main goal/objective of this study is to evaluate the biomechanical pull out strength of two S1 broken pedicle screw revision techniques: 

 

1) The broken screw, which will be 6 mm in diameter, will be removed after drilling some of the bone around the broken screw shaft that allows access to remove the broken screw and a new screw,which will be 8 mm in diameter, will be inserted. 

2) The broken screw shaft will be left in the S1 pedicle and a new screw, 8 mm in diameter, will be inserted.

 

Principal Investigator: Hossein Elgafy, MD

Trainee: Joel Gerber

 

Correlation of Proximal Junctional Kyphosis with CT-FEA analysis

The purpose of the study is to determine whether CT-FEA can be used as a test to predict  the occurrence of proximal junctional kyphosis in patients with spinal disorders following fusion.

 

Principal Investigator: Shane Burch, MD

Trainee: Rachelle Palkovsky

Tapered reduction of cement volume in the proximal vertebrae adjacent to the fused segment may translate into a decreased rate of Posterior Junctional Kyphosis

Our goals are to undertake a cadaver study to investigate the failure of adjacent segments in a stabilized long construct as a function of the amount of cement injected in the adjacent segments.  

 

Principal Investigator: Vijay Goel, PhD

Trainee: Anoli Shah

Peak back torque and range of motion as predictors for subsequent back injury at 6 and 12 months: A cohort study

In a population of hospital workers, this project will investigate the predictive relationship between the generation of torque and range of motion in the trunk/back and incidence of back injury in a 6-month and 12-month longitudinal study. The outcomes of this study will help identify a motor control/motor performance ‘biomarker’ that could give insight into the predisposition for developing musculoskeletal injury among healthcare workers. The motor control/motor performance of the back will be ascertained using the Turning Point v. 4.0 Biotechnology device. Given the high rate of nonfatal injuries within the healthcare population associated with the moving and handling of patients, this project will provide necessary information for developing a guide or protocol for recommending job responsibilities based upon the biomarker data.

Principal Investigator: Martin Rice,PhD, OTR/L, FAOTA

Trainees: Marie Zipp and Alyssa Kihara

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Clinical Outcomes

Implementation of an intercampus spine surgery registry at UC hospitals

The goal of the project is to expand the UCSF Spine Registry to all UCSF campuses involved in the care of patients with spinal disorders. The current vision is to enable the UC Spine Registry to interface with the existing IT infrastructure to forge an in-terface with other health care variables not collected directly within the current registry.

 

Principal Investigator: Shane Burch, MD

Trainee: Daniel Beckerman

The Value of Multilevel Fusions for Deformity

We will identify sources of variability and high cost in order to determine opportunities for interventions that may significantly limit overall cost, and cost variability. The results of this study will contribute to the development of an evidence-based approach to cost-containment and improvement of care quality by promoting consensus of care rather than perpetuation of variability in care. 

An evidence-based approach to the reducing cost in spinal interventions requires accurate and precise identification of the factors that are independent predictors on cost-of-care. The rates of surgery and the cost of surgery for spinal disorders have increased dramatically over the past decade. Additionally,there is significant variability in the cost for common spinal interventions.
Variability creates an added difficulty for a hospital to manage their finances. Thus, it is necessary to address both cost and cost variability.  Identifying areas where there are both high cost and high variability will present a unique opportunity for disruptive innovation, allowing us to pinpoint where future
orthopedic research would best be focused. 

 

Principal Investigator: Sigurd Berven, MD

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Novel Devices/ Materials

Development of novel impedance sensor to monitor fracture healing

10-20% of fractures result in delayed or non-union, but while radiography remains the standard technique to monitor healing, it can only diagnose delayed healing at the late stages of fracture repair (months following injury) due to its reliance on detection of mineralized tissue.
Our goal is to develop a system that utilizes impedance spectroscopy to monitor progression of fracture healing and detect delays in union at an early stage and thus enable earlier intervention.
We have shown that impedance spectroscopy can track fracture progression in cadaver and mouse models, and are currently building a prototype for a larger preclinical animal model.

 

Principal Investigator: Meir Marmor, MD

No-Touch packaging system for pedicle screws

Principal Investigator: Dr. Anand Agarwal, MD

Co-Investigator: Vijay K. Goel, PhD

Trainee: Aakash Agarwal, PhD

Design, Development, and Comparative Evaluation of Several Polymer-Based Spinal Implant Concepts

Due to the aging population, a paradigm shift in spine surgery from open approach to minimal approach (MIS), emergence of relatively new materials (e.g., PEEK, carbon-fiber PEEK), need for more cost effective spinal devices due to increase in health care costs and growing market for devices in the emerging economies, like India and China, we will undertake research to develop several spinal implants in the following areas:

• Spinal Implants fabricated from PEEK, carbon fiber reinforced PEEK, Shape Memory Alloy SMA (Translaminar screws,Pedicle screws, Unique sterile packaging concept for Pedicle screw, to name a few)

• Spinal cages suitable for minimal surgical approach

Principal Investigator: Dr. Anand Agarwal, MD

Co-Investigator: Vijay K. Goel, PhD

Trainees: Amey Kelkar and M SaeidAsadollahi

Development of Knee Joint Implants

The present generation of joint replacement technologies is successful but still has several issues that need to be addressed to enhance clinical success. For example, present generation implants are not suitable for use in younger patient population. In younger patients who fail to respond to conservative treatment, including medication for pain reduction, it is important to have arthroplasty techniques that will preserve soft and hard tissues around a joint, as much as possible. Thus, the efforts are underway to have surface replacement technology in which only articular cartilage is replaced with the implants.

We will develop polymeric implants (and other technologies) which will replace the damaged cartilage, while restoring joint cushioning and function. Such technologies additionally aide in delaying or avoiding further traumatic arthritis injury or disease progression by the delivery of regenerative pharmacologic/stem cells.

Principal Investigator: Dr. Anand Agarwal, MD; Dr. Anil Gupta, MD; Dr. Vijay Goel, PhD; 
Dr. Edward Nyman, PhD

Trainee: Marcel Ingels, BS

Co-Investigator: Amirhesam Amerinatanzi, MS

Development of Novel Magnesium Phosphate Cements in Treating Vertebral Compression Fractures (VCFs)

The proposed development of Mg-phosphate cements will be in surgical treatments of VCF such as Vertebroplasty and Kyphoplasty. Vertebroplasty may be performed with a local anesthetic and  intravenous sedation or general anesthesia. Using x-ray guidance, a small needle containing specially formulated orthopedic cement is injected into the collapsed vertebra. The cement hardens within minutes, strengthening and stabilizing the fractured vertebra. Most experts believe that pain relief is achieved through mechanical support and stability provided by the bone cement. Kyphoplasty, a newer procedure, involves an added procedure prior to the cement being injected into the vertebra.

Prior to injection of the cement, balloons are inserted to expand the space prior. Kyphoplasty has the added benefit of restoring height to the spine.

Principal Investigator: Sarit B. Bhaduri, PhD and Anand K Agarwal, MD

Trainees: Elham Babaie, Niloufar Rostami and Sameh Saleh

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