A personalized approach to prevent, treat spine injuries
Bill Marras, director of the institute, and his team of engineering faculty and researchers developed evidence-based tools to identify, evaluate and prevent the cause of neck and back injuries specific to the individual.
“It’s about arming physicians with the underlying engineering knowledge that helps us understand what’s going on mechanically in the spine, what they should be paying attention to,” said Marras, who is also professor and Honda Endowed Chair of integrated systems engineering.
Once an injury occurs, the effectiveness of diagnosing and treating it is less than ideal.
“If you looked at the imaging, meaning MRIs and CAT SCANs, you have probably a 10-15% chance of telling what is causing a back problem,” Marras said. “If you look at surgeries, they are at best 50% effective on average across the United States, so this leaves a lot of room for improvement.”
After pioneering methods of studying back injury and the other musculoskeletal disorders that afflict workers, Marras has devised a unique three-pronged approach to decipher spine maladies. First, researchers carefully observe and measure an individual’s movements in a home or work environment using patented devices they developed, such as the Lumbar Motion Monitor that electronically tracks how people move and the lumbar dynamometer that measures forces generated by spine movement. Then they return to the lab where they can recreate situations as needed to further test and analyze issues such as how the body responds internally during a particular movement and how forces are passed to the floor.
The team’s final step is to utilize all the gathered data to create a computational model.
“The model is the glue that holds our logic together,” said Marras. “Models allow us to get down to the tissue level and understand what’s happening to the discs, the tendons, the ligaments, the bones, and we can do that very, very precisely.”
By reverse engineering the spine using CT and MRI scans, researchers can create a patient-specific spine model. Truly personalized models are rare. Most, Marras said, are generic ones, merely adjusted to represent a person’s size or gender.
“When you’re dealing with spine problems, the devil’s in the detail,” said Marras. “There are these little, subtle variables in each of us that make all the difference in the world.”
The models enable engineers to do sophisticated analyses to better understand how the spine changes under realistic conditions. Virtual surgeries can also be performed to help predict the consequences of surgery, well before a patient is ever wheeled into an operating room.
Ohio State College of Medicine spine treatment physicians and surgeons work collaboratively with the institute’s engineers to determine how best to apply their injury analysis technology and techniques to the clinical setting.
Engineers can also print replica spines of individual patients via 3-D printing, to aid surgeons’ understanding and allow them to practice surgical techniques.
“We could give a surgeon something that’s down to fractions of a millimeter in terms of accuracy,” said Marras. “It matches the spine of the person with all the degeneration, nooks and crannies to help a surgeon precisely understand where the potential problems might be.”
The Spine Research Institute aggregates existing world-class College of Engineering facilities. The Biodynamics Laboratory conducts ground-breaking occupational and clinical biomechanics research. At the Institute for Ergonomics, engineers focus on safe and effective designs of work environments and consumer products. The Center for Occupational Health in Automobile Manufacturing—the only university-based, full-scale manufacturing operation in the world—enables automakers and their suppliers to test the effects of manufacturing systems on workers’ health.
One of the earliest application areas for Marras’ research has been to help industry prevent spine disorders, reduce worker injuries and lower healthcare costs. The team has worked with numerous companies including Ford, RCA, BMW and Honda. As just one example, an analysis of headliner material installation at Honda led to a procedure change that reduced worker strain and injury.
“The nice thing about the quantification we do is that it tells you very precisely where the risk is and what parts of the job you need to change to get a result,” Marras said. “It also explains any risk tradeoffs, because you don’t want to minimize a back injury only to increase the risk of a shoulder injury.”
Orthopedic and spine instrumentation companies that manufacture rods, screws and other items used during surgery can decrease prototype time by submitting CAD drawings of their designs to the institute. Researchers will be able to test those designs against a planned database of spines and provide rapid feedback on strengths and weaknesses. This capability could lead to custom instrumentation designs for individual patients.
Following their successes with industry, the institute’s team is broadening their focus to revolutionize how clinicians treat back and neck injuries. Using Marras’ Lumbar Motion Monitor, researchers can measure movement impairment compared to others of the same age and gender and provide clinicians with quantitative data on how their patients are progressing.
Researchers are currently engaged in clinical trials to monitor the thousands of lumbar and cervical spine injury patients in The Ohio State University Health System. This additional data will be used to further refine the clinical lumbar monitor system.
If all goes well, Marras foresees an expansion of the team’s services beyond the university, to metro Columbus, the state and across the nation. And with his team’s unique approach to personalized biomechanics, Marras thinks Ohio State is in a prime position to succeed.
“All of these things are game changers,” said Marras. “If we can get personalized modeling, virtual surgeries and impairment quantification into the hands of physicians, it will completely change how they think about and treat the spine.”
Written by Candi Clevenger, College of Engineering Communications, clevenger.87@osu.edu
