Giving young researchers a head start

The AO Spine Research Commission is delighted to announce the ten winners of the 2022 AO Spine Research Start-up Grant. Through this program, AO Spine aims to identify, engage, and mentor talented young researchers in the early stages of their careers. Here, the 2022 winners explain what they aim to achieve and how their studies will improve patient care.

This award is targeted towards investigators of 40 years or younger, who are within five years of completing a professional degree or initiating their first assistant professorship at an academic institution. Seed funding is provided up to CHF 25,000 for one year.

Fifty researchers, from 15 countries across all AO Spine regions, answered the open call in March 2022. In a blinded evaluation process, proposals were reviewed by the AO Spine Research Commission for scientific merit, clinical relevance, and feasibility.

The top research fields were degenerative disease and deformity, with applications also covering spinal cord injury (SCI), tumor, and trauma. Of all proposals submitted, 50% were clinical projects involving human subjects and 50% were translational research projects.

The mean applicant age was 34 years (range: 27–40 years) and the mean funding request was for CHF 23'000, ranging from CHF 5,000–25,000.

All start-up grant recipients are encouraged to disseminate their findings at the Global Spine Congress  and submit their work for publication in the Global Spine Journal.

A novel diffusion tensor image and three dimensional isotropic T2-weighted turbo spin-echo SPACE sequence in the diagnosis of elderly patients with lumbar spinal stenosis

Xiaolong Chen, Xuanwu Hospital Capital Medical University, China

Conventional magnetic resonance imaging (MRI) has been reported to produce false positives in 26% of lumbar foraminal stenosis cases. To our knowledge, age-related lumbar spine degeneration, such as degenerative lumbar scoliosis, facet joint osteoarthritis, and disc degeneration, may change anatomic structures of nerve roots’ surrounding tissue and affect reliability of traditional imaging assessment. Therefore, new diagnostic imaging techniques to detect lumbar nerve root entrapment and identify the severity of nerve root damage due to the compression are urgently required.

The new diagnostic imaging techniques for evaluation of the lumbar spinal stenosis should meet two essential criteria: (1) qualitative assessment—providing details of nerve root pathological lesions and nerve root anatomical structures; and (2) quantitative assessment—providing quantitative information regarding the extent of nerve root compression and discrepancies

In order to locating the nerve root compression and the severity of nerve root damage in the patients with lumbar spinal stenosis, this study aims to evaluate the diagnostic value of contrast-enhanced three-dimensional (3D) T2-weighted turbo spin-echo SPACE (T2-SPACE) in different nerve root compression locations and demonstrate the diagnostic capability of novel diffusion tensor imaging for structural alteration and recovery.

Elucidating neurotrophic molecular mechanisms in spinal-cord-injury-associated heterotopic ossification

Rahul Gawri, McGill University, Montreal, QC, Canada

Spinal Cord Injury (SCI) is often associated with polytrauma, intense local inflammation at the musculoskeletal injury sites, and disruption in communication between the central and peripheral nervous systems. In up to 50% of patients, the disease burden is further increased by neurogenic formation of bone tissue around large articular joints, known as heterotopic ossification (HO), profoundly impacting quality of life and long-term rehabilitation.

We hypothesize that pathological neural signalling leads to aberrant differentiation of mesenchymal stem cells in injured musculoskeletal tissues and formation of HO. The aims of this project are to elucidate the pathogenic molecular mechanisms and identify potential therapeutic targets in a novel clinically relevant mouse model of SCI-associated HO. The knowledge generated from this project will be translated into clinical practice to achieve better rehabilitative outcomes for patients with SCI.

Acute effects of natural erect posture on solute transport across human lumbar intervertebral discs: a serial post-contrast MRI study in supine and standing

Prajwal GS, The Mallika Spine Centre, Guntur, India

We aim to understand the acute effects of natural erect posture on nutrient diffusion into the lumbar intervertebral discs in healthy normal individuals.

Previous in-vivo and animal-model studies have attempted to study the diffusion pattern using compatible compressive devices mimicking axial load on the discs. Using magnetic resonance imaging, our study will document for the first time the effect of axial load on disc diffusion in the erect position, compared with the supine position.

We hope the results will provide useful insight into the mechanical causes of disc degeneration.

Concordance of expectations among surgeon, oncologist, and patient in surgical decision making for metastatic spine disease

Christina Huang Wright, Oregon Health & Science University, Portland, OR, USA

Patients with metastatic spine disease are managed in a multi-disciplinary fashion that involves oncology, radiation oncology, surgery, and palliative care. Given that interventions for spine metastases are rarely curative, it is important to understand if these involved teams are discussing treatment goals and expectations within a palliative framework.

We will explore the shared decision-making and goal-concordant care in these patients, to learn whether the priorities and values of the patient are recognized during preoperative discussions and ultimately reached after surgery.

Preoperative expectations may not be aligned between clinician and patient, nor between the various subspecialists. Patients with limited life expectancy may have unique or specific goals relating to their overall health and their spine disease. Evaluation of our capacity to respect and understand these wishes and work to achieve them surgically or medically is crucial. We hope to explore this knowledge gap.

Cerebrospinal fluid pressure monitoring as a biomarker of spinal cord decompression in spinal cord injury: a prerequisite in clinical trials and practice

Carl Zipser, Balgrist University Hospital, Zürich, Switzerland

Maximal neurological recovery in SCI and degenerative cervical myelopathy (DCM) requires sufficient spinal cord decompression; however, there are currently no established tools to measure decompression. Cerebrospinal fluid pressure dynamics (CSFP) may provide useful markers of sufficient spinal cord decompression, but their physiology is poorly understood, impeding their clinical application. In our preclinical study we will explore the relationship between CSFP dynamics, respiratory factors, and disruption of spinal CSF pathways.

Effective decompression is crucial, not only to limit secondary damage related to ongoing spinal cord compression, but also to ensure that intrathecal regenerative treatments (e.g., drug or cell therapies) have unrestricted circulation. Intraoperative and/or bedside CSFP dynamics monitoring could enable personalized treatment and improve clinical outcomes in SCI and DCM. We will develop a roadmap for their use in clinical trials and diagnostic studies.

The next AO Spine Research Start-Up Grant program opens for applications in Spring 2023. Visit the AO Spine website for research funding and subscribe to AO Spine Newsletters to stay up to date on open calls and various AO funding opportunities.