The identification of cancer metastases to the bony vertebral column obligates the treating clinician to make a surgical decision. If the spine is deemed unstable and at risk for fracture, then the patient will undergo a major spinal operation, and will often spend much of their remaining life recuperating from it. Vertebral body metastasis is sometimes treated with corpectomy of the affected vertebral body and adjacent intervertebral discs, creating a non-contained skeletal defect needing anterior column spinal reconstruction and posterior instrumentation. Reconstructive techniques requiring both an anterior surgical exposure (reconstruction of affected vertebra) and a posterior exposure (instrumentation of the spine) are quite invasive for these patients, while a posterior-only surgical approach requires small implants for anterior spinal column reconstruction. Intervertebral expandable titanium cages, although effective for this reconstruction, are expensive, and can represent the dominant cost for the reconstructive spinal procedure. In addition, they are often too large to insert safely from the posterior surgical approach. Thus, a critical need exists to provide these frail patients with a lower surgical burden while at the same time improving their quality of life. This research proposal aims to address a critical issue involved in the care of patients with metastatic spine defects. The goals of this proposal are to develop a novel expandable biomaterial system that can be delivered via a posterior-only surgical approach, would provide rigidity and stability to the spine, and would be much more cost effective than current expandable metal cages

Public Health Relevance

In 2016, 1.6 million new cancer cases are anticipated with about half of these patients presenting secondary bone metastases to the spine. Today's standard of care requiring both, an anterior and posterior surgical approach to treat vertebral fractures due to metastasis often lengthens patient's hospital stay, increasing care cost and preventing return home to their families. This research effort aims to design, develop and validate an expandable scaffold to allow for a less invasive, posterior, surgical procedure while providing stability to the spine, thus reducing the associated medical costs and improving quality of life of the patient.

National Institute of Health (NIH)
National Institute of Biomedical Imaging and Bioengineering (NIBIB)
Postdoctoral Individual National Research Service Award (F32)
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Special Emphasis Panel (ZRG1)
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Hunziker, Rosemarie
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Mayo Clinic, Rochester
United States
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Teng, Yong; Giambini, Hugo; Rezaei, Asghar et al. (2018) Poly(Propylene Fumarate)-Hydroxyapatite Nanocomposite Can Be a Suitable Candidate for Cervical Cages. J Biomech Eng 140:
Oppenheimer-Velez, Marianna L; Giambini, Hugo; Rezaei, Asghar et al. (2018) The trabecular effect: A population-based longitudinal study on age and sex differences in bone mineral density and vertebral load bearing capacity. Clin Biomech (Bristol, Avon) 55:73-78