ORUK/BASS/BSS Spine Research Fellowship Award
This year’s joint research fellowship, funded by Orthopaedic Research UK (ORUK), the British Association of Spine Surgeons (BASS) and the British Scoliosis Society (BSS), has been awarded to a team from The Royal Orthopaedic Hospital, Aston University, and The University of Edinburgh for a project to develop a working model of the Spinal Cord to improve understanding of the causes and management of compressive spinal cord pathology.
The genesis for this project, according to Professor Adrian Gardner, Consultant Spine Surgeon at The Royal Orthopaedic Hospital and Birmingham Women’s and Children’s Hospital, began with an online discussion between colleagues: ‘We have a surgical consultant WhatsApp group. One morning I was sent an MRI picture of a multi-level degenerative cervical spine with multi-level spondylolisthesis by one of my colleagues asking, ‘What do I do about this?’ I looked at it and thought, well, I would do X, Y, Z, but it occurred to me that this advice simply reflects the training I was given. There’s no science behind this solution … it is just my opinion. I thought, how can I put some science behind my ‘gut feel’ management plan? Is there some way of creating a physical model that can be used to understand the pathology and inform surgical solutions.’
Professor Gardner’s original idea featured a plumbers’ pipe (to act as the spinal canal within the vertebral column) with a pressure balloon inside the pipe, simulating the spinal cord. After further discussion, his contacts at Aston University recommended a more elegant solution for a physical model of the spinal cord and vertebral column. This model would allow the simulation of the different presentations of spinal cord compression and generates novel insights into effective managements strategies for spinal cord compression. It involves the 3D printing of a fully articulated vertebral column, combined with the use of tuneable pneumatic pressure to replicate the spinal cord. This model can then be adjusted to reflect various spinal conditions, enabling surgical teams to test the likely impact of different procedures. It opens up the possibility of replacing the traditional use of animal testing to understand spinal cord dysfunction secondary to compressive pathologies.
Professor Gardner’s specific area of interest is Degenerative Cervical Myelopathy (DCM), which despite being the commonest spinal cord injury is an under researched problem. He hopes that the model can enhance clinicians’ understanding of the best way to treat this condition, ‘Surgeons have always been appropriately cautious when treating people with DCM, not being too aggressive and timing surgery as best able to maximise recovery and outcome, but our biggest win when using this model may be to demonstrate that earlier intervention can prevent DCM becoming a serious disability.’
The team hope to develop the model still further by incorporating physiology – replicating the behaviour of the nervous system within the spinal cord. This will involve Aston University’s Institute of Photonics, using light as a surrogate for nervous tissue.
The 3D printing technology opens-up the possibility of creating bespoke models for individual patients and the approach is also being considered for other branches of medicine – for example, the creation of models of hearts with congenital anomalies is common practice for the paediatric cardiac teams in Birmingham.
The project will last 24 months. Should it prove successful, the team hope to secure longer term funding for a PhD.
 Degenerative cervical myelopathy (DCM) is the commonest type of spinal cord injury, affecting 2% of the adult population. It leads to issues with balance, ability, dexterity, bowel and bladder and can cause paralysis. According to a survey by myelopathy.org,36% of people suffering from DCM are unable to work and 42% are dependent on others for care.