The Significance of Spine Research: The economic impact of spinal disorders and its associated degenerative diseases is staggering. In 1989, about $ 11.4 billion were spent by American insurance companies to compensate for lost time at work and medical expenses. Estimates of the annual cost of spinal disorders to the United States range from $25 to $100 billion. This is on par with the cost of natural disasters; concerns that often garner much more attention.

Subject is laying on a commercially available passive distraction device called a Rola Stretcher. A study was done to measure the biomechanical effect of the device compared to that of just laying flat in a supine position.

An estimate of the suffering to an individual was put appropriately by one physician: "Back pain is some of the worst pain you'll ever feel, but it won't kill you." The fear of recurrence of the pain can be and is psychologically debilitating. Because it is estimated that 85 percent of all people will experience episodes of back pain at some time in their lives, even small advances in understanding will have a significant impact. Most of these cases are due to simple muscle strain and will heal on their own. Other injuries are the result of cumulative trauma to the spinal structures and subsequent degenerative disease. These injuries are responsible for the bulk of compensation money spent. For example, evidence has shown that 50 percent of workers disabled by low back pain for six months, and 75 percent of workers disabled for a year, did not return to productive work.

From a research perspective, and ultimately for the benefit of the patients, it is essential to understand the causes of spinal disorders, and spinal degeneration. There is a need to devise ways to reduce the incidence and prevalence of back disorders, especially in the work place (involving prolonged sitting, chronic vibration exposure, heavy lifting, etc.). To improve the outcome of a surgical procedure, one must try to understand the mechanics of spine surgery and undertake relevant studies to assess the outcome of various procedures/therapies.

A proper investigation of such broad spectrum of issues requires an interdisciplinary team of investigators. The researchers at Iowa have been very active in this area in the past. They were able to achieve national/international prominence, as is evident from the number of awards garnered by them. In recognition to their contributions, The Iowa Spine Research Center was established to further nurture the interdisciplinary collaborations in a more formal manner. Researchers in the Center come from diverse fields such as engineering (biomedical, mechanical, industrial), orthopaedics, neuro-surgery, preventive medicine, radiology, alternative therapy programs like chiropractors, physical therapists, hospitals from outside the University of Iowa, and industry.

Focus Areas of Current Research Projects: The research currently conducted at ISRC can be broadly classified into the following 4 focus areas:

(A) Design, development and evaluation of spinal instrumentation using in vitro models (cadaveric and mathematical):

The ISRC staff has a long history of undertaking quality work in this area, their work has earned international recognition from peers. Over the years, the Center staff have developed state-of-the-art research facilities to evaluate the performance of spinal instrumentation using a wide array of protocols involving plastic vertebrae models, fresh ligamentous spinal segments, and mathematical models. Although the resources for the basic research (developmental aspect) in this area were provided by agencies like the National Institutes of Health, and Orthopaedic Research & Education Foundation, the applied projects are funded by industry.

(B) In vivo investigations:

The studies can be classified in two subgroups involving animals and human subjects. The animal studies provide an understanding of the biomechanics/biology of spinal conditions and various

This decompressed specimen is stabilized using a posterior pedicle screw-rod system (DePuy, Inc).

surgical procedures such as the stabilization of the segment using spinal instrumentation. These studies supplement the investigations stated in Section A above. Employing human subjects, the ISRC staff has investigated the biomechanics of symmetric and asymmetric lifting and its applications to industry by simulating these activities in a laboratory setting. In the past, a study dealt with the effects of mammoplasty on the loads on the spine. EMG activities in the back musculature of women pre- and post-surgery were documented and loads on the spine were estimated using a mathematical model. Studies involving the informed consent process, like lumbar spinal stenosis, effects of different pharmaceutical products on patient care, and several outcome studies via the NSN (National Spine Network) are on going.

(C) Evaluation of the work place (ergonomics):

This subject is wearing a pelvic support and a weight is about to be dropped into the plastic pan he is holding. The response of the subject to the sudden load is used to determine the effectiveness of the support.

The current projects deal with environments where seating, vibration and/or impact loads play a significant role towards back pain production of the work force. The Center staff has the relevant research tools with funding from agencies like NIOSH and US Airforce. The staff has made significant contributions in this area and is committed to optimizing the seated work place, not only in the vehicular environment but also in the office.

(D) Biomechanical evaluation of interventions:

The ISRC staff is involved in a number of such projects; effects of belts on the back while undertaking activities of daily living like handling of impact loads. In collaboration with the off campus faculty, the Center staff has investigated the effects of alternative therapies currently being used in the management of low back pain patients.

The primary research interests of the ISRC staff, as detailed above, deal with spine related disorders --basic, preventive, and interventions. The staff has several funded projects in other areas of hard and soft tissue biomechanics like the knee and wrist biomechanics, and dentistry, to name a few. These projects attest to our versatility in handling a wide range of projects and our ability to render state-of-the-art expertise to clinicians and others within the Department of Orthopaedics and other units on and off campus.

A list of projects, funding sources, principal investigator(s) and collaborating faculty is provided below. The list clearly shows the breadth and depth of the research topics the ISRC staff is currently pursuing.

1. Development and Testing of Anterior and Posterior Cervical Fixation Devices
   Sponsors: Aesculap, Inc., Surgical Dynamics, Inc.
   PIs: Vijay Goel, Vincent Traynelis, Charles R. Clark
   
   
2. Computer Modeling and Simulation for Human Tooth Cavity Preparations
   Sponsor: The University of Oklahoma
   PIs: Satish Khera and Vijay Goel
   
   
3. Development and testing of Instrumentation (Plates and Cages) for the Thoraco-Lumbar Region
   Sponsors: AcroMed Corp., DePuy-Motech, Inc., Oseotech,Inc., Plus, Inc., Smith & Nephew Richards, Sofamor Danek, Inc, Spineology, Inc., Surgical Dynamics, Inc.
   PIs: Vijay Goel, Leon Grobler, Vincent Traynelis, Charles Clark, and Patrick Hitchon
   
   
4. Development and Evaluation of a Reversible Small Animal Model of the Chiropractic Subluxation
   Sponsor: Palmer Chiropractic Research Foundation
   PIs: V. Goel and J. Buckwalter (Orthopaedics)
   
   
5. Modeling Aviators With Diseased Spines For Safety in Aircraft Ejections
   Sponsor: US Air Force
   PIs: David Wilder and Vijay Goel
   
   
6. Modeling of Artificial Disc and Cages
   Sponsor: Sofamor Danek, Inc.
   PI: Vijay Goel
   
   
7. Biomechanics of Ligamentous Spine and Spinal Cord During and Post-Whiplash Injury
   Sponsor: Cervical Spine Research Society
   PIs: V. Goel, J. Reinahrdt, L. Bolinger, C. Clark, V. Traynelis
   
   
8. Biomechanical Testing of the Varigrip Instrumentation
   Sponsor: Advanced Spine Fixation Systems, Inc.
   PIs: Vijay Goel, A. G. Hadjipavlou, C. L. Nicodemus,
   
   
9. Quantification of Spinal Instability
   Sponsor: AO/ASIF
   PIs: Jim Weinstein and Malcolm Pope
   
   
10. RCT of Treatments for Degenerative Spondylolisthesis (6/95 -8/98)
    Sponsor: NIH
    PI: Malcolm Pope
    
    
11. Ergonomics of Lifting Belts
    Sponsor: Chase Ergonomics
    PIs: David Wilder, Malcolm H. Pope, Marianne Magnusson, Vijay Goel
    
    

    Subject is sitting in a device called the stadiometer, which gives an accurate measurement of the relative sitting height. The stadiometer is used ot detect small changes in the length of the subject's spine over a period of time.

12. Evaluation of a Sit-Stand Work Station
    Sponsor: HON Industries
    PI: Malcolm Pope
    
    
13. Musculoskeletal Problems Amongst Drivers
    Sponsor: Swedish Work Environment Fund/CRST
    PI: Marianne Magnusson
    
    
14. Evaluation of a Vehicle Seat Damping System
    Sponsor: LORD Corp.
    PI: Malcolm Pope, David Wilder
    
    
15. Effects of Surgery on the Back Musculature
    Sponsor: AO/ASIF
    PI: Malcolm Pope
    
    
16. Creating the Consortial Center for Chiropractic Research
    Sponsor: Palmer Center for Chiropractic Research
    PIs: Bill Meeker and Malcolm Pope
    
    
17. The Effect of Hyperextension and the True Back on Spine Height Change
    Sponsor: ETS
    PI: Malcolm Pope
    
    
18. Whitaker Foundation Fellowship for Nicole Grosland
    Sponsor: Whitaker Foundation
    PI: Vijay Goel
    
    
19. Center for Aging Fellowship for Michelle Sabick
    Sponsor: Center for Aging, Injury Research Prevention Center
    
    
20. DePuy-Motech Research Fellowship
    Sponsor: DePuy-Motech
    PIs: Vijay Goel and Leon Grobler
    
    
21. DePuy-Motech Clinical Fellowship
    Sponsor: DePuy-Motech, Inc.
    PI: Leon Grobler and Vijay Goel
    
    
22. Evaluation of Interbody Fusion using a Prototype of the BAG Construct in a Primate Fusion Model
    Sponsor: Spinelogy, Inc.
    PI: Leon Grobler and Vijay Goel
    
    
23. Fellowship for Dr. Nicole Grosland, Ph.D.
    Sponsor: NIH Training Grant
    PIs: Leon Grobler and Vijay Goel
    
    
24. Randomized Study of the Safety and Efficacy of Procrit (Epoitin Alfa) versus the Standard of Care in Blood Conservation in Subjects having Major Spine Surgery
    Sponsor: Ortho Biotech, Inc.
    PI: Leon Grobler
    
    
25. Medical Student Award for Musculoskeletal Research to Steve Mindrup
    Sponsor: Iowa Orthopaedic Society
    PI: Leon Grobler
    
    
26. Educational Fellowship for Jennifer Hess
    Sponsor: Foundation for Chiropractic Education and Research
    PI: Vijay Goel
    
    
27. Back-Muscle response to Single-Strike Impacts
    Sponsor: National Center for Injury Prevention & Control
    PI: David Wilder
    
    
28. Optimizing Heavy Mining Equipment Cockpits
    Sponsor: NIOSH Spokane Mining Research Center
    PI: David Wilder
    
    
29. The Pathomechanism of Spondylolytic Spondylolisthesis in Immature Lumbar Spines: In Vitro and Finite Element Assessments
    Sponsor: Dept. of Orthopaedics, Univ. of Iowa
    PI: Leon Grobler
    
    
30. An Open Label, Randomized, Parallel-group Study to Confirm the Safety and Efficacy of Procrit (Epotin-alfa) Administered Perioperatively Versus the Standard of Care in Blood Conservation in Subjects Undergoing Major Elective Spinal Surgery
    Sponsor: Ortho Biotech, Inc.
    PI: Leon Grobler
    

1. Load Sharing Between the Plates and Bone Grafts in the Cervical Region
   PIs: Vijay Goel, Vincent Traynelis, Charles Clark, Dennis McGowan
   
   
2. Typical Loads Exerted on a Tooth During Carries Detection
   PIs: Vijay Goel, Clark Stanford, Lynne Johnson, Karim Abdel-Malek, Christopher Squire
   
   
3. The Effects of Fall Direction & Protective Responses on the Likelihood of Hip Fractures
   PIs: Vijay Goel and James G. Hays
   
   
4. Biomechanics of Wrist
   PIs: Brian Adams and Vijay Goel
   
   
5. Biomechanics of the Knee
   PI: David G. Wilder, John Albright, and Vijay Goel
   
   
6. Design and Development of a Bio-absorbable Cage
   PIs: Joon Park, Vijay Goel and Leon Grobler
   
   
7. Ergonomics and Biomechanics of an Awkward Barrel Lift
   PI: Malcolm Pope
   
   
8. Neural Network Applications
   PIs: Malcolm H. Pope, Jeff Bishop, Vijay Goel
   
   
9. Whiplash Biomechanics
   PIs: Malcolm H. Pope, Marianne Magnusson, Vijay Goel, David G. Wilder
   
   
10. Intervertebral Disc Properties
    PI: Malcolm H. Pope
    
    
11. Pathogenesis of Isthmic Spondylolisthesis in the Immature Spine
    PIs: Koichi Sairyo, Vijay Goel, Leon Grobler
    

Significance | Focus Areas | Funded Projects | Unfunded Projects