Spine Care Research Group

Evaluation of efficacy and cost-effectiveness of contemporary treatments in spine medicine

Several spine oriented studies are currently being performed in the hospitals related to the Leiden – the Hague spine group, with the purpose to optimise patient treatment. The efficacy of the cervical disc prosthesis was evaluated in an RCT and resulted in high ranking publications advocating the use of an intervertebral cage over a prosthesis. Data were combined with data from Nijmegen and subgroup analyses could be performed. No advantage of the disc prosthesis could be appointed. Ongoing studies focus on the outcome data of conservative versus surgical treatment of a cervical radiculopathy, outcome data of odontoid fractures in the elderly, epidural injections in lumbar radiculopathy, comparison of instrumented versus non-instrumented treatment of lumbar isthmic spondylolisthesis, outcome data of treatment of degenerative spondylolisthesis, and outcome data in spine surgery in achondroplasia. Finally, traumatic spine injury is evaluated in order to determine the optimal treatment for that type of injuries. In the recent past we published data on an RCT on lumbar minimal invasive instrumented surgery (no difference with open surgery), and on an RCT studying percutaneous transforaminal treatment of lumbar herniated discs (not inferior to open surgery). The research team broadened the scope of research from analysis of clinical data of these trials to the in depth analysis of radiological data. The radiological research lines produced outcomes that gave more insight in the etiology of degeneration processes, but also in the additional value of the separate entities of image-forming techniques (NEJM publication). Outcome data led to the adjustment of Dutch guidelines and Choosing wisely projects concerning spine care.

Machine learning algorithms to systematically evaluate radiological data

In the past few years the radiological evaluation of spine care has led to a second research line: namely the development and use of machine learning algorithms to systematically evaluate radiological data. In a collaboration with experts from the radiology department of the LUMC and the Erasmus University, the Technical University of Delft, and with the Computational Neuroscience Outcomes Center (CNOC), Brigham and Woman’s Hospital, Harvard Medical school, the clinical expertise of the Leiden-the Hague spine group is combined with the technical knowledge to exploit our data. This cooperation added the use of deep learning algorithms and prediction models to our evaluation tools.

In this research line studies are included that study fusion processes in the cervical spine, thoracolumbar kyphosis treatment in achondroplasia, evaluation of cervical spine deformity and optimal treatment in rheumatoid arthritis, and optimum care of chordoma patients.

Pathophysiology of pain and loss of functionality

Concurrently, the topics studied broadened to the evaluation of histological data of the trial patients (in combination with clinical and radiological data) in order to unravel the pathophysiology of pain and loss of functionality in patients with lumbar and cervical degenerative diseases (third research line). A strategic alliance is formed with the departments of Immunology and Clinical Chemistry to explore the role of macrophages in the interaction of vertebral endplates, disc inflammation and its influence on the spinal roots. Recently, the correlation between (de)vascularization of the endplate, atherosclerotic changes of the vessels, and (apo)lipoprotein profiles in the blood was added to the scope of evaluation of back and legpain. The strength of working on these three research lines at the same time is that the interaction between research lines generates new ideas and alternative hypotheses.