Universitätsklinik
für Neurochirurgie Innsbruck

The spine research team focuses on three fields of interest: improving the clinical and functional patient outcome, experimental regenerative attempts, and biomechanical investigations of spine pathologies as well as corresponding treatment options.

In accordance with our clinical studies, the spine research group is leading ongoing studies about degenerative spine pathologies such as the N-DISC trail (Phase II). In this study, chondrocytes of a herniated disc are cultivated and are reinjected in the same patients a few months later to gain information about the regenerative potential of degenerated and herniated discs. In case of a lumbar disc herniation, the timing of operative treatment in patients with motor deficits is crucial.

Further, we are evaluating the clinical outcome of patients suffering from disc herniation on the timing of surgery in case of persistent motor deficits in an ongoing clinical study, currently including more than 350 patients. On the base of “time is muscle function”, moderate and severe motor deficits for less than 48 hours until surgery showed significantly faster recovery of paresis and sensory deficits (using quantitative sensory testing) postoperatively compared to mild paresis of the lower extremities. Additionally, a faster recovery was observed in non-obese and non-smoking patients.

A prospective randomized controlled trial evaluating the influence of surface EMG-triggered multichannel electrical stimulation on senso-motoric recovery in patients with lumbar disc herniation is currently ongoing.

As part of a prospective multicenter study, we examine the use of annulus closure devices to reduce recurrent disc herniation (Barricaid).

We have also conducted experimental studies to elucidate the benefits of therapeutic approaches for intervertebral disc diseases with a self-complementary adeno-associated virus-mediated knockdown of specific gen loci (ADAMTS4). Our experimental laboratory focuses on regenerative attempts to improve therapeutic strategies before and after spinal operations to understand the biological basis of disc degeneration and the corresponding treatment options of cell transplantation, gene therapy, and applications of supporting biomaterials.

Minimal invasive surgery using “state-of-the-art” neuro-navigation systems and imaging technology is another main clinical research interest. Besides taking part in a prospective multicenter study (EUROSPIN) evaluating the accuracy of pedicle screw placement using a “free-hand”-, a navigated- or robot-guided technique, we prospectively investigated patients treated with a minimally-invasive compared to an open lumbar stabilization procedure. The minimally invasive attempt will now be extended to the cervical spine with implemented feasibility-, biomechanical- as well as anatomical studies. According to that, we collaborate with industrial partners to improve the aforementioned surgical techniques and increase the usability of instruments in these fields of surgery. Furthermore, we are part of a prospective controlled multicenter study to assess the research field of adjacent segment disease after lumbar instrumentations pooling information of rigid compared to dynamic techniques. This is also a part of our biomechanical studies.

The spine research group is also involved and part of an international, multicenter machine learning (ML) algorithm for outcome prediction after lumbar spinal fusion aiming to develop and externally validate a robust ML-based prediction tool based on multicenter data from a range of international centers. The results will provide individualized risk-benefit profiles tailored to each patient undergoing lumbar spinal fusion for degenerative disc disease. Adult spine deformities are another major field of research, including the SAMA database. The SAMA database is a prospective trial to evaluate the radiological, clinical, and functional outcome parameters and the “learning curve” in patients treated with “pedicle subtraction osteotomy” procedures.

Due to the increasing number of spinal infectious diseases, we also conducted a database of more than 250 spondylodiscitis patients. In order to be able to evaluate the necessity of an operation in these infectious patients, we introduced a mortality score.

Cervical spine fractures, especially in patients suffering from metabolic bone disease, characterise a research interest field collaborating with the “AO spine international” and being a part of the "AO Spine Subaxial Injury Classification international validation study”. According to cervical spine fractures, spinal cord injuries also represent a major research field of our department, collaborating with other trauma centers and the not-for-profit spinal cord research foundation “Wing’s for life”. Currently, we are establishing new radiological and surgical attempts in patients suffering from spinal cord injuries. Additionally, the treatment options of complex spine instrumentations in case of cervical deformities, neoplastic infiltrations, or infectious diseases are investigated biomechanically, collaborating with the Trauma surgery department's biomechanical institute.

The COVID-19 pandemic forces us to establish a new research field according to the new situation in middle Europe, evaluating the outcome of different spine pathologies during the "lockdown". A database of patients treated during that special time period and a questionnaire-based study among spinal surgeons in central Europe were generated to investigate the impact of COVID-19. 

Selected trials:

• N-DISC
• Immediate Versus Delayed Surgical Treatment of Lumbar Disc Herniationfor Acute Motor Deficits
• Early surgery determines recovery of motor deficits in lumbar disc herniations-a prospective single-center study
• Improvement of sensory function after sequestrectomy for lumbar disc herniation: a prospective clinical study using quantitative sensory testing
• Preoperative sport improves the outcome of lumbar disc surgery: a prospective monocentric cohort study
• The influence of surface EMG-triggered multichannel electrical stimulation on sensomotoric recovery in patients with lumbar disc herniation: study protocol for a randomized controlled trial (RECO)
• The European Robotic Spinal Instrumentation (EUROSPIN) study: protocol for a multicentre prospective observational study of pedicle screw revision surgery after robot-guided, navigated and freehand thoracolumbar spinal fusion
• Comparison of minimally invasive and open lumbar transforaminal lumbar interbody fusion: A prospective controlled observational study.
• SAMA trial: A database of adult spinal deformity.
• Development and external validation of an international, multicenter machine learning algorithm for prediction of outcome after lumbar spinal fusion for degenerative disease: The FUSE-ML Study
• Self-complementary adeno-associated virus serotype 6 mediated knockdown of ADAMTS4 induces long-term and effective enhancement of aggrecan in degenerative human nucleus pulposus cells: A new therapeutic approach for intervertebral disc disorders
• Animal models of regenerative medicine for biological treatment approaches of degenerative disc diseases
• APOE-knockout in rabbits causes loss of cells in nucleus pulposus and enhances the levels of inflammatory catabolic cytokines damaging the intervertebral disc matrix
• Posterior dynamic stabilization versus fusion in the treatment of lumbar degenerative disease
• Biomechanical investigation of lumbar hybrid stabilization in two-level posterior instrumentation
• Pars interarticularis screws for posterior cervical fusion – investigating a new trajectory using a CT-based multiplanar reconstruction.
• Developing access safety, accuracy and procedural solutions for minimally invasive posterior cervical instrumentation and screw-rod fixation strategies.
• A scoring system for the preoperative evaluation of prognosis in spinal infection: the MSI-20 Score.
• Surgical nuances and construct pattern influence construct stiffness in C1-2 stabilizations – A biomechanical study of C1-2 gapping and advanced C1-2 fixation.
• Cement-augmented screws of a cervical two-level corpectomy with anterior TMC reconstruction: A biomechanical study.
• Biomechanical testing of circumferential instrumentation after cervical multilevel corpectomy
• AO Spine Subaxial Injury Classification System International Validation Study 
• Analysis of the Literature on Cervical Spine Fractures in Ankylosing Spinal Disorders
• Influence of Preoperative Magnetic Resonance Imaging on Surgical Decision Making for Patients with Acute Traumatic Cervical Spinal Cord Injury: A Survey Among Experienced Spine Surgeons
• Early Decompression ( <8 Hours) Improves Functional Bladder Outcome and Mobility After Traumatic Thoracic Spinal Cord Injury
• Spinal Meninges and Their Role in Spinal Cord Injury: A Neuroanatomical Review
• The impact of the COVID-19 pandemic on spine surgery in central Europe: A questionnaire-based study among the OEGNC, ASS, DGNC, DWG, SGNC and SGS
• Trends and outcomes for non-elective neurosurgical procedures in Central Europe during the COVID-19 pandemic