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Center for Disruptive Musculoskeletal Innovations (CDMI)

University of California, San Francisco

University of Toledo

Last Reviewed: (not done)

The Center for Disruptive Musculoskeletal Innovations (CDMI) represents an exciting and novel integration of healthcare economics, biomedical science and clinical medicine. University faculty and industry partners are able to collaborate to target novel technologies that will decrease healthcare costs and improve the management and life of patients with musculoskeletal disease.

Center Mission and Rationale

Mission:

The mission of the CDMI is to identify unmet market needs and address these with fundamental musculoskeletal research on:

  • Clinical outcomes and cost data
  • Implant materials
  • Tissue engineering
  • Biosensors
  • Evaluation of surgical techniques
  • Non-invasive diagnostic/preventative technologies

 

Rationale:

Current debates and policies surrounding healthcare create an acute conflict between the need for medical cost containment and our nation’s commitment to foster technological innovations that improve human health. Approximately 40-50% of healthcare expenses can be traced to the adoption of new technologies or the intensified use of old ones. Consequently, the control of technology is arguably the single most important factor for managing healthcare costs. As a result, third-party payors are giving ever-increasing attention to medical devices in their coverage decisions, with a growing focus on authorizing the use of medical technology only on those patient segments where it truly adds value. Unfortunately, without confidence that a new medical technology will be reimbursed, it is increasingly difficult to justify the investment required to bring that technology to market. This creates a significant deterrent to innovation, and places America’s leadership position in medical technology in jeopardy. More importantly, these trends negatively impact the opportunities for patients to experience the life-enhancing benefits of technologies that are never developed into products that can be brought to market. Therefore, there is a pressing societal need to create more value from the money spent on medical technology, and thereby manage healthcare costs without sacrificing the benefits of innovation.

Research program

Clinical Outcomes/Cost

Retrospective analysis of multilevel fusions for spinal deformity
An evidence-based approach to the reducing cost in spinal interventions requires accurate and precise identification of the factors that are independent predictors on cost-of-care. The rates of surgery and the cost of surgery for spinal disorders have increased dramatically over the past decade. Additionally, there is significant variability in the cost for common spinal interventions. Variability creates an added difficulty for a hospital to manage their finances. Thus, it is necessary to address both cost and cost variability. Identifying areas where there are both high cost and high variability will present a unique opportunity for disruptive innovation, allowing us to pinpoint where future orthopedic research would best be focused.
Principal Invesitigator: Sigurd Berven
Trainee: Daniel Beckerman

Data Registries

Implementation of an intercampus spine surgery registry at UC hospitals
The goal of the project is to expand the UCSF Spine Registry to all UCSF campuses involved in the care of patients with spinal disorders. The current vision is to enable the UC Spine Registry to interface with the existing IT infrastructure to forge an in-terface with other health care variables not collected directly within the current registry.
Principal Invesitigator: Shane Burch
Trainee: Daniel Beckerman

Devices/Surgical Techniques

Alternations in segmental stability with differing lumbar interbody cages, including expandable cages and fusion techniques: An in vitro and finite element investigation
Our goals are to undertake a cadaver study and a finite element model study to investigate the effectsof various surgical procedures, cage designs and shapes on the construct stability. Some of theseaspects will be pursued in a cadaver model and remaining in an experimentally validated finite elementmodel of the ligamentous L1-S1 spine.
Principal Invesitigator: Vijay Goel
Trainee: Sushil Sudershan

Design, development, and comparative evaluation of several polymer-based spinal implant concepts
We will design and develop a polymer-based translaminar screw and pedicle screw by finite element modeling. In addition, we will prototype the device and carrying out a feasibility study to validate the concept.
Principal Invesitigator: Anand Agarwal
Trainees: Amey Kelkar and Saeid Asadollahi

Development of knee joint implants
Our most significant contribution to the IAB is creating an innovative knee joint implant design which addresses both the needs of the patients and the health care industry. Once the design has been developed, we will proceed to rapid prototyping, initial testing, manufacturing and final testing. The data file will be transferred to the IAB and our group will assist whomever wants to secure FDA approval and CE mark.
Principal Invesitigator: Anand Agarwal
Trainee: Amir Amerinatanzi

Development of robotic knee joint surgical instruments
Our most significant contribution to the IAB is creating an innovative robotic knee joint surgical instrument which addresses both the needs of the patients and the health care industry. Once the design has been developed, we will proceed to rapid prototyping, initial testing, manufacturing and final testing. The data file will be transferred to the IAB and our group will assist whomever wants to secure FDA approval and CE mark.
Principal Invesitigator: Anand Agarwal
Trainee: Marcel Ingels

No-touch packaging system for pedicle screws
We are designing and developing a no-touch packaging system. In addition, we will prototype the system and carrying out a feasibility study to validate the concept. The no-touch packaging system, called the No-Touch tube, is a device to deliver a sterile pedicle screw from the package to the instrument without any physical contact. This will help in reducing the number of infections that are caused by improperly handling the pedicle screws and/or inadequate sterilization at the hospitals where the surgeries are being performed. The final package will be designed for economy in manufacturing cost and convenience of use, without compromising the safety of the patient.
Principal Invesitigator: Anand Agarwal
Trainee: Aakash Agarwal

Tapered reduction of cement volume in the proximal vertebrae adjacent to the fused segment may translate into a decreased rate of Posterior Junctional Kyphosis
Our goals are to undertake a cadaver study to investigate the failure of adjacentsegments in a stabilized long construct as a function of the amount of cement injected in the adjacent segments.
Principal Invesitigator: Vijay Goel
Trainee: Anoli Shah

Diagnostics

Biomechanical evaluation of the pullout strength of two S1 broken pedicle screw revision techniques: An in vitro study
The main goal/objective of this study is to evaluate the biomechanical pull out strengthof two S1 broken pedicle screw revision techniques:
1) The broken screw, which will be 6 mm in diameter, will be removed after drilling some of thebone around the broken screw shaft that allows access to remove the broken screw and a new screw,which will be 8 mm in diameter, will be inserted.
2) The broken screw shaft will be left in the S1 pedicle and a new screw, 8 mm in diameter, willbe inserted.
Principal Invesitigator: Hossein Elgafy
Trainee: Joel Gerber

Correlation of Proximal Junctional Kyphosis with CT-FEA analysis
The purpose of the study is to determine whether CT-FEA can be used as a test to predict the occurrence of proximal junctional kyphosis in patients with spinal disorders following fusion.
Principal Invesitigator: Shane Burch
Trainee: Rachelle Palkovsky

Peak back torque and range of motion as predictors for subsequent back injury at 6 and 12 months: A cohort study
In a population of hospital workers, this project will investigate the predictive relationship between the generation of torque and range of motion in the trunk/back and incidence of back injury in a 6-month and 12-month longitudinal study. The outcomes of this study will help identify a motor control/motor performance ‘biomarker’ that could give insight into the predisposition for developing musculoskeletal injury among healthcare workers. The motor control/motor performance of the back will be ascertained using the Turning Point v. 4.0 Biotechnology device. Given the high rate of nonfatal injuries within the healthcare population associated with the moving and handling of patients, this project will provide necessary information for developing a guide or protocol for recommending job responsibilities based upon the biomarker data.
Principal Invesitigator: Martin Rice
Trainees: Marie Zipp and Alyssa Kihara

Predictive relationship between trunk strength and range of motion and development of musculoskeletal injuries in firefighters
Given the high rate of firefighter injuries, this project will provide critical information for evaluating and improving the musculoskeletal spine health for this dangerous occupation using biomarker data.
Principal Invesitigator: Richard Souza
Trainee: Shiree Segev

Screening perilacunar remodeling to identify novel therapies to improve bone quality
We will establish a Perilacunar Remodeling (PLR) Screening Facility that will integrate and streamline a suite of histologic, molecular, and radiographic analyses to provide the service of comprehensive analysis of osteocyte-mediated bone remodeling to understand the effect of therapeutic agents on bone quality.
Principal Invesitigator: Tamara Alliston
Trainees: Tristan Fowler and Emmanuel Jauregui

Novel Materials

Development of novel magnesium phosphate cements in treating vertebral compression fractures (VCFs)
The principal goal of this study is to develop the Mg-P orthopedic cement compositions and generate the proof-of-concept so as to meet the above criteria. The project will be a collaborative effort between a biomaterials researcher and a clinician.
Principal Invesitigator: Sarit Bhaduri
Trainee: Niloufar Rostami

Sensors

Development of novel impedance sensor to monitor fracture healing
The long term goal of the project is to develop an impedance sensor which can be integrated into a wearable device or implant to monitor fracture healing and provide earlier detection of impaired healing. Project Aims:
1: To validate the impedance sensor's ability to detect impedance differences at various simulated stages of fracture healing in an ex-vivo model
2: To correlate in vivo impedance measurements in a murine model with histologic and imaging features at specific points in fracture healing.
Principal Invesitigators: Meir Marmor, Chelsea Bahney, and Safa Herfat
Trainee: Monica Lin

Locations

University of California, San Francisco

513 Parnassus Avenue
11th Floor, S-1157

San Francisco, California, 94143

United States

University of Toledo

2801 West Bancroft Street
5046 Nitschke Hall

Toledo, Ohio, 43606

United States

419-530-8035