The Department of Spine Surgery is a very well-established surgical department at the University Hospital with the necessary infrastructure to offer state-of-the art treatment. We perform more than 1000 spine surgeries per year. Prof. Schären has served as the head of our Department since 2014 and was the first – and to date only – surgeon to receive a full professorship for “Spine Surgery” at a Swiss University. The Spine Center was founded in 2014, and PD Dr. Cordula Netzer was honored to be assigned as the deputy head of this interdisciplinary team in 2017, a position that I still hold today. The goal of the Spine Center is to develop and provide improved treatment concepts within an interdisciplinary approach (12 different specialties) with a strong link to research departments at the University of Basel (Department of Clinical Research, Department of Biomedicine, Department of Biomedical Engineering). This interdisciplinary setting and the proximity to the University of Basel has allowed me to build a strong network within our institution and with national and international clinical and research groups.

This project is a joint application with Prof. Dr. Stephen Ferguson, Department of Health Sciences and Technology, ETH Zurich. The group of Prof. Ferguson has previously developed a musculoskeletal model of the spine allowing for estimation of internal loads. Using this model, his group investigated age-related changes in spinal motion and muscle quality for the risk of vertebral fractures, pre- and postoperative posture in spinal deformity patients, extent of spinal fusion surgery, and the type and severity of idiopathic adolescent scoliotic deformity as well as developed initial person-specific models and motion patterns. In the proposed project, his group will expand the advanced musculoskeletal spine model at the ETH Zurich considering patient specific clinical, radiological, functional and biomechanical data to systematically investigate the relative impact of various factors (including segmental instability, muscle degeneration, spinal alignment, muscle fatigue) and their interplay on spinal segmental loads and predict the rehabilitation potential of spinal surgery by elucidating the combined effect of changes caused by surgery and factors that can be altered with rehabilitation, such as muscle strength or postural and dynamic alignement.

The Functional Biomechanics Research Group under the lead of Prof. Annegret Mündermann at the Department of Orthopedics and Traumatology at the University Hospital Basel was founded in 2012 when we also initiated our research collaboration. Since then, our groups strengthen our common scientific focus and establish an independent spine study subgroup. Dr. Corina Nueesch as a Co-leader of the Functional Biomechanics Research Group is allocated to the Departement of Spine Surgery. The laboratory currently houses an interdisciplinary research team of spine surgeons, orthopaedic surgeons, movement scientists, biomedical engineers, sport scientists and physiotherapists with strong track records in and active exchange between the members’ respective specialties and closely collaborates with other clinicians, neurologists, radiologists and the biostatisticians. Because of our broad expertise and our facilities (surgical spine clinic, state-of-the-art gait lab and musculoskeletal imaging all in proximity on the University Hospital grounds), we are able to conduct all aspects of the in vivo experiments at our center. In the proposed project, we will closely collaborate with the Functional Biomechanics Research Group and carry out the in vivo experiments at the Functional Biomechanics Laboratory.

Other contributors are Dr Dominika Ignasiak, Institute of Biomechanics ETH Zurich, Dr Soheila Aghlmandi, Institute for Clinical Epidemiology and Biostatistics University Hospital Basel, Dr Friedericke Prüfer, Pediatric Radiology, Department Pediatrics University Children's Hospital Basel, and Dr Dorothee Harder, Musculoskeletal Radiology, Department of Radiology and Nuclear Medicine, University Hospital Basel.

Most importantly, the proposed research project is not only interdisciplinary but also translational as the research question is based on our clinical experience and expertise and the results of the proposed work will directly influence treatment of patients with lumbar spinal stenosis at our clinic. Based on the results of the proposed project, we will formulate specific recommendations for clinic and rehabilitation regarding complementary and improved prevention, rehabilitation and surgical interventions either instead or additional before or after surgery.

After gaining research experience in the United States as research assistant at the Case Western Reserve University, Cleveland Ohio and at the Walter Reed Army Medical Center in Washington DC, PD Dr. Cordula Netzer completed two inspiring clinical Fellowships at the Rizzoli Istitutio in Bologna, Italy and the National Spine Health Center in Budapest, Hungary. Having performed spine surgery at these excellent clinical centers for more than 10 years and despite indicating surgery and treating patients the best possible way, seeing some of these patients’ treatment fail or problems recur greatly motivates us pursue research to ultimately understand the holistic background of the disease.

Building a solid foundation with our previous basic research and various pilot studies, we are well prepared and fully committed to conducting the proposed project. We are convinced that our goal can only be reached by pursuing a multidisciplinary and translational approach as proposed in this project. The close proximity to world leading scientists in musculoskeletal modeling with a profound knowledge on spine biomechanics at the ETH Zurich and the clinical, radiological and biomechanical possibilities at the University Hospital Basel represents a unique and promising setting to successfully carry out the proposed work, and all collaborators have expressed their enthusiastic support.