Department of  Neurosurgery
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Current Research — Hawasli Lab

A Functional Neurological Spine Surgery Research Laboratory

The foundation of spinal surgery research has focused on biomechanical studies and not yet utilized the skills natural to neurosurgeon scientists. Our lab utilizes our experiences in neuroscience, neurosurgery and spine surgery to study how the diseases of the spine affect the brain and changes in the brain affect the spine. Some inroads have been made in this general field by functional neurosurgeons and pain medicine specialists. However, the research is relatively scarce and cannot be translated into clinical medicine.

With advances in human systems neuroscience and advanced magnetic resonance imaging research, we are now able to map human brain networks and directly apply these networks to human disease and clinical practice. Efforts in functional neuroimaging and machine learning at Washington University and a handful of other institutions have directly impacted how we practice neurosurgery. We utilize such powerful methods along with validated clinical outcome measures to study the spine—brain relationship. Although our research vision in the spine—brainrelationship opens the doors to numerous important questions, we are currently focused on three key clinically-relevant and attainable areas:

Spinal Cord Injury (SCI)

Despite 337,000+ Americans with spinal cord injury (SCI), 12,000 new SCI per year and $10-billion spent annually on SCI, there are insufficient diagnostic tools and therapeutic interventions.  Furthermore, our understanding of how SCI affects the brain is incomplete. There are no reliable methods to measure changes in brain architecture or networks after SCI. The International Standards for the Neurological Classification of SCI (ASIA) is a standard functional assessment for patients, but it is not prognostic nor does it provide information on brain architecture or networks. We urgently need to better understand how SCI affects the brain in order to predict recovery, guide current therapies, and develop new therapies. Our long-term goal is to determine how SCI alters cerebral architecture and connectivity and develop non-invasive biomarkers to predict recovery and guide therapy. We use the Human Connectome Project (HCP) multi-modal parcellation of the cerebral cortex and related methods to assess how SCI affects cerebral architecture and connectivity as a biomarker of functional recovery following SCI. We are testing the overall hypothesis that SCI leads to short- and long-term reorganization of brain architecture and functional connectomes, which can be used to predict long-term recovery.

Cervical Spondylitic Myelopathy (CSM)

Because acute SCI produces changes in brain networks, we anticipate that chronic spinal cord compression in CSM leads to long-term changes in brain networks. Natural history studies have shown that 75% of CSM patients will experience neurological decline over time. Spinal decompression halts the clinical progression of neurological impairments in most CSM patients. For some patients, decompression improves their clinical neurological function. A small fraction of CSM patients continue to decline despite decompression. Similarly to above, our goal is to determine how CSM alters cerebral architecture and connectivity and develop non-invasive biomarkers to predict recovery and guide therapy.

Lower back pain

One in five visits to a primary care doctor is for back pain. The prevalence of lower back pain is thought to be near 15-30%. Estimated health care costs for back pain in the United States are thought to exceed $1 trillion each year. Patients will often receive MRIs of the lumbar spine and a subsequent neurosurgical referral. For a small portion of these patients, surgical decompression of central or foraminal spinal nerves can remedy neurogenic claudication or radiculopathy. In other select patients, surgical treatment of sagittal or coronal imbalance offers some benefits. However, for the majority of patients with back pain, there is no clear surgical remedy. Spine surgeons’ anecdotal experiences and recent data suggests that mental health, psychology and centrally-mediated factors can be used to prognosticate a benefit from lumbar spine surgery.  Consistent with our laboratory method, we seek to  determine how lower back pain alters cerebral architecture and connectivity and develop non-invasive biomarkers to predict recovery and guide therapy.