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Junction function

By Nick Piotrowicz and Anita Martin

For many first-year medical students, it’s enough just to juggle coursework. But when Paul Eichenseer, OMS III, arrived at OU-COM, he immediately launched a little side-project: finite element analysis on spino-pelvic biomechanics.

For his research, Eichenseer, a Johns Hopkins University graduate with a degree in biophysics, combines his biomedical acumen and computer programming skills to explore low back pain. He has created a three-dimensional virtual model of the historically under-researched sacroiliac joint.

“I’m looking at how stresses are transmitted from the upper body through the spine and pelvis to the lower extremities,” Eichenseer said. “Then, at the spinal-pelvic junction, how do those stresses affect the ligaments and other soft tissues, and finally, how might that manifest as low back pain?”

Eichenseer collaborates with Daryl Sybert, D.O. (’86), FAOAO, clinical associate professor of orthopedic surgery at the Mt. Carmel New Albany Surgery Hospital, and with John Cotton, Ph.D., assistant professor of mechanical engineering at the Fritz J. and Dolores H. Russ College of Engineering and Technology.

His research began “day one” in OU-COM’s August Osteopathic Clinical Anatomy Orientation, where he and Sybert measured cadaveric ligaments. Eichenseer then worked with a computer program called Amira^Ò, to build an exact digital replica of the spine and pelvis based on a CT scan he and Sybert conducted. Eichenseer uses the model to conduct finite element analysis, which breaks up his model into 500,000 little pieces, each representing a minute area of the spine or pelvis.

“(To) all those small pieces, I can apply whatever loads that I want. It’s like a massive calculator: it calculates the displacements, the stresses and the strains at any point in my model,” Eichenseer said.

With this information, Eichenseer can determine how the sacroiliac junction influences low back pain. Because of challenges presented by the irregularly shaped sacroiliac junction, there is very little biomechanical information about the joint. In fact, there was no consensus that the joint even moved until the early 1900s—a laughable concept for any woman who’s gone through childbirth—and now the debate centers on its range of motion. 

“When you look back to how long anatomy has been around, it’s pretty recent that they even accepted that motion is capable with this joint,” Eichenseer said. “Now, one of the big debates is about how much motion is actually capable there, and whether it’s enough to produce any type of pain. Well, we have better evidence now with interventional pain management techniques, that yes, it is a pain generator.”

Eichenseer conducts much of his research at OU-COM’s Institute for Neuromusculoskeletal Research (INR), which, together with the Office of Medical Development, awarded him the inaugural 2009-2010 Sybert Family Orthopaedic Research Award to continue this research.

“Paul’s very independent. His intellectual input is astounding,” said Brian Clark, Ph.D., director of the INR and assistant professor of neuromuscular biology. “He’s not just assisting in some technical way; he’s driving this project like a faculty member or a Ph.D. candidate would.”

Eichenseer won first place in the medical research category at Ohio University’s 2009 Student Research and Creative Activity Expo last spring, and he presented his work at this year’s American Osteopathic Academy of Orthopedics in Boston.

This student physician-physicist sees his research as a lifelong project with potential applications in both surgery and osteopathic manipulative medicine. One angle he’d like to pursue is comparing different fixation methods at the lumbosacral junction for patients preparing for scoliosis surgery.

“One thing people always ask me is, ‘Are you done with your research yet?’ That’s not how I see it,” Eichenseer says. “For me research is never over. This will continue next year, the next year and throughout my career.

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