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Metastatic Burst Fracture Risk Assessment Based on Complex Loading of the Thoracic Spine

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Abstract

The mechanical integrity of vertebral bone is compromised when metastatic cancer cells migrate to the spine, rendering it susceptible to burst fracture under physiologic loading. Risk of burst fracture has been shown to be dependent on the magnitude of the applied load, however limited work has been conducted to determine the effect of load type on the stability of the metastatic spine. The objective of this study was to use biphasic finite element modeling to evaluate the effect of multiple loading conditions on a metastatically-involved thoracic spinal motion segment. Fifteen loading scenarios were analyzed, including axial compression, flexion, extension, lateral bending, torsion, and combined loads. Additional analyses were conducted to assess the impact of the ribcage on the stability of the thoracic spine. Results demonstrate that axial loading is the predominant load type leading to increased risk of burst fracture initiation, while rotational loading led to only moderate increases in risk. Inclusion of the ribcage was found to reduce the potential for burst fracture by 27%. These findings are important in developing a more comprehensive understanding of burst fracture mechanics and in directing future modeling efforts. The results in this study may also be useful in advising less harmful activities for patients affected by lytic spinal metastases.

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Abbreviations

VB:

vertebral bulge

LICN:

load-induced canal narrowing

PWTHS:

posterior wall tensile hoop strain

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ACKNOWLEGMENTS

Support for this work was provided by Natural Sciences and Engineering Research Council of Canada (NSERC).

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Authors and Affiliations

  1. Orthopaedic Biomechanics Laboratory, Sunnybrook and Women's College Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, UB19, Toronto, Ontario, Canada, M4N 3M5

    Craig E. Tschirhart, Joel A. Finkelstein & Cari M. Whyne

  2. Department of Surgery, University of Toronto, Toronto, Ontario, Canada

    Joel A. Finkelstein & Cari M. Whyne

  3. Institute of Biomaterials and Biomedical Engineering and Institute of Medical Sciences, Toronto, Ontario, Canada

    Craig E. Tschirhart & Cari M. Whyne

  4. Orthopaedic Biomechanics Laboratory UB19, Sunnybrook and Women's College Health Sciences Centre, 2075 Bayview Avenue, UB19, Toronto, Ontario, Canada, M4N 3M5

    Cari M. Whyne

Authors
  1. Craig E. Tschirhart
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  3. Cari M. Whyne
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Correspondence to Cari M. Whyne.

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Tschirhart, C.E., Finkelstein, J.A. & Whyne, C.M. Metastatic Burst Fracture Risk Assessment Based on Complex Loading of the Thoracic Spine. Ann Biomed Eng 34, 494–505 (2006). https://doi.org/10.1007/s10439-005-9063-7

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  • DOI: https://doi.org/10.1007/s10439-005-9063-7

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