Biomechanically derived guideline equations for burst fracture risk prediction in the metastatically involved spine

Methods to quantify burst fracture risk and neurologic deficit for patients with spinal metastases have not been well defined. This study aims to develop objective biomechanically based guidelines to quantify metastatic burst fracture risk. An experimentally validated finite element model of a human lumbar motion segment was used to simulate burst fracture. Through parametric analysis, the behavior of metastatically involved vertebrae was quantified and a formula to relate patient-specific variables to burst fracture risk defined. The equation-based guidelines were able to describe the mechanical behavior of the metastatically involved vertebral model (R2 = 0.97) reflecting the risk and mechanism of fracture. Vertebral density was found to influence the mechanism of burst fracture with respect to endplate failure. These analyses provide clinically feasible equation-based guidelines for burst fracture risk assessment in the metastatically involved spine.