Metastatic burst fracture risk assessment based on complex loading of the thoracic spine

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.