Abstract
BackgroundCancer patients are likely to undergo osteoporosis as consequence of hormone manipulation and/or chemotherapy. Little is known about possible increased risk of fracture in this population. The aim of this study was to describe the biomechanical effect of a metastatic lesion in an osteoporotic lumbar spine model.MethodsA finite element model of two spinal motion segments (L3-L5) was extracted from a previously developed L3-Sacrum model and used to analyze the effect of metastasis size and bone mineral density (BMD) on Vertebral bulge (VB) and Vertebral height (VH). VB and VH represent respectively radial and axial displacement and they have been correlated to burst fracture. A total of 6 scenarios were evaluated combining three metastasis sizes (no metastasis, 15% and 30% of the vertebral body) and two BMD conditions (normal BMD and osteoporosis).Results15% metastasis increased VB and VH by 178% and 248%, respectively in normal BMD model; while VB and VH increased by 134% and 174% in osteoporotic model. 30% metastasis increased VB and VH by 88% and 109%, respectively, when compared to 15% metastasis in normal BMD model; while VB and VH increased by 59% and 74% in osteoporotic model.ConclusionA metastasis in the osteoporotic lumbar spine always leads to a higher risk of vertebral fracture. This risk increases with the size of the metastasis. Unexpectedly, an increment in metastasis size in the normal BMD spine produces a greater impact on vertebral stability compared to the osteoporotic spine.
Highlights
Cancer patients are likely to undergo osteoporosis as consequence of hormone manipulation and/or chemotherapy
In normal bone mineral density (BMD) scenarios, 15% metastasis increased Vertebral bulge (VB) by 178% (0.139 mm) and Vertebral height (VH) by 248% (0.522 mm); while a 30% metastasis increased VB by 424% (0.262 mm) and VH by 626% (1.09 mm)
A comparison of metastatic lesion size showed a 30% metastasis to increase VB by 88% (0.139 mm vs 0.262 mm) and VH by 109% (0.522 vs 1.09) when compared to a 15% metastasis
Summary
Cancer patients are likely to undergo osteoporosis as consequence of hormone manipulation and/or chemotherapy. Little is known about possible increased risk of fracture in this population. The aim of this study was to describe the biomechanical effect of a metastatic lesion in an osteoporotic lumbar spine model. The spine is the most common site for skeletal metastasis, with one third of all cancer patients developing metastases of the spine [1]. Many patients with metastases of the spine are likely to decrease their bone mineral density (BMD), leading to osteopenia or osteoporosis, as a consequence of Salvatore et al BMC Musculoskeletal Disorders (2018) 19:38. Biomechanical studies investigating the risk of fracture in metastatic spines lack realistic models and are not ideal for parametric analyses [12]. Finite element analysis, successful in predicting failure loads and fracture patterns for bone structures [8, 17,18,19,20,21,22,23,24], allows a parametric representation of complex geometric and material property distributions
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