A comparative study utilizing finite element modeling to analyze the biomechanical differences in various cement distributions within osteoporotic vertebral compression fractures

This study aims to assess the biomechanical impact of bone cement perfusion on osteoporotic vertebral compression fractures across various distribution sites through finite element simulation. The finite element model of the L1-L3 vertebral body was constructed and its efficacy was validated. Simulated compression fractures of the L2 vertebral body resulted in the distribution of cement in the anterior, middle, and posterior thirds of the L2 vertebral body. Physiological loading and boundary conditions of axial compression experienced by the spine in the upright position were established, and loading models were examined in various states of movement including forward flexion, extension, left and right lateral bending, and left and right rotational movements. The study compared the stress distribution, maximum Von-Mises stress, maximum elastic strain of the vertebral body, and maximum deformation displacement of the vertebral body and intervertebral disc based on the distribution differences of L2 vertebral bone cement. In flexion, extension, and lateral bending, the peak stress experienced by the L2 vertebral body due to the bone cement model was found to be lower in the anterior 1/3 compared to the middle and posterior 1/3. Furthermore, when the left side of the vertebral body was subjected to bending and rotation, the maximum stress values observed in the fracture model and the posterior 1/3 of the L2 vertebral body cement model on the L3 vertebral body were similar to, and significantly higher than, those seen in the anterior and middle 1/3 of the L2 vertebral body cement models. The elastic modulus of the vertebral body is enhanced when bone cement is strategically placed in the anterior middle region, potentially facilitating the transmission of pressure from the vertebral body to the upper and lower lumbar spine through the bone cement. This redistribution of pressure may alleviate stress in the central region, thereby reducing the likelihood of vertebral injury and adjacent vertebral fractures.