Patient-Specific Finite Element Analysis of Stress Redistribution and Adjacent Vertebral Fracture Risk Following Cement Augmentation Toward Predictive Adjacent Fracture Modeling in Pre/Post-Operative Vertebroplasty for Cancer Relief

Abstract

This thesis develops a patient-specific finite element analysis (FEA) framework to evaluate stress redistribution and adjacent vertebral fracture risk following vertebroplasty with polymethyl methacrylate (PMMA) cement. Using CT-derived DICOM data, individualized vertebral geometries and cement morphologies were segmented, reconstructed, and assembled into a tri-vertebral model subjected to physiologically relevant compressive loads. Results show that while PMMA significantly reduces strain and stabilizes the treated vertebra, it creates a stiffness mismatch that redistributes stress to adjacent levels, producing elevated stress concentrations at vertebral endplates. These stress patterns align with clinically observed adjacent-level fractures and are strongly influenced by cement volume, geometry, and spatial distribution. The study develops a framework and demonstrates the potential of CT-driven, patient-specific FEA as a predictive tool for optimizing vertebroplasty planning and reducing post-operative fracture risk.