Biomechanics of Thoracic and Lumbar Spinal Metastases: Implications for Stability Assessment, Treatment Strategies, and Surgical Planning

Metastatic disease to the spine is primarily located within the thoracic and lumbar regions of the spine and is a major source of cancer-related pain, mechanical instability, and neurological deficits. With the recent rapid developments in oncologic treatment modalities, we have witnessed a significant improvement in patient survival, thereby emphasizing the importance of maintaining long-term spinal stability and functional status. Metastatic disease is inherently different from other conditions and involves a complex chain of interactions that specifically relate to the involved spinal level, type, shape, and size of the lesion, three-dimensional geometry, bone remodeling, infiltrating pattern of the disease (lytic vs. sclerotic), and bone quality. Despite the use of clinically applicable tools like the Spinal Instability Neoplastic Score (SINS), there is growing biomechanical evidence that these tools consistently fail to identify patient-specific mechanical vulnerabilities. This review aims to consolidate experimental research, finite element modeling, and state-of-the-art artificial intelligence-assisted methodologies into a cohesive biomechanical framework for sophisticated insight into thoracic and lumbar spinal metastases. We perform a detailed review of their effects on clinical risk stratification, surgical stabilization techniques, radiotherapy planning, and discuss prospects for future developments.

کلیدواژه ها:

spinal metastases ، thoracolumbar spine ، biomechanics ، finite element analysis ، SINS