bims-rebome Biomed News
on Management of bone metastases
Issue of 2026–03–29
two papers selected by
Alberto Selvanetti, Azienda Ospedaliera San Giovanni Addolorata
  1. Biomechanical effects of defect size and location on vertebral fracture.
  2. Radiotherapy for malignant spinal cord compression - prognostic factors for better functional outcome.
  1. J Med Biol Eng. 2025 Oct;45(5): 641-648
    Biomechanical effects of defect size and location on vertebral fracture.
    Asghar Rezaei, Areonna Schreiber, Babak Dashtdar, Cameron Aubert, Abdelrahman M Hamouda, Benjamin Elder, Kenton Kaufman, Lichun Lu.
       Purpose: Investigating the effect of metastatic lesions on the load-bearing capacity of the spinal column is essential for identifying appropriate interventions for patients. Most studies on the effects of tumor size and location on vertebral fractures are computational, with limited experimental data available. Furthermore, it remains unclear which parameters are most critical for assessing fracture risk in metastatic spines. The purpose of the current study was to investigate the effect of lesion size and location on fracture characteristics of the vertebral body and to find contributing factors associated with vertebral fractures.
    Methods: Human cadaveric spine segments were dissected from fresh frozen torsos and divided into three groups: intact, central defects affecting only trabecular bones, and anterior defects affecting both cortical and trabecular bones. Computed tomography imaging was performed to measure the geometry and Hounsfield Unit (HU) values and then, these specimens were mechanically tested to failure to record vertebral fracture forces.
    Results: Compared to the intact specimens (2092 kPa), the average fracture strength in the defect groups were reduced by at least 750 kPa with a defect size as small as 25% of the cross-sectional area (CSA) or 9% of the volume (p=0.0097). Tumor location did not significantly affect vertebral fracture forces (p=0.77), as both locations primarily involved trabecular bone.
    Conclusion: The results of this study suggest that the vertebral body becomes significantly weaker even with simulated lytic defects involving as little as approximately 9% of the vertebral volume or 25% of the vertebral cross-sectional area (CSA). This degree of bone involvement may represent a new biomechanical threshold for assessing fracture risk in metastatic spines with bone loss. These findings underscore the importance of proactive assessment and potential early intervention in patients with small vertebral lytic lesions-particularly in individuals already at elevated risk of vertebral fracture due to conditions such as osteoporosis.
    Keywords:  Vertebral fracture; biomechanics of spine; lesion size and location
    DOI:  https://doi.org/10.1007/s40846-025-00976-x
  2. Radiol Oncol. 2026 Mar 01. 60(1): 132-140
    Radiotherapy for malignant spinal cord compression - prognostic factors for better functional outcome.
    Jasna But-Hadzic, Blaz Groselj, Dirk Rades, Barbara Segedin.
       BACKGROUND: Malignant spinal cord compression (MSCC) is one of the most devastating complications in cancer patients. This retrospective single-center analysis was aimed to identify prognostic factors for better functional outcome after radiotherapy for MSCC.
    PATIENTS AND METHODS: Consecutive patients with MSCC treated with upfront radiotherapy between January 2017 and December 2022 were included in this analysis. Data on patient, tumor and treatment characteristics, functional status before and after treatment and diagnostic work-up were collected from the hospital digital database. The treatment was considered effective if performance status (PS) was maintained in PS 1-2 patients or PS improved in PS 3-4 patients.
    RESULTS: 295 patients were treated for MSCC. The most common primary tumor type was lung cancer (29.3%), followed by prostate (18%) and breast cancer (12%). The treatment was effective in 44.7% of patients. Patients who survived more than 1 month after radiotherapy were more likely to experience functional improvement than patients who died within the first month (60.5% vs. 16.5%, p < 0.001). In the multivariate analysis PS 1-2, myeloma/lymphoma, MRI at the time of MSCC and no motor deficits vs. paralysis were associated with better functional outcome.
    CONCLUSIONS: The prognosis of patients with MSCC remains poor. Better stratification of patients to assess possible benefit of radiotherapy for MSCC is warranted.
    Keywords:  malignant spinal cord compression; outcome; prognostic factors; radiotherapy
    DOI:  https://doi.org/10.2478/raon-2026-0013
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