Biomechanics of the thoracic spine and the influence of the chest.

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The rib cage is assumed to have a strong influence on the stability and flexibility of the human thoracic spine. The magnitude of this influence and the relevance of the different structures are poorly understood. Therefore it is vague as to which is the best strategy for the treatment of fractures, deformations, and degenerations in the thoracic spine. If thoracic fractures are not stabilized sufficiently, the consequence may be loss of correction. However, it is not known how many segments of the thoracic spine are needed to be stabilized in case of vertebral body fractures and subsequent restabilisation by vertebral replacement implants and dorsal instrumentation using pedicle screw-rod systems. The operative treatment of serial rib fractures is also discussed. Moreover, the ribs and other structures resected during scoliosis surgery are mostly chosen empirically, potentially leading to instabilities of the spine. The influence of these different resection strategies on the stability of the thoracic spine is not understood well enough. Biomechanical in vitro experiments with thoracic spine specimens were mostly performed without the rib cage, which lead to unrepresentative data and difficulties interpreting the results. Finite element models or multi-body models including the rib cage have critical limitations due to the unknown biomechanical properties of the ribcage.The purpose of the extension of this project is to understand and quantify, in detail, the biomechanics and importance of all relevant structures of the thoracic spine and rib cage. This is accomplished by performing several biomechanical in vitro studies on thoracic spines with and without the rib cage, implementing multiple resection steps. Using this generated biomechanical data and morphological analyses of the corresponding anatomical structures, a parameterized finite element model of the human thoracic spine including the rib cage will be generated, calibrated, and validated. Subsequently preliminary investigations to answer clinically relevant questions will be performed in vitro and using the generated finite element model..