“…Presumably, an anterior wedge fracture — as opposed to a concavity fracture — occurs because the stress in the bone hard tissue is greatest in the anterior portion of the vertebral body. While cadaver experiments that apply forward-flexion loading to a vertebral body via a stiff layer of plastic do indeed produce anterior wedge-shaped fractures (Buckley et al, 2009; Dall'Ara et al, 2010; Rotter et al, 2015), experiments that load the vertebra through the disc typically produce bone failure in the trabecular bone and endplates more centrally, that is, not anteriorly (Farooq et al, 2005; Granhed et al, 1989; Hutton and Adams, 1982; Jiang et al, 2010; Landham et al, 2015). Consistent with these findings, micro-CT-based finite element analyses (Fields et al, 2010; Yang et al, 2012) have shown that, for both compression and forward-flexion loading applied via a simulated compliant homogenized disc (Young's modulus of 8 MPa), the highest stresses in the vertebral bone occur mostly centrally in the trabecular bone and endplates, whereas high stress occurs anteriorly only when the flexion loading is applied via a stiff layer of plastic (Young's modulus of 2,500 MPa).…”