Abstract
Purpose To develop and evaluate an automated workflow for the setup of single-vertebra finite element (FE) simulations from clinical CT data. Specifically, we quantified how automated endplate identification, vertebra-specific coordinate system definition, and load-application-point assignment influence the simulated fracture-load estimates. Methods We analyzed 113 vertebrae from 70 patients that had previously undergone manual FE setup. The automated pipeline identified vertebral endplates, assigned a vertebra-specific coordinate system, and assigned the load application point for axial compression simulations. Automated setups were visually graded as good, acceptable, or bad using predefined criteria. Agreement with manual reference models was evaluated, and the effects of each setup component on fracture-load estimates were quantified separately. Results Of 113 vertebrae, 53 (47%) automated setups were graded good, 40 (35%) acceptable, and 20 (18%) bad. In the good subset, fully automated models showed strong agreement with manual reference workflow ( R 2 = 0.950), with a median percent difference in fracture-load estimate of 13.0% (95% CI, 9.0% to 15.3%). Among individual setup components, endplate identification produced the smallest change in fracture-load estimates, followed by coordinate-system definition, whereas the load-application-point assignment produced the largest deviations and the widest limits of agreement. Changes in load-point location showed the clearest association with changes in fracture-load estimates, whereas endplate-area differences showed no clear association. Conclusion Automated setup of vertebral FE simulations can reduce manual intervention and support scalable processing, but current robustness remains insufficient for fully unsupervised use. In successfully processed cases, the workflow showed strong agreement with a manually configured reference workflow and identified load-point assignment as the most influential boundary-condition component in fracture-load estimates.