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Computed tomography and magnetic resonance imaging are two powerful modalities which can be used in the clinical setting to produce data for the creation of patient-specific finite element analysis (FEA) models and physical analogues—for instance, by using additive manufacturing (AM)—that mimic the properties of soft and hard tissues, both morphologically and mechanically. However, there remains a gap between creating a perfect biofidelic physical analogue and its computational counterpart. This gap exists because, firstly, in silico models are often too complex to realise, and secondly, real-life conditions are challenging to emulate both computationally and mechanically, as they involve multiscale situations that are inherently heterogeneous and patient specific. In this study, we applied a multi-scale approach to design and model porcine vertebral specimens. Our results identified critical design factors that affect the quality and accuracy of the models, specifically highlighting that scanning resolution/fidelity and the thresholding technique have a directly proportional impact on model accuracy. A small shift up and down the greyscale level by 20 units can affect the behaviour of the AM sample by as much as [−15% +47%]. Working up the levels for manufacturing, testing and modelling (i) cylindrical cores to (ii) whole vertebrae and then (iii) a whole spine motion segment, we observed that the fidelity of predictions reduces, and errors increase as the structure becomes more complicated and intricate (3.6%, 7.5% and 15%, respectively). We are confident that further material-level developments will provide solutions for the more intricate parts of spinal motion segments, such as the intervertebral discs and facets, which in their natural form are highly sophisticated structures. To the best of our knowledge, this is the first time a holistic multiscale approach has been implemented to produce AM biofidelic analogues of skeletal parts. Our data showed good agreement between the physical and in silico models, confirming that it is possible to model real-time objects and situations both physically and in silico. This ultimately will enable the development of accurate, patient-specific physical models for use in biomechanical testing and medicolegal applications. Full article

A semi-automated framework for vertebral measurement has been developed to overcome clinical limitations of subjectivity and poor reproducibility in spinal assessment. The framework integrates watershed segmentation with level-set functions and deterministic cylindrical modeling to convert pixel-based measurements to physical dimensions, achieving 2% reproducibility error. Interactive region-of-interest selection enables the effective handling of multi-vertebrae cases while preserving clinical expertise input. Validation using a lumbar spine MRI dataset on 515 patients confirms measurements fall within established anatomical parameters for L3–L5 vertebrae. This methodology provides a transparent, reproducible approach for standardized vertebral assessment that balances automation with clinical reasoning, offering immediate implementation potential without the computational demands and regulatory challenges associated with complex AI systems. Full article