Unstable spine fractures

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Background

Three-column-concept-2.jpg

Denis' three column concept helps to determine whether a vertebral fracture is stable or unstable

  • I: Anterior column
    • Anterior longitudinal ligament
    • Anterior 1/2 of the vertebral body and disk
  • II: Middle column
    • Posterior 1/2 of the vertebral body and disk
    • Posterior longitudinal ligament
  • III: Posterior column
    • Facet joints
    • Ligament flavum
    • Posterior elements

Examples of Unstable Fractures

Clinical Features

  • I:Always stable
  • II:Possibly unstable
  • III:Always unstable

Evaluation

  • CT with reconstructions
  • Consider plain x-ray in conjunction as this is what is used during orthospine follow up
  • MRI to assess cord and ligament damage

Management

  • C-collar
  • Consult ortho or spine as needed

Disposition

See Also

References