The three column spine and its significance in the classification of acute thoracolumbar spinal injuries

Abstract

Background: Building on Holdworth's [ 1[ classifi cation and subsequent basic science, Francis Denis presents his three column theory of spinal stability and reports its application to fractures of the thoracic and lumbar spine. Method: This was a retrospective study of 412 thoracolumbar fractures. Fractures were followed up by clinical review, review of roentgenograms (radiographs) and computerised axial tomograms (CTs). Fractures were classifi ed as minor or major. Minor fractures included fractures of the transverse processes, facet joints, pars interarticularis, and spinous processes. Major fractures were classifi ed into four different types, these included: Compression fractures, burst fractures, seat-belt-type injuries, and fracture dislocations. The middle column was defi ned as lying between the posterior ligamentous complex and the anterior longitudinal ligament, comprising of the posterior wall of the vertebral body, the posterior longitudinal ligament and posterior annulus fi brosus. The correlation between the 3-column system, the classifi cation of the fracture, and both neurological and biomechanical stability was examined. Conclusion: The author concludes that the mode of failure of the third column correlates with both the type of fracture and neurological injury.