Three column concept of spinal fractures

The three column concept of thoracolumbar spinal fractures was initially devised by Francis Denis and presently CT is mandatory for an accurate classification.

While initially developed for classification of thoracolumbar spinal fractures, it can also be applied to the lower cervical spine 3 as the general vertebral anatomy is similar to thoracic and lumbar vertebrae. Due to its simplicity, it is widely used in routine clinical practice. 

Columns

Denis divided the vertebral column into three vertical parallel columns based on biomechanical studies related to stability post traumatic injury. Instability occurs when injuries affect two contiguous columns (i.e. anterior and middle column or middle and posterior column).

The three columns are: 

  • anterior column
  • middle column
  • posterior column
    • everything posterior to the PLL
      • pedicles
      • facet joints and articular processes
      • ligamentum flavum
      • neural arch and interconnecting ligaments

Classification

In his original article in 1976 1, Denis differentiated five types of fractures A-E:

  • type A
    • fracture of both endplates without kyphosis
    • mechanism of injury: pure axial load
    • predilection site: low lumbar region
  • type B
    • fracture of the superior endplate (CT may also demonstrate a sagittal split of the lower endplate)
    • most frequent burst fracture
    • mechanism of injury: axial load and flexion
    • predilection site: thoracolumbar junction
  • type C
    • fracture of the inferior endplate
    • rare
    • mechanism of injury: probably axial load and flexion.
    • no particular site pattern could be identified
  • type D
    • burst rotation fracture
    • burst fracture with comminution of the vertebral body, large central defect on CT, loss of posterior height, increase of the interpedicular distance, vertical fracture of the lamina, bone retropulsed into the spinal canal.
    • mechanism of injury: axial load and rotation
    • predilection site: mid lumbar region
  • type E
    • burst lateral flexion fracture
    • fractured posterior wall of the vertebral body with fragment extrusion towards the side of the flexion
    • mechanism of injury: axial load and lateral flexion

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Article Information

rID: 15488
Synonyms or Alternate Spellings:
  • Thoracolumbar spinal fractures : three column concept
  • Denis classification of thoracolumbar spinal fracture
  • Three column concept of thoracolumbar spinal fractures
  • Denis classification

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Cases and Figures

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    Figure 1: illustration
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    Case 1: burst fracture - Denis type B
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    Case 2: three column thoracic spine fracture
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