Spinal Fractures: The Three-Column Concept

Spinal fractureSpinal fractures, whether caused by disease or trauma, can range from a mildly painful condition to a serious and even life-threatening situation. Since the human spine is a complex structure, spine surgeons need to be very careful in diagnosing exactly where a fracture occurs. Accurate classification of a spinal fracture is a very important factor in determining the appropriate treatment plan.

The Three-Column Concept
When describing and diagnosing spinal fractures, spine surgeons divide the spinal column into 3 sections:

1. Anterior column - made up of the anterior longitudinal ligament and the anterior one-half of the vertebral body, disc, and annulus.

2. Middle column - made up of the posterior one-half of the vertebral body, disc, and annulus, and the posterior longitudinal ligament.

3. Posterior column - made up of the facet joints, ligamentum flavum, the posterior elements and the interconnecting ligaments.

Types of Fractures
Most spinal fractures can be classified into 4 main types, including:

Wedge fractures - a compression fracture in which the front part of the vertebral body is crushed, forming a wedge shape.

Burst fractures - when the vertebral body is crushed in all directions, potentially causing bone fragments to enter the spinal canal.

Dislocation injuries - occurs when any part of the spinal column breaks away from another part, often caused by severe compression, rotation, or tension.

Seat belt fractures - often the result of a car crash when the passenger is wearing a lap-only seat belt and experiences a forceful forward flexion of the spine.

Stable and Unstable Fractures
Generally, a fracture is considered stable if only the anterior column is involved, as in the case of most wedge fractures. When the anterior and middle columns are involved, the fracture may be considered more unstable. When all three columns are involved, the fracture is by definition considered unstable, because of the loss of the integrity of the posterior stabilizing ligaments. The table below shows the types of fractures, the part or parts of the spine involved, and whether or not it is a stable or unstable injury.

Type of Fracture Column Affected Stable vs Unstable
Wedge fractures Anterior Only Stable
Burst fractures Anterior and middle Unstable
Fracture/dislocation injuries Anterior, middle, posterior Unstable
Seat belt fractures Anterior, middle, posterior Unstable


Updated on: 07/16/15
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Spinal Fractures: Stability and Treatment Options
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Spinal Fractures: Stability and Treatment Options

Treatment of stable spinal fractures usually involves immobilization using a back brace, brief bed rest, and pain medications as necessary. If the compression is significant, while it may be considered stable and does not require urgent surgical management, surgery may be indicated. This is due to the fact that a significant deformity can result as well as neurologic deficit.
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