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The Three Column Spine and Its Significance in the Classification of Acute Thoracolumbar Spinal Injuries
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1983
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Anterior Longitudinal LigamentSurgeryThoracic SpineSpinal DisorderOsteoporosisOrthopaedic SurgeryMiddle ColumnThree Column SpineLumbar SpineBiomechanicsOsteoarthritisRadiologySpinal Cord InjuryThird ColumnSpinal InjurySpine SurgerySinal SurgerySpinal FractureLumbosacral RadiculopathySpinal TraumaThoracic SurgeryMedicine
The middle column consists of the posterior vertebral wall, posterior longitudinal ligament, and posterior annulus fibrosus. This study introduces the middle osteoligamentous column concept in thoracolumbar injuries based on a retrospective review of 412 cases. Injuries were categorized into minor (fractures of transverse processes, facets, pars interarticularis, spinous process) and major (compression, burst, seat‑belt‑type, fracture‑dislocation) types, each further subdivided into sub‑types. The mode of middle column failure correlates with fracture type and neurological injury, and the three‑column system aligns with classification, stability, and treatment indications.
From a retrospective study of 412 thoracolumbar injuries, the author introduces the concept of middle column or middle osteoligamentous complex between the traditionally recognized posterior ligamentous complex and the anterior longitudinal ligament. This middle column is formed by the posterior wall of the vertebral body, the posterior longitudinal ligament and posterior annulus fibrosus. The third column appears crucial, as the mode of its failure correlates both with the type of spinal fracture and with its neurological injury. Spinal injuries were subdivided into minor and major. Minor injuries are represented by fractures of transverse processes, facets, pars interarticularis, and spinous process. Major spinal injuries are classified into four different categories: compression fractures, burst fractures, seat-belt-type injuries, and fracture dislocations. These four well-recognized injuries have been studied carefully in clinical terms as well as on roentgenograms and computerized axial tomograms. They were then subdivided into subtypes demonstrating the very wide spectrums of these four entities. The correlation between the three-column system, the classification, the stability, and the therapeutic indications are presented.