- See:
Ligamentous Instability:
- Discussion:
- antatomic structures in the anterior column that resist compression
forces are the vertebral body centrum and intervertebral disc;
- structures that counter act tensile forces in anterior motion segment
are anterior longitudinal ligament and the
annulus fibrosis;
-
stable injuries to anterior column include
compression frx
of < 25% loss of vertebral body ht. & anteroinferior avulsion frx
where the fragment width is < 20% of vertebral body width;
-
unstable injuries to anterior column include
compression frxs w/
> 25% loss of ht indicating posterior ligament rupture,
and fractures thru the vertebrae;
-
fracture lines extend thru vertebral body centrum in coronal plane
represent anterior collumn failure;
- anterior ligamentous disruptions can be detected by the presence of
small anteroinferior avulsions and segmental disc widening;
(ligaments include: ant. longitudinal lig. &
Annulus fibrosus)
- w/ complete cervical dislocation from anterior ligament failure, more
stable internal fixation (posterior plate stabilization) should be
considered to permit early patient mobilization;
- note: failure of the anterior vertebral body should always suggest
posterior ligament failure;
- if posterior ligament failure is ruled out, then treat patient w/ hard collar;
- w/ posterior ligament disruption (or w/
Middle column collapse)
- treat w/ gradual traction, reduction, & posterior stabilization & then fusion;
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The three column spine and its significance in the classification of acute
thoracolumbar spinal injuries.
Spinal instability as defined by the three-column spine concept in acute
spinal trauma.
Complications in three-column cervical spine injuries requiring anterior
-posterior stabilization.
