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Anterior Column: the anterior half of the vertebral body

(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