Thoracolumbar Spine Fractures

Three column theory (Denis, 1984)
Ant.-ALL and ant. 2/3 vertebrae
Mid.-post. 1/3 body and PLL
Post.-bony arch, inter/supra spinous and flavum

Stability based on 2 columns.
Divided into 4 categories:
1) Compression
-compression of ant. column with intact middle column and post.
-post. column fails under tension with >40 to 50% loss of ant. height
A-failure of both endplates (16%)
B-failure of sup. endplate (62 %)
C-failure of inf. endplate (6 %)
D-both endplates intact (15 %)

2) Burst Fractures
-compression failure of ant. and middle columns +- post. columns
-retropulsion common
A-both endplates (24 %)
B-sup. endplate (49%)
C-inf. endplate (7%)
D-Burst/rotation injury (15%)
E-Burst/lateral flexion injury (5%)

3) Seat-belt injuries
A-one level bony injury (Chance)
B-one level ligamentous injury
C-two-level injury through bone in middle column
D-two-level injury through ligamentous middle column

4) Fracture-dislocations
-failure of all 3 columns
-high rate of neurologic injury
-M/P columns fail in tension and rotation and A column in flexion