Evidence brief
The Three Column Spine and Its Significance in the Classification of Acute Thoracolumbar Spinal Injuries
Anterior column: anterior 2/3 vertebral body, anterior longitudinal ligament
Middle column: posterior 1/3 vertebral body, posterior longitudinal ligament
Posterior column: posterior elements, ligamentous complex
Instability requires failure of middle column plus either anterior or posterior
Replaced two-column concept for thoracolumbar injuries
The three-column concept revolutionized understanding of spinal stability. Middle column involvement is key to determining instability and need for surgical stabilization.
Draw the three columns on request. Key teaching point: middle column is the 'keystone' of stability. Burst fractures involve middle column (unstable), compression fractures do not (stable). Understand relationship to PLC integrity in TLICS.
Denis F. The three column spine and its significance in the classification of acute thoracolumbar spinal injuries. Spine. 1983;8(8):817-831.
Level IV
Case series or case reports