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					Assessment of stability · Spinal column injuries                                                                   H 04


 What criteria can be used to assess the stability of a vertebral fracture?




                                                                                                                            Spine Surgery Information Portal · Prof. Dr. Jürgen Harms · www.harms-spinesurgery.com
 The assessment of the stability of a vertebral fracture is an important criterion when determining therapeutic
 measures	to	be	taken	(surgical	stabilization	or	conservative	therapy).	A	stable	fracture	must	fulfill	the	following	
 criteria:
 · Spinal cord and spinal nerves must not be at risk
 · The physiological loads must be supported without the vertebral fracture resulting in a deformity of the spinal
   column.

 Denis introduced the three-column method for stability assessment. He differentiates between the anterior
 column (A), consisting of the vertebral bodies, the middle column (B), consisting of the vertebral arches and
 articular processes, and the posterior column (C), consisting of the spinous processes and dorsal ligamentous
 apparatus.
 Denis	defines	stability	based	on	the	following	criteria:
 · Involvement of all three columns leads to instability
 · Injury of two columns with rotation of the damaged column portions about the intact column leads to instability
 · Isolated injury of one column does not lead to instability

 • The Denis three-column model



                                          · Ligamentum longitudinale anterius, anterior longitudinal ligament
                                          · Ligamentum longitudinale posterius, posterior longitudinal ligament
                                          · Ligamentum supraspinale, supraspinal ligament
                                          ·	Ligamentum	flavum,	yellow	ligament
                                          · Vertebral body
                                          · Intervertebral disc
                                          · Ligamentum interspinale, interspinal ligament


                                          · Intervertebral foramen
                                          · Vertebral arch




           Prof. Dr. med. Jürgen Harms · Klinikum Karlsbad-Langensteinbach · Guttmannstraße 1 · 76307 Karlsbad
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                                  © www.harms-spinesurgery.com 2007. All rights reserved.

				
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