Unstable spine fractures

Revision as of 22:59, 30 December 2014 by Neil.m.young (talk | contribs)



Denis' three column concept helps to determine whether a vertebral fracture is stable or unstable

  • I: Anterior column
    • Anterior longitudinal ligament
    • Anterior 1/2 of the vertebral body and disk
  • II: Middle column
    • Posterior 1/2 of the vertebral body and disk
    • Posterior longitudinal ligament
  • III: Posterior column
    • Facet joints
    • Ligament flavum
    • Posterior elements

Clinical Features

  • I:Always stable
  • II:Possibly unstable
  • III:Always unstable

Example of Unstable Fractures

  • Jefferson's fracture
  • Bilateral facet dislocation
  • Odontoid type II or III
  • Any fracture and dislocation (atlanto-axial or atlanto-occiptial)
  • Hangman's fracture
  • Flexion teardrop


  • CT with reconstructions
  • Consider plain x-ray in conjunction as this is what is used during orthospine f/u
  • MRI to assess cord and ligament damage


  • C-collar
  • Consult ortho or spine as needed

See Also