Spinal Stability

The determination of spinal stability is an important factor in the evaluation of the injured spine. White and Panjabi define stability as the ability of the spine to limit patterns of displacement under physiologic loads so as not to damage or irritate the spinal cord or nerve roots and to prevent incapacitating deformity or pain due to structural changes.2 CT evaluation applied to Denis's three-column system for classification of thoracolumbar injuries can be used to assess spinal stability. According to Denis, the spine consists of three columns.3 The anterior column is formed by the anterior part of the vertebral body, the anterior annulus fibrosus, and the anterior longitudinal ligament. The middle column is formed by the posterior wall of the vertebral body, the posterior annulus fibrosus, and the posterior longitudinal ligament. The posterior column includes the bony complex of the posterior vertebral arch and the posterior ligamentous complex. In order for an injury to be unstable, there must be disruption of at least two columns. In evaluating stability, it is also important to include the degree of compression of the vertebral body. Vertebral body compressions of more than 50 percent are generally considered unstable.

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