The Three Column Spine and Its Significance in the Classification of Acute Thoracolumbar Spinal Injuries

Denis, Francis

doi:10.1097/00007632-198311000-00003

Cited by 2,326 publications

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“…Denis et al [21] reported neurologic manifestations in six patients initially treated nonoperatively (17%). Three patients later recovered neurologic function after undergoing surgery, one patient did not achieve full recovery after incomplete surgical decompression, whereas the other two patients refused surgery for the neurologic deficit [20]. The one case of single-root radiculopathy reported by Mumford et al [34] was reversed by surgery.…”

Section: Discussionmentioning

confidence: 97%

“…The mechanism of injury is usually a fall from a height or a motor vehicle accident, occurring in 34% to 59% and 25% to 43% of cases, respectively [47,50]. Burst fractures are characterized by failure of the middle and anterior spinal columns secondary to axial compression [20,36]. Patients with such fractures may be treated with either nonoperative or operative modalities.…”

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confidence: 99%

“…Approximately 50% of thoracolumbar burst fractures have an associated neurologic deficit, with the deficit predominantly occurring at the time of injury [9,20,28]. Burst fractures are radiographically characterized by posterior vertebral body angle exceeding 100°, reduction in posterior vertebral height, widened interpedicle distance, posterior cortical line disruption, and posterior vertebral body break, which may be associated with varying degrees of canal stenosis [6,25].…”

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confidence: 99%

“…The majority of nonoperative trials show that patients experience little or no pain and good functional outcomes (as assessed by return to work, Denis work scale [20], Greenough Low Back Outcome Score [23], and Roland Morris Disability Questionnaire (RMDQ) [39]) at followup, with between 75% to 100% returning to work. This is associated with kyphosis progression of 1°to 8.3°, spontaneous spinal canal remodeling (from an average of 26% to 36% compression at the time of injury to 12% to 18% at last followup) [3, 4, 10-14, 27, 41, 44], and rare cases of neurologic deterioration [21,34].…”

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confidence: 99%

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Nonoperative versus Operative Treatment for Thoracolumbar Burst Fractures Without Neurologic Deficit: A Meta-analysis

Gnanenthiran¹,

Adie²,

Harris³

2012

Clinical Orthopaedics &Amp; Related Research

149

121

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Section: Discussionmentioning

confidence: 97%

mentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Nonoperative versus Operative Treatment for Thoracolumbar Burst Fractures Without Neurologic Deficit: A Meta-analysis

Gnanenthiran¹,

Adie²,

Harris³

2012

Clinical Orthopaedics &Amp; Related Research

149

121

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“…Development of new imaging technology, such as CT and MRI, has increased the understanding of these injuries and has contributed to development of more comprehensive classification systems. Widely utilized classifications for spinal trauma were developed by Holdsworth [10] and Denis [6]. The former system was based on a concept of two columns and the latter on three columns.…”

Section: Introductionmentioning

confidence: 99%

AO-classification of thoracic and lumbar fractures—reproducibility utilizing radiographs and clinical information

Kriek

Govender

2005

Eur Spine J

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This study was designed to assess the inter-observer reliability and intra-observer reproducibility of standard radiographic evaluation of 150 thoraco-lumbar fractures using the AO-classification. The influence of clinical information on agreement levels was also evaluated. Six observers (two junior and four senior residents) evaluated the radiographic images. The injuries were classified by each observer as either type A, B or C according to the AOclassification system and the levels of agreement were documented. After 3 months the injuries were again classified with the addition of the clinical findings of each patient and the level of agreement evaluated. The level of agreement was measured using Cohen's j-test. The overall inter-observer agreement was rated as fair (0.291) in the first session and moderate (0.403) in the second. Intra-observer values ranged from slight (0.181) to moderate (0.488). The increased level of agreement in the second session was attributed to the value of additional clinical information, the learning curve of the junior residents and the simplicity of the classification.

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Musculoskeletal Low Back Pain in School-aged Children

2017

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ow back pain (LBP) in school-aged children is a common occurrence; nevertheless, it is often underappreciated. 1 The prevalence of LBP rises with age: 1% at age 7 years, 6% at age 10 years, and 18% at ages 14 to 16 years. 2 By age 18 years, the lifetime prevalence rates of LBP approach those documented in adults, with an estimated yearly prevalence of 20% and a lifetime prevalence of 75%. 3 More than 7% of adolescents experiencing LBP will seek medical attention. 1 The effect of LBP on this population can be considerable and may significantly restrict instrumental activities of daily living for this population, such as attendance at school and gym or sports participation. 4 Low back pain in this age group is a significant risk factor for developing LBP as an adult. 5 Several potential risk factors for developing LBP in schoolaged children have been investigated. The prevalence of LBP correlates with participation in sports and level of competition. 4,6,7 There is a U-shaped association between physical activity and the incidence of LBP in school-aged children, with both low and high levels of physical activity associated with a higher risk. 8,9 Female sex, growth acceleration, adverse psychosocial factors, increasing age, previous back injury, and family history of LBP are all potential risk factors for school-aged children to develop LBP. 9-12 Although there has been concern about a potential association of LBP and backpacks, the evidence pointing to use of backpacks as a risk factor is weak. 9 No single risk factor for a first episode of LBP in school-aged children has been definitively validated (level of evidence, 1). 13 Historically, it has been taught that most LBP in school-aged children has an identifiable diagnosis. More recent research has challenged this thinking. A high-quality prospective study of 73 pediatric patients with LBP (level of evidence, 2) followed up for 2 years found that nearly 80% had no definitive diagnosis. 14 Most cases of LBP in school-aged children are nonspecific and self-limiting. 15,16 Discussion and Observations Relevant AnatomyPediatricians need a basic but solid understanding of the anatomy of the lumbosacral spine to provide effective care to school-aged children with LBP. The lumbar spine is composed of 5 vertebrae IMPORTANCE Low back pain (LBP) in children and adolescents is a common problem. The differential diagnosis of LBP in this population is broad and different from that seen in the adult population. Most causes of LBP are musculoskeletal and benign in their clinical course. Clinicians should have an understanding of the relevant anatomy and the most commonly encountered etiologic factors of LBP in children and adolescents to provide effective care.OBSERVATIONS Low back pain is rarely seen in youth before they reach school age. Subsequently, rates of LBP rise until age 18 years, at which age the prevalence of LBP is similar to that in adults. The differential diagnosis of LBP in this population is broad, and individual etiologic factors are most often associated wit...

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The Three Column Spine and Its Significance in the Classification of Acute Thoracolumbar Spinal Injuries

Cited by 2,326 publications

References 0 publications

Nonoperative versus Operative Treatment for Thoracolumbar Burst Fractures Without Neurologic Deficit: A Meta-analysis

Nonoperative versus Operative Treatment for Thoracolumbar Burst Fractures Without Neurologic Deficit: A Meta-analysis

AO-classification of thoracic and lumbar fractures—reproducibility utilizing radiographs and clinical information

Musculoskeletal Low Back Pain in School-aged Children

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