Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on sleep in brain health

LIVE: Thursday 2nd May 2024, 18:00-19:30 (CEST)

Quality sleep is essential for health. But what happens to our brains when sleep patterns are disturbed? Join our experts to explore the interplay between sleep disruption and neurological diseases, and the questions that you need to be asking your patients to help you prevent the harmful effects of sleep deprivation.
ADVANCED SEARCH
Log in
Top
BMC Musculoskeletal Disorders
Published in: BMC Musculoskeletal Disorders 1/2020

Open Access 01-12-2020 | Research article

Analysis and improvement of the three-column spinal theory

Authors: Qihang Su, Cong Li, Yongchao Li, Zifei Zhou, Shuiqiang Zhang, Song Guo, Xiaofei Feng, Meijun Yan, Yan Zhang, Jinbiao Zhang, Jie Pan, Biao Cheng, Jun Tan

Published in: BMC Musculoskeletal Disorders | Issue 1/2020

Login to get access

Abstract

Background

Denis and Ferguson et al.’s three-column spinal theory has been widely accepted and applied. However, this three-column theory was proposed based solely on observation and experience without thorough documented data and analysis. The aim of this study was to analyze and improve Denis and Ferguson et al.’s three-column spinal theory to propose a novel three-column concept in epidemiology, morphology and biomechanics.

Methods

A retrospective analysis of the computed tomography imaging data of patients with a diagnosis of T11-L5 vertebral fractures was conducted between February 2010 and December 2018. Three-dimensional (3D) distribution maps of fracture lines of all subjects were obtained based on 3D mapping techniques. In addition, a 25-year-old health male volunteer was recruited for the vertebral finite element force analysis.

Results

The present study enrolled 459 patients (age: 48 ± 11.42 years), containing a total of 521 fractured vertebrae. The fracture lines peaked in the upper and the outer third sections of the vertebra, starting from the anterior part of the vertebral pedicles in 3-D maps. Regarding flexion and extension of the spine, the last third of the vertebral body in front of the spinal canal was one main stress center in the finite element analysis. The stress on the vertebral body was greater in front of the pedicles in the lateral bending.

Conclusion

The study reveals that the posterior one-third of the vertebral body in front of the spinal canal and the posterior one-third of the vertebral body in front of the pedicle are very different in terms of fracture characteristics and risks to spinal canal (3D maps and stress distributing graphs), therefore, they should be classified as different columns. We provide strong evidence that Su’s three-column theory complies with the characteristics of vertebral physiological structure, vertebral fracture, and vertebral biomechanics.

Graphical abstract

Literature
1.
Cahueque M, Cobar A, Zuniga C, et al. Management of burst fractures in the thoracolumbar spine. J Orthop. 2016;13(4):278–81.PubMedCrossRef
2.
Holdsworth FW. Fractures, dislocations, and fracture-dislocations of the spine[J]. J Bone Joint Surg( British Volume). 1963;45(1):6–20.CrossRef
3.
Holdworth F. Fractures, dislocations and fracture-dislocations of the spine. J Bone Joint Surg Am. 1970;52:1534–51.CrossRef
4.
Whitesides TE Jr. Traumatic kyphosis of the thoracolumbar spine. Clin Orthop Relat Res. 1977;128:78–92.
5.
Kelly RP, Whitesides TE Jr. Treatment of lumbodorsal fracture-dislocations. Ann Surg. 1968;167(5):705.PubMedCrossRef
6.
Louis R. Les théories de l'instabilité[J]. Rev Chir Orthop Reparatice Appar Mot. 1977;63:423–5.
7.
Denis F. Updated classification of thoracolumbar fractures. Orthop Trans. 1982;6(8):41–8.
8.
Denis F. The three column spine and its significance in the classification of acute thoracolumbar spinal injuries[J]. Spine. 1983;8(8):817–31.PubMedCrossRef
9.
Denis F. Spinal instability as defined by the three-column spine concept in acute spinal trauma. Clin Orthop Relat Res. 1984;189:65–76.
10.
Ferguson RL, Allen BL. A mechanistic classification of thoracolumbar spine fractures. Clin Orthop Relat Res. 1984;189:77–88.
11.
Magerl F, Aebi M, Gertzbein SD, et al. A comprehensive classification of thoracic and lumbar injuries. Eur Spine J. 1994;3(4):184–201.PubMedCrossRef
12.
Su Q, Zhang Y, Liao S, et al. 3D computed tomography mapping of thoracolumbar vertebrae fractures. Med Sci Monit. 2019;25:2802–10.PubMedCrossRef
13.
Su QH, Liu J, Zhang Y, et al. Three-dimensional computed tomography mapping of posterior malleolar fractures. World J Clin Cases. 2020;8(1):29–37.PubMedCrossRef
14.
Cai XY, Sang D, Yuchi CX, et al. Using finite element analysis to determine effects of the motion loading method on facet joint forces after cervical disc degeneration. Comput Biol Med. 2020;116:103519.PubMedCrossRef
15.
Schmidt H, Heuer F, Claes L, et al. The relation between the instantaneous center of rotation and facet joint forces – a finite element analysis[J]. Clin Biomech. 2008;23(3):270–8.CrossRef
16.
Guo LX, Teo EC, Lee KK, et al. Vibration characteristics of the human spine under axial cyclic loads: effect of frequency and damping[J]. Spine. 2005;30(6):631–7.PubMedCrossRef
17.
Goel VK, Kong W, Han JS, et al. A combined finite element and optimization investigation of lumbar spine mechanics with and without muscles[J]. Spine. 1993;18(11):1531–41.PubMedCrossRef
18.
Schmidt H, Heuer F, Drumm J, et al. Application of a calibration method provides more realistic results for a finite element model of a lumbar spinal segment[J]. Clin Biomech. 2007;22(4):377–84.CrossRef
19.
Renner SM, Natarajan RN, Patwardhan AG, et al. Novel model to analyze the effect of a large compressive follower pre-load on range of motions in a lumbar spine. J Biomech. 2007;40(6):1326–32.PubMedCrossRef
20.
Du CF, Yang N, Guo JC, et al. Biomechanical response of lumbar facet joints under follower preload: a finite element study. BMC Musculoskelet Disord. 2016;17(1):126.PubMedCrossRef
21.
Panjabi MM, Oxland TR, Yamamoto I, et al. Mechanical behavior of the human lumbar and lumbosacral spine as shown by three-dimensional load-displacement curves. J Bone Joint Surg Am. 1994;76(3):413–24.PubMedCrossRef
22.
McCormack T, Karaikovic E, Gaines RW. The load sharing classification of spine fractures. Spine. 1994;19(15):1741–4.PubMedCrossRef
23.
Wang XB, Lü GH, Li J, et al. Posterior distraction and instrumentation cannot always reduce displaced and rotated posterosuperior fracture fragments in thoracolumbar burst fracture. Clin Spine Surg. 2017;30(3):E317–22.PubMedCrossRef
24.
Kuner EH, Kuner A, Schlickewei W, et al. Ligamentotaxis with an internal spinal fixator for thoracolumbar fractures. J Bone Joint Surg (British volume). 1994;76(1):107–12.CrossRef
25.
Mohanty SP, Bhat SN, Ishwara-Keerthi C. The effect of posterior instrumentation of the spine on canal dimensions and neurological recovery in thoracolumbar and lumbar burst fractures. Musculoskelet Surg. 2011;95(2):101–6.PubMedCrossRef
26.
Mueller LA, Mueller LP, Schmidt R, et al. The phenomenon and efficiency of ligamentotaxis after dorsal stabilization of thoracolumbar burst fractures. Arch Orthop Trauma Surg. 2006;126(6):364–8.PubMedCrossRef
27.
Arlet V, Orndorff DG, Jagannathan J, et al. Reverse and pseudoreverse cortical sign in thoracolumbar burst fracture: radiologic description and distinction—a propos of three cases. Eur Spine J. 2009;18(2):282–7.PubMedCrossRef
28.
Machino M, Yukawa Y, Ito K, et al. The complement of the load-sharing classification for the thoracolumbar injury classification system in managing thoracolumbar burst fractures. J Orthop Sci. 2013;18(1):81–6.PubMedCrossRef
29.
Vaccaro AR, Oner C, Kepler CK, et al. AOSpine thoracolumbar spine injury classification system: fracture description, neurological status, and key modifiers. Spine. 2013;38(23):2028–37.PubMedCrossRef
30.
Vaccaro AR, Lehman RA Jr, Hurlbert RJ, et al. A new classification of thoracolumbar injuries: the importance of injury morphology, the integrity of the posterior ligamentous complex, and neurologic status. Spine (Phila Pa 1976). 2005;30(20):2325–33.CrossRef
31.
Vaccaro AR, Schroeder GD, Kepler CK, et al. The surgical algorithm for the AOSpine thoracolumbar spine injury classification system. Eur Spine J. 2016;25(4):1087–94.PubMedCrossRef
Metadata
Title
Analysis and improvement of the three-column spinal theory
Authors
Qihang Su
Cong Li
Yongchao Li
Zifei Zhou
Shuiqiang Zhang
Song Guo
Xiaofei Feng
Meijun Yan
Yan Zhang
Jinbiao Zhang
Jie Pan
Biao Cheng
Jun Tan
Publication date
01-12-2020
Publisher
BioMed Central
Published in
BMC Musculoskeletal Disorders / Issue 1/2020
Electronic ISSN: 1471-2474
DOI
https://doi.org/10.1186/s12891-020-03550-5

Other articles of this Issue 1/2020

BMC Musculoskeletal Disorders 1/2020 Go to the issue

Study protocol

A protocol for chronic pain outcome measurement enhancement by linking PROMIS-29 scale to legacy measures and improving chronic pain stratification

Research article

Degenerative central lumbar spinal stenosis: is endoscopic decompression through bilateral transforaminal approach sufficient?

Research article

Relationship between the sectional area of the rectus capitis posterior minor and the to be named ligament from 3D MR imaging

Research article

Structural validity of the Boston Carpal Tunnel Questionnaire and its short version, the 6-Item CTS symptoms scale: a Rasch analysis one year after surgery

Research article

Absence of pain in subjects with advanced radiographic knee osteoarthritis

Research article

Reference chart for knee flexion following total knee arthroplasty: a novel tool for monitoring postoperative recovery