Spinal Instability: The Orthopedic Approach

Choll W. Kim; Andrew Perry; Steven R. Garfin

doi:10.1055/s-2005-867098

Seminars in Musculoskeletal Radiology, Inhaltsverzeichnis

Semin Musculoskelet Radiol 2005; 09(1): 77-87
DOI: 10.1055/s-2005-867098

Spinal Instability: The Orthopedic Approach

Choll W. Kim¹ , Andrew Perry¹ , Steven R. Garfin¹

¹Department of Orthopedic Surgery, University of California, San Diego, San Diego VA Healthcare System, San Diego, California

Abstract

ABSTRACT

The determination of spinal stability remains an important task of the spine surgeon, as treatment strategies rely heavily on this assessment. However, a clinically useful definition of spine stability remains elusive. Numerous classification systems have been proposed: White and Panjabi proposed a checklist point system to assess spinal stability for each of the cervical, thoracic, and lumbar spines. This remains one of the best recognized systems to date. Denis proposed that spinal integrity depended on the three-column system (anterior, middle, and posterior) and used it to describe thoracolumbar fractures. The spine is considered unstable when any two of the three columns are disrupted. These two classification systems are designed for traumatic injuries and do not explain other causes of instability. In the end, numerous factors must be taken into account when determining spinal stability. These include the disease process causing the injury, the medical and neurologic status of the patient, the anatomic site, and findings on imaging studies.

KEYWORDS

Spine fracture - spinal cord injury - spine stability

Volltext

Referenzen

REFERENCES

1 Watson-Jones R. Fracture and Joint Injuries. 3rd ed. Baltimore; Williams & Wilkins 1943
2 Nicoll E A. Fractures of the dorso-lumbar spine. J Bone Joint Surg Br. 1949; 31 376-394
3 Denis F. The three-column spine and its significance in the classification of acute thoracolumbar spinal injuries. Spine. 1983; 8 817-831
4 White A A, Panjabi M M. The problem of clinical instability in the human spine: a systematic approach. In: White AA, Panjabi MM Clinical Biomechanics of the Spine. 2nd ed. Philadelphia; Lippincott, Williams & Wilkins 1990: 277-378
5 Holdsworth F W. Fractures, dislocations and fracture-dislocation of the spine. J Bone Joint Surg Am. 1970; 58 1534-1551
6 Louis R. stability as defined by the three column spine concept. Anat Clin. 1985; 7 33-42
7 Gertzbein S D, Seligman J H, Holtby R et al.. Centrode characteristics of the lumbar spine as a function of segmental instability. Clin Orthop. 1986; 208 48-51
8 Gertzbein S D, Seligman J H, Holtby R et al.. Centrode patterns and segmental instability in degenerative disc disease. Spine. 1985; 10 257-261
9 Kirkaldy-Willis W H, Farfan H F. Instability of the lumbar spine. Clin Orthop. 1982; 165 110-123
10 Panjabi M M, Brand R A, Augustus A W. Three dimensional flexibility and stiffness properties of the human thoracic spine. J Biomech. 1976; 9 185-192
11 Reuber M, Schultz A, Denis F, Spencer D. Bulging of lumbar intervertebral disks. J Biomech Eng. 1982; 104 187-192
12 Roberts J B, Curtiss Jr P H. Stability of the thoracic and lumbar spine in traumatic paraplegia following fracture or fracture-dislocation. J Bone Joint Surg Am. 1970; 52 1115-1130
13 Kostuik J P, Errico J N. Differential diagnosis and surgical treatment of metastastic spine tumors. In: Frymoyer JW The Adult Spine: Principles and Practice (vol. 1). New York; Raven 1991: 861-888
14 Asdourian P L, Mardjetko S, Rauschning W et al.. An evaluation of spinal deformity in metastatic breast cancer. J Spinal Disord. 1990; 3 119-134
15 Taneichi H, Kaneda K, Takeda N et al.. Risk factors and probability of vertebral body collapse in metastases of the thoracic and lumbar spine. Spine. 1997; 22 239-245
16 Wholey M H, Browner A H, Baker H L. The lateral roentgenogram of the neck (with comments on the atlantoodontoid-basion relationship). Radiology. 1958; 71 350-356
17 Wiesel S W, Rothman R H. Occipitoatlantal hypermobility. Spine. 1979; 4 187-191
18 Spence K F, Decker S, Sell K W. Bursting atlantal fracture associated with rupture of the transverse ligament. J Bone Joint Surg Am. 1970; 52 543-549
19 Fielding J W, Cochran G VB, Lawsing J F, Hohl M. Tears of the transverse ligament of the atlas. A clinical and biomechanical study. J Bone Joint Surg Am. 1974; 56 1683-1691
20 Conlon P W, Isdale I C, Rose B S. Rheumatoid arthritis of the cervical spine: An analysis of 333 cases. Ann Rheum Dis. 1966; 25 120-126
21 Cabot A, Becker A. The cervical spine in rheumatoid arthritis. Clin Orthop. 1978 Mar-Apr; (131) 130-140
22 Dvorak J, Hayek J, Zehnder R. CT-functional diagnostics of the rotatory instability of the upper cervical spine. Spine. 1987; 12 726-731
23 Sullivan J D, Farfan H F. The crumpled neural arch. Orthop Clin North Am. 1975; 6 199-214
24 Mc Cullen G M, Yuan H A, Frederickson B E. Thoraco-lumbar spine injuries. In: An HS Principles and Techniques of Spine Surgery. Baltimore; Lippincott, Williams & Wilkins 1998: 359-384
25 Lifeso R M, Colucci M A. Anterior fusion for rotationally unstable cervical spine fractures. Spine. 2000; 25 2028-2034
26 Cantor J B, Lewohl N H, Garvey T, Eismont F J. Nonoperative management of stable thoracolumbar burst fracture with early ambulation and bracing. Spine. 1993; 18 971-976
27 Chow G H, Nelson B J, Gebhard J S, Brugman J L, Brown C W, Donaldson D H. Functional outcome of thoracolumbar burst fractures managed with hyperextension casting or bracing and early mobilization. Spine. 1996; 21 2170-2175
28 Wood K, Butterman G, Mehbod A, Garvey T, Jhanjee R, Sechriest V. Operative compared with nonoperative treatment of a thoracolumbar burst fracture without neurological deficit. A prospective, randomized study. J Bone Joint Surg Am. 2003; 85-A(5) 773-781
29 Gertzbein S D. Scoliosis Research Society. Multicenter spine fracture study. Spine. 1992; 17 528-540
30 Willen J, Anderson J, Toomoka K, Singer K. The natural history of burst fractures at the thoracolumnar junction. J Spinal Disord. 1990; 3 39-46
31 Edwards C C, Levine A M. Early rodsleeve stabilization of the injured thoracic and lumbar spine. Orthop Clin North Am. 1986; 17 121-145
32 Edwards C C, Levine A M, Weigel M C. Determinants of neurologic recovery following posttraumatic incomplete paraplegia. Orthop Trans. 1987; 11 453
33 Stambough J L. Posterior instrumentation for thoracolumbar trauma. Clin Orthop. 1997; 335 73-88
34 Ghanayem A J, Zdeblick T A. Anterior instrumentation in the management of thoracolumnar burst fractures. Clin Orthop. 1997 Feb; (335) 89-100
35 Deramond T H, Champion B, Clark W A. Management of acute osteoporotic vertebral fractures: a nonrandomized trial comparing percutaneous vertebroplasty with conservative therapy. Am J Med. 2003; 114(4) 257-265
36 Lieberman I H, Dudney M S, Reinhardt M K, Bell G. Initial outcome and efficacy of kyphoplasty in the treatment of painful osteoporotic vertebral compression fractures. Spine. 2001; 26 1631-1638
37 Phillips F M. Minimally invasive treatments of osteoporotic vertebral compression fractures. Spine. 2003; 28 S45-S53
38 Garfin S R, Reilley M A. Minimally invasive treatment of osteoporotic vertebral body compression fractures. Spine J. 2002; 2 76-80

Choll W KimM.D. Ph.D. Assistant Professor

Department of Orthopedic Surgery, University of California

San Diego, 200 West Arbor Drive

San Diego, CA 92103-8894