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Semin Musculoskelet Radiol 2005; 09(1): 77-87
DOI: 10.1055/s-2005-867098
Copyright © 2005 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001 USA.

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
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Publication History

Publication Date:
05 April 2005 (online)

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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

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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