====== Denis three-column model ======

{{rss>https://pubmed.ncbi.nlm.nih.gov/rss/search/1NqsX9BbHlDogR7UdhDMJikujKun7m_M59TsKTakFz8KrMJQVo/?limit=15&utm_campaign=pubmed-2&fc=20230926060647}}
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The [[TLICS]], [[SLIC]], and three-column classification systems cannot be applied to civilian [[gunshot wound]]s (CGSWS) to quantify injury severity, predict outcomes, or guide treatment decision-making. Despite significant neurologic injuries and disruption of multiple spinal columns, CSGSW do not appear to result in unstable injuries requiring operative intervention. Further research is needed to identify the rare spinal gunshot injury that would benefit from immediate surgical intervention
((Staggers JR, Niemeier TE, Neway WE 3rd, Theiss SM. Stability of the Subaxial Spine after Penetrating Trauma: Do Classification Systems Apply? Adv Orthop. 2018 Oct 9;2018:6085962. doi: 10.1155/2018/6085962. PMID: 30402292; PMCID: PMC6198542.)).
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Denis’ 3-column model of the spine attempts to identify [[CT]] criteria of the instability of [[thoracolumbar spine fracture]]s
((Denis F. The three-column spine and its significance in the classification of 
acute thoracolumbar spinal injuries. Spine (Phila Pa 1976). [[1983]]
Nov-Dec;8(8):817-31. PubMed PMID: 6670016.
)).
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From a [[retrospective]] [[study]] of 412 [[thoracolumbar injury]], [[Francis Denis]] introduced the concept of [[middle column]] or middle osteoligamentous complex between the traditionally recognized posterior [[ligament]]ous complex and the [[anterior longitudinal ligament]]. This middle column is formed by the posterior wall of the [[vertebral body]], the [[posterior longitudinal ligament]], and posterior [[annulus fibrosus]]. The third column appears crucial, as the mode of its failure correlates both with the type of [[spinal fracture]] and with its [[neurological deficit]]. [[Spine injury]] is subdivided into minor and major. Minor injuries are represented by fractures of [[transverse process]]es, [[facet]]s, [[pars interarticularis]], and [[spinous process]]. Major spinal injuries are classified into four different categories: [[compression fracture]]s, [[burst fracture]]s, seat-belt-type injuries, and fracture dislocations. These four well-recognized injuries have been studied carefully in clinical terms as well as on roentgenograms and computerized axial tomograms. They were then subdivided into subtypes demonstrating the very wide spectrums of these four entities
((Denis F. The three column spine and its significance in the classification of 
acute thoracolumbar spinal injuries. Spine (Phila Pa 1976). [[1983]]
Nov-Dec;8(8):817-31. PubMed PMID: 6670016.
)).

===== Anterior column =====

Anterior [[annulus fibrosus]] plus [[anterior longitudinal ligament]].

===== Middle column =====

Posterior [[annulus fibrosus]] plus [[posterior longitudinal ligament]].

===== Posterior column =====

[[Supraspinous ligament]] and [[interspinous ligament]], [[facet joint]]s and [[joint capsule]], and [[ligamentum flavum]].

Injury to this column alone does not cause instability.

===== Denis classification =====

see [[Denis classification]].