Analysis and improvement of the three-column spinal theory

• DOI: 10.1186/s12891-020-03550-5
• Publication Date: 2020-08-12T12:03:47Z
• 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
• Keywords: Adult; Male; Lumbar Vertebrae; Finite element force analysis; Diseases of the musculoskeletal system; Middle Aged; Thoracic Vertebrae; Fracture Fixation, Internal; 03 medical and health sciences; 0302 clinical medicine; RC925-935; Vertebral fractures; Humans; Spinal Fractures; Three-dimensional mapping; Three-column spinal theory; Research Article; Retrospective Studies

AbstractBackgroundDenis 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.MethodsA 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.ResultsThe 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.ConclusionThe 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