Unstable spine fractures


Denis' three column concept helps to determine whether a vertebral fracture is stable or unstable

  • I: Anterior column
    • Anterior longitudinal ligament
    • Anterior 1/2 of the vertebral body and disk
  • II: Middle column
    • Posterior 1/2 of the vertebral body and disk
    • Posterior longitudinal ligament
  • III: Posterior column
    • Facet joints
    • Ligament flavum
    • Posterior elements

Examples of Unstable Cervical Spine Fractures

Clinical Features

  • I:Always stable
  • II:Possibly unstable
  • III:Always unstable


  • CT with reconstructions
  • Consider plain x-ray in conjunction as this is what is used during orthospine follow up
  • MRI to assess cord and ligament damage


  • C-collar
  • Consult ortho or spine as needed

See Also

  • Cervical Spine Injuries
  • Spinal Cord Trauma
  • Spinal Cord Compression (Non-Traumatic)
  • Neurogenic Shock
  • C-spine (NEXUS)
  • C-Spine X-Ray
  • Fractures (Main)


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