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Denis

three-column classification of spinal injury

Classifies thoracolumbar fractures by spinal columns involved.

vigenteSpine consensus1983CT
Fonte primária4 categorias
compressionCompression fractureburstBurst fractureseat-beltSeat-belt (Chance) injuryfracture-dislocationFracture-dislocation

Aplicar o Denis a um achado

Descreva o achado como no laudo. A resposta aponta uma das categorias publicadas, com a probabilidade e o trecho que a decide.

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Categorias

Reescritas a partir da fonte e citadas
compression
1 de 4

Compression fracture

Failure of the anterior column (anterior vertebral body) under flexion/axial load with the middle column intact, so the posterior vertebral wall and spinal canal are preserved.

CondutaGenerally stable: conservative management (bracing; vertebroplasty/kyphoplasty in selected cases). Posterior instrumentation/fusion reserved for severe injuries (e.g. >50% body-height loss or significant kyphosis).
RiscoMechanically stable with low neurologic risk because the middle column and canal are spared.
verificadoThe three-column spine and its significance in thoracolumbar injuries (Denis)NBK544310: compression = anterior column only, middle intact; stable, low neurologic risk; conservative bracing, surgery for severe height loss/kyphosis.
burst
2 de 4

Burst fracture

Compressive failure of both the anterior and middle columns; the middle column (posterior vertebral wall) is breached, often with retropulsion of bone into the canal; the posterior column may or may not be involved.

CondutaConsidered unstable: bracing for neurologically intact, mechanically stable cases; decompression with instrumented fusion when there is neurologic deficit, significant canal compromise, deformity, or posterior ligamentous disruption.
RiscoUnstable with moderate-to-high neurologic risk owing to middle-column failure and possible canal retropulsion.
verificadoThe three-column spine and its significance in thoracolumbar injuries (Denis)NBK544310: burst = anterior + middle column failure; unstable, moderate-high neurologic risk; bracing vs decompression/instrumented fusion per deficit/canal/deformity.
seat-belt
3 de 4

Seat-belt (Chance) injury

Flexion-distraction (seat-belt / Chance-type) injury: distraction failure that typically disrupts the posterior and middle columns (and may extend through all three) without anterior translation.

CondutaUnstable in distraction: bracing for minimally displaced bony (Chance) injuries; posterior instrumentation +/- fusion for ligamentous injury or kyphotic deformity (e.g. >20 degrees).
RiscoUnstable through distraction with moderate neurologic risk; associated intra-abdominal injuries are common with the seat-belt mechanism.
verificadoThe three-column spine and its significance in thoracolumbar injuries (Denis)NBK544310: flexion-distraction = distraction across columns, no translation; unstable, moderate neurologic risk; bracing vs posterior instrumentation per displacement/kyphosis.
fracture-dislocation
4 de 4

Fracture-dislocation

Failure of all three columns with associated translation/displacement (and/or rotation); mechanisms include shear, rotation, flexion, and tension.

CondutaMost unstable pattern: essentially all require operative open reduction with instrumented fusion (often with decompression).
RiscoHighly unstable with the highest neurologic injury risk of the Denis types due to three-column failure with translation.
verificadoThe three-column spine and its significance in thoracolumbar injuries (Denis)NBK544310: fracture-dislocation = all three columns + translation; highly unstable, high neurologic risk; all require open reduction with instrumented fusion.
Lógica de decisão estruturada
{
  "categories": [
    "compression",
    "burst",
    "seat-belt",
    "fracture-dislocation"
  ]
}

Referência, não é dispositivo médico. Confira a publicação primária vigente. O radiologista que assina o laudo continua autor e responsável.