Junior call case 6

Three column theory of Denis:

o Anterior column = anterior 2/3 of vertebral bodies

o Middle column = posterior 1/3 of VB up to the posterior longitudinal ligament

o Posterior column = posterior elements

o If any 2 of the 3 columns are disrupted, the injury is considered unstable.

Patients with ankylosing spondylitis have fusion of the spine and the associated ligaments.

• They lose the natural flexibility of normal spines, conferred by the non-osseous intervertebral disc and more flexible non-ossified ligaments.
• Thus, they are at risk of catastrophic spinal injury with very minor trauma.
• There should be a very low threshold for CT imaging of this patient population.