The contribution of the three columns of the spine to spinal stability: a biomechanical model

The load carrying capacity (LCC) of the human spine was evaluated in 10 human cadaver spines. The specimens consisted of segments from T11 to S1 with markers placed on the specimens at each vertebral level in both Ap and lateral planes. The specimens were loaded to 1250 N and spinal deflections were recorded and photographed at 125 N intervals during the loading cycle. In 5 specimens, axial and flexion loads were applied to the intact spine. The anterior and middle columns were destroyed in sequence at L2 and the loading process repeated. In the remaining 5 specimens, axial and extension loads were applied with the spine intact and after the posterior and middle columns were destroyed in sequence at L2. Load deflection curves were generated for each test and comparisons were made between intact spines and spines with single and double column destruction.

When the axis of loading was anterior to the posterior longitudinal ligament (PLL), destruction of the anterior and middle columns reduced the LCC by 46% and 68% respectively and destruction of the posterior and middle columns reduced the LCC by 30% and 63% respectively. There was minimal change in the LCC when the axis of loading was posterior to the PLL and the anterior and middle columns were destroyed. Two column destruction of the spine reduced its load carrying capacity for flexion loads by 70%. In thoracolumbar spinal fractures where flexion loads are predominant and anticipated, the authors conclude that surgical stabilisation is indicated with double column failure.