Denis · Coluna

Denis three-column classification of spinal injury

vigente

Classifies thoracolumbar fractures by spinal columns involved.

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Escala de categorias

compression burst seat-belt fracture-dislocation

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Procedência e vigência

Órgão emissor: Spine consensus
Versão: 1983
Ano: 1983
Família: léxico
Tipo de lógica: flat
Modalidade: CT
Fonte primária: The three-column spine and its significance in thoracolumbar injuries (Denis) · doi:10.1097/00007632-198311000-00003
Última verificação: 2026-06-26
Última checagem: 2026-06-26

Lógica de decisão

Forma estruturada (flat). Uma futura calculadora a lê; as categorias abaixo são a superfície legível.

Mostrar a lógica estruturada (JSON)

{
  "categories": [
    "compression",
    "burst",
    "seat-belt",
    "fracture-dislocation"
  ]
}

Categorias num relance

Cat.	Significado	Conduta	Risco	Fonte
compression	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.	Generally 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).	Mechanically stable with low neurologic risk because the middle column and canal are spared.	okfonte NBK544310: compression = anterior column only, middle intact; stable, low neurologic risk; conservative bracing, surgery for severe height loss/kyphosis.
burst	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.	Considered 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.	Unstable with moderate-to-high neurologic risk owing to middle-column failure and possible canal retropulsion.	okfonte NBK544310: burst = anterior + middle column failure; unstable, moderate-high neurologic risk; bracing vs decompression/instrumented fusion per deficit/canal/deformity.
seat-belt	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.	Unstable in distraction: bracing for minimally displaced bony (Chance) injuries; posterior instrumentation +/- fusion for ligamentous injury or kyphotic deformity (e.g. >20 degrees).	Unstable through distraction with moderate neurologic risk; associated intra-abdominal injuries are common with the seat-belt mechanism.	okfonte NBK544310: flexion-distraction = distraction across columns, no translation; unstable, moderate neurologic risk; bracing vs posterior instrumentation per displacement/kyphosis.
fracture-dislocation	Fracture-dislocation Failure of all three columns with associated translation/displacement (and/or rotation); mechanisms include shear, rotation, flexion, and tension.	Most unstable pattern: essentially all require operative open reduction with instrumented fusion (often with decompression).	Highly unstable with the highest neurologic injury risk of the Denis types due to three-column failure with translation.	okfonte NBK544310: fracture-dislocation = all three columns + translation; highly unstable, high neurologic risk; all require open reduction with instrumented fusion.

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