# Denis — Denis three-column classification of spinal injury

> Classifies thoracolumbar fractures by spinal columns involved.

**Situação:** vigente · **Órgão:** Coluna · **Órgão emissor:** Spine consensus · **Versão:** 1983 · **Ano:** 1983

## Procedência e vigência
- Família: léxico
- Tipo de lógica: flat
- Modalidade: CT
- Fonte primária: Denis F. The three-column spine and its significance in thoracolumbar injuries (Denis) (1983) — https://doi.org/10.1097/00007632-198311000-00003
- Última verificação: 2026-06-26
- Última checagem: 2026-06-26

## Categorias

| Código | Rótulo | Critérios | Conduta | Risco | Localizador | Verificado |
| --- | --- | --- | --- | --- | --- | --- |
| 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. | 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. | 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. | 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. | NBK544310: fracture-dislocation = all three columns + translation; highly unstable, high neurologic risk; all require open reduction with instrumented fusion. | ✓ |

### Citações por categoria
- **compression**: Denis F. The three-column spine and its significance in thoracolumbar injuries (Denis) (1983) — https://doi.org/10.1097/00007632-198311000-00003 · NBK544310: compression = anterior column only, middle intact; stable, low neurologic risk; conservative bracing, surgery for severe height loss/kyphosis.
- **burst**: Denis F. The three-column spine and its significance in thoracolumbar injuries (Denis) (1983) — https://doi.org/10.1097/00007632-198311000-00003 · NBK544310: burst = anterior + middle column failure; unstable, moderate-high neurologic risk; bracing vs decompression/instrumented fusion per deficit/canal/deformity.
- **seat-belt**: Denis F. The three-column spine and its significance in thoracolumbar injuries (Denis) (1983) — https://doi.org/10.1097/00007632-198311000-00003 · NBK544310: flexion-distraction = distraction across columns, no translation; unstable, moderate neurologic risk; bracing vs posterior instrumentation per displacement/kyphosis.
- **fracture-dislocation**: Denis F. The three-column spine and its significance in thoracolumbar injuries (Denis) (1983) — https://doi.org/10.1097/00007632-198311000-00003 · NBK544310: fracture-dislocation = all three columns + translation; highly unstable, high neurologic risk; all require open reduction with instrumented fusion.


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> Conteúdo de referência reescrito. Confira a publicação primária vigente. Não é dispositivo médico nem substitui o julgamento clínico. O radiologista responsável pelo laudo permanece o autor e o responsável.

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