الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Background: Documented treatment of spine fractures dates back several thousands of years. Closed treatment and manipulation to correct the sustained deformity were typically used. In the early 20th century, most treatment consisted of immobilization in hyperextension. Internal fixation was first seen after World War II. Initially, it was in the form of spinous process plating. Harrington then introduced his posterior spinal instrumentation. from this, modern surgical techniques and instrumentation have developed. Holdsworth proposed the 2-column theory of spinal stability. In this model, the vertebra is divided into an anterior and posterior column. One of the most popular and useful classification systems is based on the ”three-column” theory proposed by Denis. The spine is divided into anterior, middle, and posterior columns.
Aim of the work: To evaluate the procedure of anterior surgical approach of thoracolumbar fractures to compare between decompression of the neural canal by just removal of the compressing bone fragments with metallic fixation by titanium plate and screws and decompression of the neural canal by removal of almost all the fractured vertebra and exchange it by distractable titanium cage with fixation by titanium plate and screws in point of clinical and radiological views.
Patients and methods: This study was carried out at Neurosurgical Department, Zagazig University Hospitals on 50 patients of thoracolumbar fractured spine undergoing anterior surgery who were divided into 2 groups: Group ”A”: Twenty five patients had partial decompression of the fractured vertebra by removal of the compressing bone fragments and interbody fusion with the adjacent ”superior and inferior” vertebrae using the removed bone fragments and the excised rib and metallic fixation by plate and screws. Group ”B”: Twenty five patients had removal of the most of the body of the fracture vertebra and the use of an artificial prosthesis (interbody distractable cage) filled of bone fragments from the corpectomy and excised rib instead of the body of the fracture vertebra and internal fixation by plate and screws. All patients were clinically evaluated preoperatively according to Frankle grading system. All patients had preoperatively: plain X-ray anterior-posterior and lateral views, CT and MRI for dorsolumbar spine. All patients were fitted with thoracolumbar orthosis for 3 months postoperatively and will then weaned over an additional 2 to 3 weeks.
Results: Middle age group was the most common. Males are more common than females. Falling from height is the much common cause for spinal fractures. Preoperatively, in group ”A”, there were 2 patients having Frankle B, 14 patients having Frankle C and 9 patients having Frankle D, but no patient had Frankle A or B and in group ”B”, there were 4 patients had Frnakle B, 17 patients having Frnakle C and 4 patients having Frankle D, but no patient had Frankle A or E. The most common fractured vertebral level was the first lumbar vertebra (32 cases), then the last dorsal vertebra (13 cases) and there was 5 cases having L2 fracture. Early postoperatively, in group ”A”, there were 2 patients having Frankle B, 7 patients having Frankle C and 16 patients having Frankle D, but no patients had Frankle A or E and in group ”B”, there were 8 patients having Frankle C and 17 patients having Frankle D, but no patients had Frankle A, B or E.
Conclusion: The anterior approach for fracture of the thoracolumbar spine provides excellent exposure and direct visualization for maximal decompression of the neural structures to promote neurological recovery.