الفهرس 
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Abstract
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 .
A pathological fracture is a fracture that occurs through a bone that is previously weakened by disease. Normally, the fracture occurs due to trivial violence and often the patient gives a history of pain or discomfort much before the fracture occurs.
The vast majority of spine fractures occur as a result of motor vehicle accidents (45%), falls (20%), sports (15%), acts of violence(15%), and miscellaneous activities (5%). Males are at four times higher risk than females. Other organ system injury is encountered in up to 50% thoracolumbar trauma patients. High-energy injuries, such as those causing thoracic level paraplegia, have a first-year mortality rate of 7%.
Numerous classification systems have been proposed for thoracolumbar fractures. The nature of these systems has changed over time, with better understanding of the spinal biomechanics as well as improvements in imaging technology.
As a management tool, The thoracolumbar injury classification and scoring system (TLICS) seems to be an acceptably reliable system when compared with the Denis and AO systems. There is a base level of knowledge and familiarity necessary for the application of the system at reliable levels.
An anterior approach is to be recommended on mechanical grounds to repair anterior bone loss, and neurologically, to release medullary compression by removing intracanal bone fragments. It provides a oneshot solution: decompression by corporectomy, reduction by anterior PDF created with pdfFactory trial version www.pdffactory.com spinal reopening, inter- or intrabody bone graft and, finally, plate osteosynthesis. Neurologic recovery rates are slightly better than in posterior surgery, with better spinal profile correction . It also involves a smaller number of instrumentally fixed levels.
This prospective non-randomized study was designed to evaluate the short-term functional and radiological outcome of patients undergoing
anterior decompression and fusion surgery for dorsal and lumbar spine
instability caused by traumatic or pathological fractures.
This study included fourteen patients with traumatic and pathologic
spine fractures of the dorsal and lumbar regions. The patients were
divided into two groups:
· Group (A): seven patients that underwent anterior approach
only with neural decompression, interbody bone fusion and
internal metallic fixation.
· Group (B): seven patients that underwent combined
anteroposterior approach, including posterior transpedicular
fixation in addition to anterior approach with neural
decompression, interbody bone fusion ± internal metallic
fixation.
The patients were treated in the Neurosurgical Departments in
Menofiya university hospital, Zagazig university hospital, Tanta
university Hospital and Naser institute hospital from 2010 to 2012.
The inclusion criteria were:
1. Patients with traumatic or pathological spine fracture of the dorsal
or lumbar region.
2. Single or double level instability.
3. incomplete neurologic deficit.
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4. Significant segmental kyphotic deformity
5. significant comminution of the vertebral body
6. Severe pain not controlled medically
The last three points were not considered obligatory inclusion
criteria yet they were not considered as grounds for exclusion.
The exclusion criteria were:
1. Previous Anterior approach surgery at the diseased levels.
2. Systemic metabolic disorders known to affect bone healing.
3. Osteoporosis (confirmed by Bone densimetry).
4. Abdominal or thoracic cavity pathology obscuring the surgical
corridor.
5. No major organ failure.
6. No extensive visceral involvement in case of metastasis.
All cases were subjected to thorough history taking, general and
neurological examinations and routine laboratory investigations. All cases
had first aid management lines, then subjected to imaging investigations
in the form of plain X-ray dorsal/lumbar spine; anteroposterior and lateral
views, computed tomography and magnetic resonance imaging of the
dorsal/lumbar spine. The cases with pathologic fractures were subjected
to thorough investigations including: metastatic workup, Bone scan, Bone
densimetry and Bacteriological laboratory tests according to the clinically
acquired data.
As regard to age distribution and the nature of the condition, we
noted that 75% of the trauma patients were <40 years old with the mean
age of 28.5 years, ranging from 18 years to 45 years. Fall from height was
the main cause in our trauma cases (75%) and represented 42.85% of the
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total number, while road traffic accidents caused only 25% of our trauma
cases and about 14.28% of the total number
In our study, group B had a better neurogenic improvement (the
average neurogenic improvement was 1.0 ASIA grade) than group A (the
average neurogenic improvement was 0.6 ASIA grade) and that – though
being statistically insignificant - may be due to better neural canal
decompression and the time factor in favor of Group B in which the
patients with neurologic deficits had an early initial (familiar) posterior
approach.