الفهرس 
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Abstract
Trauma, specially high velocity road traffic accidents, is one of the most common causes of death worldwide.
The combination of abdominal trauma and spinal trauma is most frequently caused by car accidents with restrained passengers. Association of Chance fractures and abdominal trauma in the presence of an abdominal wall contusion is well documented.
Liver & spleen are the most common injured intra-abdominal organs in blunt abdominal trauma. Hollow viscus injury is most commonly resulting from penetrating abdominal trauma. It is relatively infrequent in blunt abdominal trauma.
Mortality occurring early after injury is due to ”first hits”, including severe organ injury, hypoxia, hypovolaemia or head trauma. Massive injury leads to activation of the immune system and the early inflammatory immune response after trauma has been defined as systemic inflammatory response syndrome (SIRS). ”Second hits” such as infections, ischaemia/reperfusion or operations can further augment the pro-inflammatory immune response and have been correlated with the high morbidity and mortality in the latter times after trauma.
The initial evaluation of a person who is injured critically from multiple traumas follows a protocol of primary survey, resuscitation, secondary survey, and either definitive treatment or transfer to an appropriate trauma center for definitive care. This approach is the heart of the ATLS system, which is designed to identify life-threatening injuries and to initiate stabilizing treatment in a rapidly efficient manner.
Diagnosis of thoracolumbar injury includes brief history, physical examination and neurologic evaluation then radiological assessment by plain X-ray, CT and MRI which provide data for classification and prognosis.
Classification systems have evolved considerably during the last 75 years and this helps neurosurgeons for decision making.
The thoracolumbar injury severity score (TLISS) system (2006) is a novel classification scheme for describing and treating thoracolumbar injuries. It allows the simple classification of an injury by describing the mechanism of the injury, integrity of the PLC, and neurologic status. A point system is then assigned in a logical manner to these categories to arrive at a final score, which assists in injury treatment and decision making.
Combination of abdominal trauma and spinal trauma is a complex injury pattern, in which damage control management is effective. Intra- abdominal injuries are operated prior to vertebral injuries, and control of bleeding, and decontamination have the highest priority.
The optimal timing for surgical intervention has not been conclusively demonstrated. However, there is likely some neurological benefit to early decompression for patients with incomplete injuries or for those with neurological deterioration. It also assists in mobilizing patients, thereby preventing medical complications.
The evolution of the abbreviated laparotomy or “Damage Control” for trauma has improved patient survival by decreasing the operative stress on patients in physiologic exhaustion. This technique requires rapid control of bleeding and contamination, temporary abdominal closure, and then intensive care resuscitation of physiology with return to the operating room for eventual definitive operative repair. This sequence should be utilized in patients with coagulopathy, acidosis, and hypothermia.