الفهرس 
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Abstract
Successful surgical treatment of thoracolumbar fractures using posterior instrumentation system can restore the height of fractured vertebrae while correcting segmental kyphosis. However, recent studies have demonstrated that loss of correction is common in thoracolumbar fractures repaired with short segment posterior instrumentation.
The aim of this work was to evaluate retrospectively a group of 20 patients who sustained unstable thoracolumbar fractures and were treated with long segment posterior fixation.
The patients’ age ranged between 18 to 50 years with a mean of 29.7 years. Most of the patients (60%) were in the age group of 20-29 years. There were 14 male and six female patients. Three patients had associated calcaneal fractures and one had a tibial plateau fracture. The mechanism of injury was fall from a height in 60% and road traffic accidents in 40% of cases. All patients had type A3 burst fractures according to the AO classification. The most frequent level of injury was LV1 (35%), followed by LV2 (25%) and DV12 (20%). The pre-operative neurological status was grade E in 85% of cases, grade C in 10% of cases and grade B in 5% of cases according to ASIA classification. The pre-operative load sharing scores were 7 in 60% of cases, 8 in 25% of cases and 9 in 15% of cases. The pre-operative local kyphotic angle was more than 10º in 45% of cases, between 5º and 10º in 30% of cases and less than 5º in 25% of cases. The pre-operative anterior vertebral body compression percentage (AVBC %) was more than 30% in 35% of cases and between 15% and 30% in 65% of cases. The pre-operative canal compromise was less than 30% in 85% of cases, between 30% and 50% in 10% of cases and 60% in 5% of cases.
All patients were treated with long segment posterior fixation with two pairs of polyaxial pedicular screws above and two pairs below the fractured vertebra, after reduction of the fracture and canal decompression together with posterior intertransverse fusion. The follow up period ranged from 6 to18 months with an average of 10 months.
The results showed that 40% of patients had no pain and 55% had mild to moderate pain (satisfactory results). Also, 30% returned to their previous work without restrictions, and 60% returned with restrictions (satisfactory results). According to ASIA neurological status scale, 95% of patients had score E post-operatively compared to 85% pre-operatively, and 5% improved from score B to score D post-operatively, but this was statistically insignificant. There was post-operative improvement of the mean local kyphotic angle from 9.4º±5.3 pre-operatively to 5.85º±3.03 post-operatively, and this was statistically significant. Although, at the last follow up the mean became 6.50º±4.14 denoting that there was a loss of correction of 11.11%. There was a statistically significant improvement of the mean anterior vertebral body compression percentage (AVBC %), when comparing the pre-operative values with the post-operative and the follow-up ones. However, by comparing the post-operative compression percentage with the last follow-up values, there was no statistically significant difference. The canal compromise percentages improved post-operatively in all patients. The fractures healed at 6 months in 5 cases (25%) and during 6-18 months in 15 cases (75%). One patient had broken screws and another had loosening and migration of the screws.