الفهرس 
ACKNOWLEDGMENT
(Lumbar vertebrae(L1-L5Only 14 pages are availabe for public view
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Abstract
1- Introduction:
In the trauma patients, thoracic and lumbar fractures occur in 150,000 individuals annually in United States, and account for 30-60% of all spinal injuries.
The thoracolumbar junction injuries are the commonest spinal injuries.
2-Aim of our sudy:
Assessment of the clinical, radiological and functional results of posterior long segment transpedicular screw fixation in type B (flexion distraction injury) of thoracolumbar spine fracture which is considered one of the unstable thoracolumbar spine fracture.
3-Epidemiology of our patients:
This study is a prospective study which was conducted in the Trauma Unit of Assiut University Hospital on patients with spine fractures in a period of one year :(January 2015 to December 2015).
a- Inclusion criteria :
• Traumatic single thoracolumbar vertebral fracture s .
• patients between (16 and 65)years old .
• AO type B (flexion distraction injuries) whatever the neurological condition of the patients.
b- Exclusion criteria:
• AO type ( A&C) spine fracture according to( AO) classification.
• Fractures reconstruction of anterior column.
• Pathological spine fracture.
c- Patients characterstics: The study includes (50) patients: (38) males (76%) patients,12 females ( 24% ), included aged from (16 to 65) years with mean of (33.6) years.
d-The mechanism of trauma : Fall from height(F.F.H) in 28 patients (56%) , motor car accidents(MCA) in (10) patients (20%), motor bike accident(MBA ) in 7 patients(14%), fall down stairs (FDS)in 2 patients (4%) ,heavy object trauma(HOT)in one patient (2%) and wall collapse in 2 patients(4%).
Chapter(10) Summary
e-Associated injuries : They included long bone fracture in(10%) of patients,(8%) associated with ankle injuries,(8%) of patients associated with calcaneus injury,(4%)of patients were associated with head injury , where (2%), and (6%) of them were associated with pelvis and ribs respectively.
4-material and methods of assessment: Three methods were used for patients assessment.
1-The clinical evaluation: Included; General examination: for chest, heart, abdomen and other injuries. Local examination: for evaluation of pain (VAS ),and neurological examination (Frankel grade).
2-The radiological evaluation:
A-Plain X-ray:
Plain X-ray was evaluated with AP and lateral views(AVH, PVH, Cobbe angle and IPD)also can be detected using x-ray imaging.
B-Computed Tomography (CT) scans :
CT Provided finer detail of the bony involvement in thoracolumbar injuries and(TLI) classification .also CT was used for assessment of canal compromise of our patients preoperatively and in follow up visits.
3-functional evaluation:
Oswestry Disability Index (also known as the Oswestry Low Back Pain Disability Questionnaire) is an extremely important tool that researchers and disability evaluators use to measure a patient’s permanent functional disability. The test is considered the ‘gold standard’ of low back functional outcome tools.
5-results of our study:
a-Distribution of spine fracture according to AO classification: Type (B2) was the most common type and type(B3) was the least .
b- Level of fractured vertebra:(L1)and (D12) were the most affected levels and (D10) was
the least affected level .
Chapter(10) Summary
c- Neurological examination of patients :
-All (25) patients who were neurologically free( Frankel E) showed no neurological deterioration at post operative and last follow up visits.
-Twenty patients of(25patients)(80%) with neurological deficit showed neurological improvement at least one grade ,while the only five patients who were complete paraplegia (Frankel A) showed no neurological improvement at post operative and last follow up visits.
d- Distribution of surgical techniques:
Transpedicular screw fixation and indirect decompression (ligamentotaxis) was done in 30 patients(60%) while transpedicular screw fixation with direct decompression was done in 20 patients(40%) .
e-Distribution of operative data:
• Time: ranged from( 60-130) minutes with mean value 101.1±19.88 m.
• Blood loss: ranged from (450- 1050) cc. with mean value 739.6±154.06cc.
• Blood transfusion: ranged from (0-1000)cc with mean value 362±245. 69cc.
f- Pain evaluation of studied patients(VAS): The pain was evaluated according to VAS.It showed significant improvement from9.5±0.7 preoperatively to 3.2±1.5 at last follow up
g- Radilogical assesment of studied patients:
• X-ray assessment:
This study showed that there was significant improvement in AVBH,PVBH and Cobbe angle in relation post operative and follow up .
• computed tomography(CT): This study shows that there is a significant improvement in spinal canal diameter postoperatively and at last follow up visits Preoperative evaluation of canal compromise showed no relation between degree of canal compromise and neurological deficit of the patients .