الفهرس 
Acknowledgements
EpidemiologyOnly 14 pages are availabe for public view
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Abstract
Thoracolumbar fracture is the most common skeletal injury of the axial skeleton and accounts for around 90% of all spinal fractures.Spinal cord injuryoccurs in about 10–30%of traumatic spinal fractures. Spinal cord injury occurs at the time of trauma rather than being a result of pressure from fragments persisting in the canal.
In this study, the purpose is to understand the relation between fracture pattern according to AO classification and the neurological recovery after TPSF.
This study is a prospective study which is conducted in the Trauma Unit of Assiut University Hospital. It included 60 patients with thoracolumbar spine fractures with neurological insult, who were treated with transpedicular screw fixation (TPSF) in the emergency department, from January 2016 till June 2017.
The age of the patients ranged from 16 years to 60 years. Males were predominant in this study.
Fall from height was the commonest mode of trauma and it was followed by motor car accidents. Fracture of L1 vertebra was the commonest followed by D12 fracture.
Fractures were classified according to AO classification. Type A was the least in number (only two patients); while type B was the commonest (45 Patients). Thirteen patients were presented with type C fractures.
Thirty seven patients (61.7%) underwent long segment TPSF and 23 patients (38.3%) underwent short segment TPSF. Thirty two patients (53.3%) underwent direct canal decompression while the remaining 28 patients (46.7%) underwent indirect decompression (Ligamentotaxis).
Patients were ob¬served for more than 12 months.Back Pain was assessed via VAS score and preoperative values improved significantly at last follow up (P< 0.001). Neurological evaluation at admission and final follow up according to Frankel classification showed that thirty nine patients of 60 (65%) improved at least one grade of Frankel classification (P<0.001). The total percentage of neurologic recovery was 34%.
The preoperative neurological insult was the highest in fracture AO- type C and the least in AO-type A. At final follow up, the neurological insult was still the highest in fracture AO- type C, and the least in AO-type B (P= 0.001). The best neurological recovery was observed in AO-type B (40%).
The severity of preoperative neurologic insult was the highest in thoracic spine fractures and the least was with TL junction (T11, T12& L1) fractures. At the final follow-up, neurologic com¬promise was the highest in thoracic spine fractures and the least was with lumbar fractures. The percentage of neurologic recovery was significantly the worst in thoracic spine fractures (0%) and the best was in the lumbar spine fractures (46%).
Canal compromise range decreased postoperatively by 32%.No relation was found between degree of canal compromise and neurological deficit of the patients neither preoperatively nor in final follow up. The 32 patients who underwent canal decompression showed (39%) neurological recovery while the remaining 28 who underwent indirect decompression) showed relatively less neurological recovery (25%) with no significant difference.
Functional assessment was done using ODI. Thirty patients (50%) were with minimal or moderate disability at final follow up.