الفهرس 
Anatomy and Biomechanics of thoracic and lumbar spineOnly 14 pages are availabe for public view
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Abstract
Traumatic injuries to the thoracolumbar region comprises 75% of total spinal skeletal injuries, a large portion of these thoracolumbar injuries specifically comprises the thoracolumbar junction (T10–L2). from a biomechanical perspective, the transfer of axially directly kinetic energy from a mobile lumbar spine to a stiff thoracic spine leads to a high incidence of injuries at this junction.
Surgical treatment of thoracolumbar fractures of the spine is usually necessary when there is impaired biomechanical stability, or existing or imminent neurological deficit, compression of the vertebral canal, or associated injuries that prevent conservative treatment.
Open surgical internal fixation may be associated with significant morbidity, such as denervation of the paraspinal muscles, increased intramuscular pressure, muscle ischemia, pain and blood loss. Percutaneous fixation has been used for spine fractures, and the initial results have a lower rate of complication.
Open operative stabilization with pedicle instrumentation remains a familiar, prevalent treatment for thoracolumbar burst fracture. Denis et al recommended open prophylactic stabilization in thoracolumbar burst fractures even in the absence of neurologic deficit. The posterior open approach is considered appropriate for neurologically intact patients with burst fractures and posterior ligamentous complex injuries. The use of an open posterior approach for pedicle screw instrumentation and reduction of thoracolumbar fractures has shown good radiologic and clinical outcomes.
With the advent of minimally invasive spine surgery, studies have evaluated the percutaneous approach for stabilization of thoracolumbar fractures. The minimally invasive surgery (MIS) approach to pedicle screw instrumentation of thoracolumbar fractures minimizes soft tissue injury, reduces intraoperative blood loss, and results in better postoperative pain scores than other approaches.
This study carried on100 neurologically intact patients with thoracolumbar fractures (only AO Spine type A); 50 patients have been treated by the percutaneous pedicle screw fixation technique and 50 patients have been treated by the open technique. The two groups were evaluated clinically, radiologically, laboratory (Creatine phosphokinase level) and surgically (operative time, perioperative blood loss, intraoperative radiation exposure time, complication, postoperative mobilization and hospital stay).
The result of the study is that, both treatment strategies are safe and effective, but the percutaneous pedicle fixation technique presents (intraoperative blood loss, VAS, operation time, postoperative hospital stay, muscles destruction according to postoperative CPK level and postoperative mobilization) results that are significantly better than the conventional open pedicle screw fixation. There were no significant differences regarding to the radiological parameters and functional outcome (ODI%) between both groups at the end of the follow up. The exposure to continuous x-ray should be considered as a disadvantage to percutaneous technique.
Thus, the results of this study indicate that percutaneous fixation is a valid, safe, and effective treatment for thoracolumbar fractures.