الفهرس 
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Abstract
The incidence of thoracolumbar spine injuries is approximately 2% to 7.5% after blunt trauma to the back. 19% to 50% of these injuries have associated neurological deficits. Even in the absence of neurological deficits, injuries to thoracolumbar spine can be associated with long term pain and disability. (1)
The thoracolumbar spine is the transition point between the more rigid thoracic spine and the more flexible lumbar spine and, as a result, is predisposed to unique fracture patterns and neurological deficits. Higher prevalence of injury at the T11-L1 level than at more proximal aspects of the thoracic spine or distal lumbar spine. Unfortunately, in adults the part of spinal cord that ends near the mechanically vulnerable thoracolumbar junction contains the primary efferents for the lumbosacral roots (conus medullaris) and hence canal encroachment can have significant neurological consequences.(2)
Imaging studies are ultimately required to make the diagnosis of thoracolumbar injuries and to guide. To date, no standardized imaging algorism for assessment of spine trauma has been established, although many institutions have developed their own protocols in an attempt to minimize the incidence of missed injuries. The most common cause of a missed thoracolumbar injury is inadequate imaging, which occur not infrequently in the setting of a patient with urgent life-threatening conditions. (3)
Management of thoracolumbar burst fractures in a neurologically intact or compromised individual is the most controversial topic. Traditionally, treatment of burst fractures without neurological deficits is controversial and depending on extent of anterior height loss, localized kyphosis or percentage of canal compression. In cases of neurological deficits, surgery is indicated. (4)
The general goals of surgical management of all spinal fractures are similar: decompression of neural elements, correction of deformities and stabilization of the spine. Achievement of these goals is intended to maximize neurological functions, allow early mobilization and rehabilitation of the patient with prevention of pain and deformities. There is a little debate that surgical intervention has far greater potential than conservative treatment to correct deformity, decompress neural structures and provide immediate stability. (5)
In general, surgery for thoracolumbar injuries can be done from a posterior, anterior or combined approaches, depending on the goal of the procedure. The posterior approach is familiar to all spine surgeons and is the most commonly used. Posterior pedicle screw instrumentation is a common place as the technique used for achieving rigid stability. In principle, correction of sagittal and coronal plain deformities is most easily achieved and corrected with posterior approach. (6)
An anterior approach is used primarily for thoracolumbar burst fractures and pathological fractures in which vertebrectomy and anterior reconstruction are required either to decompress retropulsed fragments of bone directly off the ventral dura or to provide immediate reconstruction of the anterior weight-bearing column for reasons of mechanical stability. In principle, in the setting of severer neurological deficit as the result of a large retropulsed piece of bone, an anterior approach and corpectomy provide the most direct and ensured decompression of the neural elements for thoracolumbar burst fractures. (7)