الفهرس 
Relevant anatomy of thoroacolumbar spineOnly 14 pages are availabe for public view
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Abstract
Background &Purpose: Ninety percent of spine fractures are related to the thoracolumbar region. Type A3 & A4 fractures are the most common among them. However their management is controversial. Nonsurgical management is related to some complications such as posttraumatic kyphosis which can consistently worsen the quality of life of the patient. The traditional open surgery may be an overtreatment in these types of fractures, considering blood loss, possible complications, hospital stay, and delayed functional recovery. In this setting, a good option can be a percutaneous minimally invasive surgery The purpose of this study was to assess the results, advantages & disadvantages of minimally invasive percutaneous fixation for type A3 & A4 thoracolumbar fractures.
Patients &Methods: In the period from September 2017 to December 2019, an interventional prospective study was conducted in Ain Shams University hospitals including 25 cases with types A3 & A4 thoracolumbar fracture. The patients were evaluated preoperatively including thorough history, neurological examination, radiologic findings including computerized tomography and plain radiographs to measure angle of kyphosis, vertebral wedging, anterior and posterior vertebral height loss.. Postoperative evaluation included the same radiographic assessment done preoperatively, complications were recorded and assessment of time of returning to the work was done. Visual analogue scale and Oswestry disability index. The evaluation was done for a minimum period of follow up of one year.
Results: Intraoperative blood loss was less than 100 ml in all cases. Operation time ranged from 80 to 110 minutes with a mean 86.4 minutes. Mean postoperative hospital stay was 48 hours. Regarding radiological parameters, the mean angle of kyphosis in our study was (12.52° preoperatively,-0.92° postoperatively and 2.42° at the end of follow up). The mean vertebral wedging was (15.68° preoperatively, 3.56° postoperatively and 5.58° at the end of follow up). The mean percentage of loss of anterior vertebral height was (28% preoperatively, 7% postoperatively and10% at the end of follow up). The mean percentage of loss of posterior vertebral height was (8% preoperatively, 3% postoperatively and 3% at the end of follow up). Regarding clinical assessment and functional scores, the mean VAS was 1.24, the mean ODI was 8 % at the last follow up visit. As regard return to work, all patients in our study returned to their original occupations.
Conclusion: Minimally invasive percutaneous fixation for type A3 & A4 thoracolumbar fractures is a safe and effective procedure with good functional and radiological outcomes, with additional benefits of short hospitalization and early rehabilitation without major complications.