BACKGROUND: Pedicle screw fixation is a well-known and increasingly performed technique to achievernfixation and fusion especially in thoracolumbar region. This technique is used for variety of indications. Despite rntechnical advances in screw fixations complications can happen intraoperative or postoperative, and still PSF isrnassociated with a risk of complication. rnOBJECTIVE: To assess early complicat ions and short term neurologic outcome following thoracolumbarrnpedicle screw fixat ions at two Ethiopian teaching hospitals. rnMETHODS: One year hospital-based prospective descriptive study was conducted on 68 patients thatrnunderwent posterior thoracolumbar pedicle screw fixation and fusion at ALERT and MCM hospitals from rnSeptember 2019 to August 2020. To determine the existence and level of association between independent andrndependent variables bivariate PearsonÂ´s correlation analysis was done, and multiple regression analysis was alsorndone to identify the existence of statistically significant association between independent variables and neurologicrnstatus at 3rnrdrn month. rnRESULTS: 52 male and 16 female patients were included. The mean age was 31.79. Indications for hardwarernplacement were trauma - 82.4 % (56 patients), degenerative and spondylolisthesis - 11.8% (8 patients), tumour -rn2.9% (2 patients), infection - 1.5 % (1 patient), and one patient L2 screw fracture (previously PSF was done).rnA total of 351 screws were inserted. Most screws (76 screws - 21.7%) were inserted at the level of T12. rnDetermined accuracy rate screws inserted was 88.0%, with screw malposition rate of 12%. Highest number ofrnbreech was found at the level of T12 - 9 breeches. Medial breech was the commonest (47.6 % of breeches, 20rnscrews), followed by anterior breech (38.09 %, 16 screws). rnIntra-op complications happened for 16 patients (23.5%), 8 were intra-op CSF leak, 7 - intra-op pedicle fracture,rnand one nerve root injury. Early post-op complications that happened during hospital stay were one deep SSI, twornUTI, three HAI, and five bed sores. Complications after discharge were two superficial SSI, two UTI, sevenrnadditional bedsores. Revision surgery was done for two patients (2.9%). rnOn neurologic evaluation at third month, 72.9% of patient (35 patients) were neurologically the same, 14.6% (7rnpatients) had some improvement, and 12.5% (6 patients) had significant improvement. The majority of patientsrn87.9% did not receive physiotherapy. rnWith 95% CI, only the presence of associated other site of injury (P=0.02) and lower extremity power statusrn(P=0.02) have moderate correlation with the development of in-patient complications with r value of .404 andrn.362 respectively. On multiple regression analysis pre-op sensory level has a negative and significant effect onrnneurologic outcome at third month (standardized beta = . -1.690). rnCONCLUSIONS: Trauma was the commonest indication for fixation. Based on our result finding posteriorrnthoracolumbar pedicle screw fixations and fusions with can be done with acceptable complication rate and goodrnrecovery considering the limited resources. Since our follow-up period was only 3 month, we recommend furtherrnfollow-up study of these patients for assessing late instrument related complications.