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Guo X, Li Z, Guo Z, Li W. Factors associated with non-fusion after direct pars repair of lumbar spondylolysis with pedicle screw and lamina hook: a clinical and CT-assessed study. BMC Musculoskelet Disord 2024; 25:152. [PMID: 38368342 PMCID: PMC10873963 DOI: 10.1186/s12891-024-07252-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 02/02/2024] [Indexed: 02/19/2024] Open
Abstract
BACKGROUND Pedicle screw and lamina hook (PSLH) technique is an effective and popular method for direct pars repair of lumbar spondylolysis. There is a lack of studies to explore factors that may influence the healing of spondylolysis after direct pars repair surgery. The present study aimed to investigate the factors associated with non-fusion after direct pars repair of lumbar spondylolysis with PSLH technique. METHODS A total of 55 subjects (average age 21.1 ± 6.3 years, a total of 120 pars defects) diagnosed with symptomatic spondylolysis and underwent pars repair surgery with PSLH were followed up and their clinical data were analyzed. Subjects were divided into a non-fusion group and fusion group according to whether the pars defect had bony fusion at last follow-up assessed by CT. Radiographic data, data related to spondylolysis and clinical outcomes were collected and compared between groups. RESULTS The mean follow-up time of the 55 patients was 24.8 ± 12.0 (12-64) months. Among the 120 pars defects, 101 defects were successfully fused and 19 were not fused according to CT. The fusion rate was 84.2%. Multivariable logistic regression analysis showed the factors correlated with non-fusion after pars repair surgery: whether the spondylolysis segment was associated with spina bifida occulta (SBO) (P = 0.001), stage of the defect (P = 0.047), width of the defect (P = 0.002), and disc degeneration (P = 0.014). CONCLUSION Direct pars repair by PSHL is a reliable treatment for lumbar spondylolysis with a fusion rate of 84.2%. Association with SBO of the spondylolysis segment, a terminal stage of the defect, a wider defect gap, and grade III disc degeneration may be factors associated with non-fusion after direct pars repair of lumbar spondylolysis with PLSH. Non-fusion patients after pars repair appear to have worse clinical results compared to fusion patients.
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Affiliation(s)
- Xinhu Guo
- Department of Orthopaedics, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China
- Beijing Key Laboratory of Spinal Disease Research, Beijing, China
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China
| | - Zhuofu Li
- Department of Orthopaedics, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China
- Beijing Key Laboratory of Spinal Disease Research, Beijing, China
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China
| | - Zhaoqing Guo
- Department of Orthopaedics, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China
- Beijing Key Laboratory of Spinal Disease Research, Beijing, China
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China
| | - Weishi Li
- Department of Orthopaedics, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China.
- Beijing Key Laboratory of Spinal Disease Research, Beijing, China.
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China.
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Li DM, Li YC, Jiang W, Peng BG. Application of a new anatomic hook-rod-pedicle screw system in young patients with lumbar spondylolysis: A pilot study. World J Clin Cases 2022; 10:5680-5689. [PMID: 35979102 PMCID: PMC9258354 DOI: 10.12998/wjcc.v10.i17.5680] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 03/28/2022] [Accepted: 04/20/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The pedicle screw-laminar hook system has strong fixation and is conducive to bone graft fusion for lumbar spondylolysis. However, the current pedicle screw-laminar hook fixation system is not specifically designed for lumbar spondylolysis. AIM To investigate the clinical effects of a new anatomical hook-rod-pedicle screw system in the treatment of lumbar spondylolysis in young adults. METHODS We designed a new anatomic hook-rod-pedicle screw system for young patients with lumbar spondylolysis. The isthmus and the corresponding pedicle screw entry point were exposed through the intermuscular approach. Autogenous iliac bone graft was obtained to bridge the isthmus defect, and then the anatomic hook-rod-pedicle screw system was used to fix the isthmus in 15 young patients. RESULTS At 24 mo follow-up, the visual analogue scale score of low back pain decreased from 6.73 ± 0.88 to 0.73 ± 0.59, and the Oswestry disability index score decreased from 58.20 ± 8.99 to 7.87 ± 4.97. Computed tomography showed bilateral isthmic bone healing in 14 cases and unilateral isthmic bone healing in 1 case. Magnetic resonance imaging showed that the lumbar disc signal of diseased segment and adjacent segments had no change compared with that before surgery. The pain visual analogue scale score of the donor site was 0.20 ± 0.41 at the last follow-up. According to the Modified Macnab score, the excellent and good rate was 100%. CONCLUSION The application of this new anatomical hook-rod-pedicle screw system to treat young patients with lumbar spondylolysis has the advantages of less trauma, a simple operation and satisfactory clinical effects.
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Affiliation(s)
- Duan-Ming Li
- Department of Orthopaedics, The Third Medical Center of PLA General Hospital, Beijing 100039, China
| | - Yong-Chao Li
- Department of Orthopaedics, The Third Medical Center of PLA General Hospital, Beijing 100039, China
| | - Wei Jiang
- Department of Anesthesiology, The Third Medical Center of PLA General Hospital, Beijing 100039, China
| | - Bao-Gan Peng
- Department of Orthopaedics, The Third Medical Center of PLA General Hospital, Beijing 100039, China
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Zayan M, Hussien MA, El Zahlawy H. Pars interarticularis repair using pedicle screws and laminar hooks fixation technique in patients with symptomatic lumbar spondylolysis. SICOT J 2022; 8:13. [PMID: 35389337 PMCID: PMC8988864 DOI: 10.1051/sicotj/2022013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 03/22/2022] [Indexed: 11/23/2022] Open
Abstract
STUDY DESIGN Prospective case series. PURPOSE To assess the outcomes of pars repair surgery using pedicle screws and laminar hooks. METHODS This study was conducted on 22 patients with symptomatic lumbar spondylolysis. Curettage of the fibrocartilage in the defect and drilling of the sclerotic bone ends were done, followed by impaction of cancellous bone graft. Pedicle screws were inserted bilaterally in the corresponding pedicles and connected to a laminar hook via rods (screw-rod-hook fixation). The intensity of back pain and the functional outcome were assessed using the visual analog scale (VAS) and the Oswestry disability index (ODI). Plain radiographs were performed immediately postoperatively and after 3 and 6 months. CT scan was done at the final follow-up to assess pars healing. The mean follow-up period was 27 months. RESULTS The mean preoperative VAS and ODI were 7.4 ± 0.8 and 64.8 ± 6.7, which improved to 2.4 ± 0.8 and 20 ± 6 respectively at the final follow-up (P < 0.001). Healing of the defect was found in 19 patients at the final follow-up. Non-fusion with graft resorption was noticed in the remaining 3 cases (13.6%). However, postoperative VAS and ODI values improved even in the radiologically non-fused patients. LEVEL OF EVIDENCE Therapeutic study, Level IV. CONCLUSION Pars repair using pedicle screws and laminar hooks is a relatively simple yet effective procedure.
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Affiliation(s)
- Mohammed Zayan
- Department of Orthopedic surgery, Faculty of Medicine, Ain Shams University 38 Abbassia Square, Next to Al-Nour Mosque Cairo 11865 Egypt
| | - Mohammed Ali Hussien
- Department of Orthopedic surgery, Faculty of Medicine, Ain Shams University 38 Abbassia Square, Next to Al-Nour Mosque Cairo 11865 Egypt
| | - Hany El Zahlawy
- Department of Orthopedic surgery, Faculty of Medicine, Ain Shams University 38 Abbassia Square, Next to Al-Nour Mosque Cairo 11865 Egypt
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Wang PT, Zhang JN, Liu TJ, Yang JS, Hao DJ. Multivariate analysis of pedicle screw invasion of the proximal facet joint after lumbar surgery. BMC Musculoskelet Disord 2022; 23:39. [PMID: 34991578 PMCID: PMC8740339 DOI: 10.1186/s12891-021-04975-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 12/20/2021] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND To analyze the risk factors for pedicle screw invasion of the proximal facet joint after lumbar surgery. METHODS From January 2019 to January 2021, 1794 patients with lumbar degenerative disease, such as lumbar disc herniation, lumbar spinal stenosis and lumbar spondylolisthesis, were treated at our hospital. In all, 1221 cases were included. General data (sex, age, BMI), bone mineral density, proximal facet joint angle, degenerative lumbar spondylolisthesis, isthmic lumbar spondylolisthesis and fixed segment in the two groups were recorded. After the operation, vertebral CT of the corresponding surgical segments was performed for three-dimensional reconstruction and evaluation of whether the vertebral arch root screw interfered with the proximal facet joint. The included cases were divided into an invasion group and a noninvasion group. Univariate analysis was used to screen the risk factors for pedicle screw invasion of the proximal facet joint after lumbar surgery, and the selected risk factors were included in the logistic model for multivariate analysis. RESULTS The single-factor analysis showed a significant difference in age, BMI, proximal facet joint angle, degenerative lumbar spondylolisthesis, and fixed segment (P < 0.1). Multifactor analysis of the logistic model showed a significant difference for age ≥ 50 years (P < 0.001, OR = 2.291), BMI > 28 kg/m2 (P < 0.001, OR = 2.548), degenerative lumbar spondylolisthesis (P < 0.001, OR = 2.187), gorge cleft lumbar relaxation (P < 0.001, OR = 2.410), proximal facet joint angle (35 ~ 45°: P < 0.001, OR = 3.151; > 45°: P < 0.001, OR = 3.578), and fixed segment (lower lumbar spine: P < 0.001, OR = 2.912). CONCLUSION Age (≥ 50 years old), BMI (> 28 kg/m2), proximal facet joint angle (35 ~ 45°, > 45°), degenerative lumbar spondylolisthesis, isthmic lumbar spondylolisthesis and fixed segment (lower lumbar spine) are independent risk factors for pedicle screw invasion of the proximal facet joint after lumbar surgery. Compared with degenerative lumbar spondylolisthesis, facet joint intrusion is more likely in isthmic lumbar spondylolisthesis.
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Affiliation(s)
- Peng Tao Wang
- Spine Surgery, Honghui Hospital Affiliated with Xi’an Jiaotong University, Xi’an City, 710054 Shaanxi Province China
| | - Jia Nan Zhang
- Spine Surgery, Honghui Hospital Affiliated with Xi’an Jiaotong University, Xi’an City, 710054 Shaanxi Province China
| | - Tuan Jiang Liu
- Spine Surgery, Honghui Hospital Affiliated with Xi’an Jiaotong University, Xi’an City, 710054 Shaanxi Province China
| | - Jun Song Yang
- Spine Surgery, Honghui Hospital Affiliated with Xi’an Jiaotong University, Xi’an City, 710054 Shaanxi Province China
| | - Ding Jun Hao
- Spine Surgery, Honghui Hospital Affiliated with Xi’an Jiaotong University, Xi’an City, 710054 Shaanxi Province China
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Wang PT, Zhang JN, Liu TJ, Yang JS, Hao DJ. Comparison of degenerative lumbar spondylolisthesis and isthmic lumbar spondylolisthesis: effect of pedicle screw placement on proximal facet invasion in surgical treatment. BMC Musculoskelet Disord 2022; 23:6. [PMID: 34980080 PMCID: PMC8725374 DOI: 10.1186/s12891-021-04962-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 12/07/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pedicle screw invasion of the proximal articular process will cause local articular process degeneration and acceleration, which is an important factor affecting adjacent segment degeneration. Although lumbar spondylolisthesis is a risk factor for screw invasion of the proximal joint, there is no clear conclusion regarding the two different types of spondylolisthesis. Therefore, the purpose of this study was to explore the influence of pedicle screw placement on proximal facet invasion in the treatment of degenerative spondylolisthesis and isthmic spondylolisthesis. METHODS In total, 468 cases of lumbar spondylolisthesis treated by decompression and fusion in our hospital from January 2017 to January 2020 were included in this retrospective study. Among them, 238 cases were degenerative spondylolisthesis (group A), and 230 cases were isthmic spondylolisthesis (group B). Sex, age, body mass index, bone mineral density, preoperative visual analog scale (VAS) and Oswestry Disability Index (ODI) scores, postoperative VAS and ODI scores at 1 month and 3 months, and angle of the proximal facet joint at the last follow-up were recorded and compared between the two groups. The degree of pedicle screw invasion of the proximal facet joint was graded and compared by the SEO grading method. RESULTS There were no significant differences in sex, age, body mass index, bone mineral density, preoperative VAS and ODI scores, or proximal facet joint angle between the two groups (P > 0.05). There was no significant difference in VAS and ODI scores between the two groups at 1 month and 3 months after the operation (P > 0.05). The VAS score of group A at the last follow-up was 1 (1,2). The VAS score of group B at the last follow-up was 3 (1,3). The ODI score of group A at the last follow-up was 6(4,26). The ODI score of group B at the last follow-up was 15(8,36). The VAS and ODI scores of the two groups at the last follow-up were significantly different (P < 0.05). According to the SEO grading method, the invasion of the proximal articular process by pedicle screw placement in group A involved 320 cases in grade 0, 128 cases in grade I and 28 cases in grade II. In group B, there were 116 cases in grade 0, 248 cases in grade I and 96 cases in grade II, with a significant difference (P < 0.01). CONCLUSION In summary, a certain number of cases involving screws invading the proximal facet joint occurred in the two different types of lumbar spondylolisthesis, but the number in the isthmic spondylolisthesis group was significantly higher than that in the degenerative spondylolisthesis group, which caused more trauma to the proximal facet joint and significantly affected the patient prognosis.
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Affiliation(s)
- Peng Tao Wang
- Spine Surgery, Honghui Hospital Affiliated, Xi'an Jiaotong University, Xi'an City, 710054, Shaanxi Province, China
| | - Jia Nan Zhang
- Spine Surgery, Honghui Hospital Affiliated, Xi'an Jiaotong University, Xi'an City, 710054, Shaanxi Province, China
| | - Tuan Jiang Liu
- Spine Surgery, Honghui Hospital Affiliated, Xi'an Jiaotong University, Xi'an City, 710054, Shaanxi Province, China
| | - Jun Song Yang
- Spine Surgery, Honghui Hospital Affiliated, Xi'an Jiaotong University, Xi'an City, 710054, Shaanxi Province, China
| | - Ding Jun Hao
- Spine Surgery, Honghui Hospital Affiliated, Xi'an Jiaotong University, Xi'an City, 710054, Shaanxi Province, China.
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Debnath UK. Lumbar spondylolysis - Current concepts review. J Clin Orthop Trauma 2021; 21:101535. [PMID: 34405089 PMCID: PMC8358467 DOI: 10.1016/j.jcot.2021.101535] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 06/27/2021] [Accepted: 07/26/2021] [Indexed: 12/27/2022] Open
Abstract
Lumbar pars interarticularis (PI) injury or spondylolysis occurs only in humans. This represents a stress fracture of the PI. Excessive loading in repetitive hyperextension is a significant risk factor and occurs most commonly at L5 followed by L4. It is bilateral in 80% of symptomatic cases but can be unilateral defect as well which runs a more benign course. Symptoms of low back pain relating to this lesion are more common in young athletes involved in trunk twisting sports. Like other stress fractures, the pain may come on abruptly or more insidiously over time and only related to certain activities. The pathologic progression starts with a stress reaction in the pars, progressing to an incomplete stress fracture, and then a complete pars fracture. Diagnosis is dependent on clinical examination and radiological imaging studies (plain radiography, computed tomography (CT) scans and magnetic resonance imaging (MRI) scans). Treatment is dependent on symptoms as well as radiographic stage of the lesion. Conservative management is the mainstay of treating early lesions. A comprehensive rehabilitation program incorporates core spinal stabilization exercises. Athletes should not return to sports until pain free. Professional sporting individuals are at increased risk of failure of resolution of symptoms that may require early surgical repair of the PI defect. Modified Buck's technique & pedicle screw-hook constructs for direct repair has a high success rate in patients who have persistent low back pain. Minimally invasive lumbar pars defect repair has given similar successful outcome with added advantage of minimizing muscle injury, preserving the adjacent joint and reduced hospital stay. Functional outcome is evaluated using the Visual Analogue Scale (VAS) for back pain, Oswestry Disability Index (ODI) and 36-Item Short-Form Health Survey (SF-36). Preoperative ODI and SF-36 physical component scores (PCS) are significant predictor of a good functional outcome.
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Affiliation(s)
- Ujjwal K Debnath
- Professor of Orthopaedics, Jagannath Gupta Institute of Medical Sciences, Kolkata
- Consultant Orthopaedic & Spine, Surgeon, Fortis Hospital, Kolkata
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Comparing Surgical Treatments for Spondylolysis: Review on Current Research. Clin Spine Surg 2021; 34:276-285. [PMID: 33298798 DOI: 10.1097/bsd.0000000000001115] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 11/07/2020] [Indexed: 11/27/2022]
Abstract
STUDY DESIGN Narrative review. OBJECTIVE To compare the various surgical methods of repairing spondylolysis defects in regard to improving pain, restoration of function, radiographic improvement, and complication rate. SUMMARY OF BACKGROUND DATA Spondylolysis is a defect in the pars interarticularis of the vertebral arch, typically in the lumbar vertebra. Treatment can be nonoperative and/or surgical. There are various types of surgical repair including spinal compression, fusion, and direct pars repair. METHODS A comprehensive review of the English literature was performed utilizing Medline, Embase, and Web of Science. Inclusion criteria included papers or abstracts that evaluated the surgical techniques. Exclusion criteria included non-English-language papers or abstracts with inadequate information about outcomes. RESULTS Postoperative pain levels and patient function were consistently improved, regardless of surgical technique chosen. Positive clinical outcomes after surgery were seen more often in patients under age 20 and those who underwent minimally invasive repairs. Positive radiographic improvements were reported broadly, although some reported higher rates of nonunion with spinal compression. Complication rates were low throughout and minimally invasive techniques reported decreased blood loss and shorter hospital stays. CONCLUSIONS Present surgical options appear largely comparable in terms of their ability to provide meaningful treatment for spondylolysis where conservative treatments have failed or otherwise remain unattempted.
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Omran K, Othman AM. Lumbar Spondylolysis Reconstruction-Stabilization Using a Motion-Preserving Technique. World Neurosurg 2021; 154:e698-e706. [PMID: 34358690 DOI: 10.1016/j.wneu.2021.07.124] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 07/24/2021] [Accepted: 07/26/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Conservative methods are the traditional options in the management of lumber spondylolysis whereas surgery is indicated for symptomatic patients not responding to medical treatment and cases with a multilevel pars defect. The aim of this prospective study was to evaluate the clinical, functional, and radiologic results of using bone graft and fixation with pedicular screw-rod-laminar hook construct in treatment of lumber spondylolysis. PATIENTS AND METHODS Between October 2017 and January 2020, 20 patients with symptomatic lumbar spondylolysis not responding to conservative treatment for more than 6 months were treated by defect reconstruction fixation using bone block autografting and pedicular screw laminar hook construct. The mean follow-up time was 12.5 ± 03.5 months. All patients were examined pre- and postoperatively and followed up clinically (pain [visual analog scale]), functionally (Oswestry Disability Index, Modified Prolo Functional Economic Scales, and Macnab criteria), and radiologically (pars defect healing). Perioperative outcomes and complications were documented. RESULTS Clinical, radiologic, and functional outcomes were significantly improved. Bony union was evident in all patients (100%). Blood loss, operative time, and hospital stay increased in cases with a multilevel pars defect and cases with associated injuries. Two cases reported complications in this study as misplaced pedicular screw and superficial wound infection. CONCLUSIONS Reconstruction fixation of pars defect using this construct is an effective, feasible procedure in the treatment of lumber spondylosis regarding the preservation of lumbar motion and avoidance of adjacent-segment problems after fusion.
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Affiliation(s)
- Khaled Omran
- Department of Orthopedic Surgery and Traumatology, Faculty of Medicine, Minia University, El-Minia, Egypt; Minia University Spine Unit (MUSU), Faculty of Medicine, Minia University, El-Minia, Egypt.
| | - Ahmed M Othman
- Department of Orthopedic Surgery and Traumatology, Faculty of Medicine, Minia University, El-Minia, Egypt; Minia University Spine Unit (MUSU), Faculty of Medicine, Minia University, El-Minia, Egypt
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Kumar N, Madhu S, Pandita N, Ramos MRD, Tan BWL, Lopez KG, Alathur Ramakrishnan S, Jonathan P, Nolan CP, Shree Kumar D. Is there a place for surgical repair in adults with spondylolysis or grade-I spondylolisthesis-a systematic review and treatment algorithm. Spine J 2021; 21:1268-1285. [PMID: 33757872 DOI: 10.1016/j.spinee.2021.03.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 01/13/2021] [Accepted: 03/16/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVES Pars repair is less explored in adults due to associated disc degeneration with advancing age. The aim of our systematic review was to define optimal characteristics of adults with spondylolysis/grade-I spondylolisthesis suitable for pars repair and evaluate the feasibility, effectiveness, and safety of standard repair techniques in these adults. METHODS This systematic review is reported in line with PRISMA-P and protocol is registered with PROSPERO (CRD42020189208). Electronic searches were conducted in PubMed, Embase, Scopus, and Web of Science in June 2020 using systematic search strategy. Studies involving adults aged ≥18-years with spondylolysis/grade-1 isthmic spondylolisthesis treated with standard pars repair techniques were considered eligible. A two-staged (titles/abstracts and full-text) screening was conducted independently by three authors followed by quality assessment using the Joanna Briggs Institute critical appraisal checklist for selection of final articles for narrative synthesis. RESULTS A total of 5,813-articles were retrieved using systematic search strategy. First screening followed by removal of duplicates resulted in 111-articles. Second (full-text) screening resulted in exclusion of 64-articles. A final 47-articles were considered for data extraction after quality assessment. A total of 590-adults were enrolled across 47-studies; 93% were 'young adults' (18-35 years); 82% were males. Persistent low back pain was the common presenting complaint. Lysis defect was primarily bilateral (96.4%) and L5 was the most involved level (68.5%). Majority had no disc degeneration (83.5%) and had spondylolysis as the primary diagnosis (86%); only 14% had grade-I spondylolisthesis. Pars infiltration test was conducted in 22-studies and discography in 8-studies. Duration of prior conservative therapy was 3 to 72-months. Buck's repair was the commonest technique (27-studies, 372-adults). Successful repair was reported in 86% of patients treated with Buck's and ≥90% treated with Scott's, Morscher's and pedicle-screw-based techniques. Improvement in pain/functional outcomes, union rate and rate-of-return to sports/activity was high and comparable across all techniques. Intraoperative blood loss was low with minimally invasive versus traditional repair. The overall complication rate was 11.9%, with implant failure being the major complication. CONCLUSIONS Our systematic review establishes a definite place for lysis repair in carefully selected adults with spondylolysis/grade-I spondylolisthesis. We propose a treatment algorithm for optimizing patient selection and outcomes. We conclude that adults with age 18 to 45 years, no/mild disc or facet degenerative changes, positive diagnostic infiltration test, and normal preoperative discography will have successful outcomes with pars repair, regardless of the technique.
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Affiliation(s)
- Naresh Kumar
- Department of Orthopaedic Surgery, National University Health System, Singapore.
| | - Sirisha Madhu
- Department of Orthopaedic Surgery, National University Health System, Singapore
| | - Naveen Pandita
- Department of Orthopaedic Surgery, National University Health System, Singapore
| | - Miguel R D Ramos
- Department of Orthopaedic Surgery, National University Health System, Singapore
| | - Barry W L Tan
- Department of Orthopaedic Surgery, National University Health System, Singapore
| | - Keith G Lopez
- Department of Orthopaedic Surgery, National University Health System, Singapore
| | | | - Paul Jonathan
- Department of Orthopaedic Surgery, National University Health System, Singapore
| | - Colum P Nolan
- Department of Neurosurgery, National Neuroscience Institute, Singapore
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Barakat AS, Soliman WS, Elgharabawy AF, Fawaz K, Diab NM, Alinani WG, Azzam A, Sultan AM. Repair of spondylolysis using a pedicle screw U-shaped rod construct: A preliminary study of 25 young patients with a mean follow-up of 24 months. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2021; 12:170-177. [PMID: 34194164 PMCID: PMC8214231 DOI: 10.4103/jcvjs.jcvjs_36_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 03/31/2021] [Indexed: 11/13/2022] Open
Abstract
Study Design: Prospective case series, therapeutic Level IV. Objectives: Functional and radiographic outcome evaluation of patients with spondylolysis treated with pars interarticularis defect repair with iliac bone grafting and application of a construct consisting of a pair of polyaxial pedicle screws connected by a U-shaped rod passing beneath the spinous process. Methods: Twenty-five patients (27 operated lumbar levels) with an average of 20 months of follow-up (range 12–24 m) with spondylolysis who met our inclusion criteria were treated with the above-mentioned technique. Functional assessment was by the Visual Analog Score (VAS) for low back pain (LBP) and Oswestry Disability Index (ODI). Fusion was confirmed with plain x-rays and when indicated with computed tomography scan. Return to activities of daily living (ADL) was also assessed. Results: There were 16 males (64%) and 9 females (36%), with a mean age of 18 ± 3 years at surgery, with a mean operating time of 79 ± 13 min and a mean blood loss of 186 ± 57 ml. ODI significantly improved from a mean of 63 ± 7 preoperatively to 10 ± 4 at 12 months postoperatively (P < 0.001). The mean preoperative LBP VAS score 8 ± 1 showed also a statistically significant decrease of values to 1 ± 1 at 12 months, (P < 0.001). At 12 m, all patients returned to unrestricted ADL. Pars healing was present in 19 patients (76%) at 6 months and in all patients at 12 months. Conclusions: Polyaxial pedicular screws with a U-shaped rod offer an effective and reproducible treatment for spondylolysis with an appropriate fusion rate, predictable return to daily activities, and good pain relief in young adults.
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Affiliation(s)
| | | | | | - Khaled Fawaz
- Department of Orthopedics and Traumatology, Cairo University, Cairo, Egypt
| | - Nader M Diab
- Department of Orthopedics and Traumatology, Cairo University, Cairo, Egypt
| | | | - Akram Azzam
- Department of Orthopedics and Traumatology, Cairo University, Cairo, Egypt
| | - Ahmed Maher Sultan
- Department of Orthopedics and Traumatology, Cairo University, Cairo, Egypt
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A Novel Technique for Spondylolysis Repair With Pedicle Screws, Rod and Polyester Band: Case Report With Technical Note and Systematic Literature Review. Spine (Phila Pa 1976) 2020; 45:E1682-E1691. [PMID: 32947495 DOI: 10.1097/brs.0000000000003697] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Systematic review and case report. OBJECTIVE Our study aims to present a new technique using three components to repair the pars defect: pedicle screws, rod and polyester band. Furthermore, we perform a systematic literature review of the previously described techniques. SUMMARY OF BACKGROUND Spondylolysis is a common condition in children and adolescents. Depending on the severity it may be treated either nonoperatively or surgically. Surgery is required if nonoperative treatment failed to give sustained pain relief. Several surgical techniques have been described. METHODS The literature review investigates the database (MEDLINE-EMBASE-Cochrane-ScienceDirect) up to May 2019 for studies presenting a surgical technique for spondylolysis.The Screw-Rod-Band (SRB) technique combines the use of pedicle screws, a rod and a polyester band to repair the spondylolysis. The horizontal rod connects the pedicle screws. The polyester band linked to the rod passes below the spinous process to apply compressive forces on the pars. RESULTS Twenty-one out of 982 studies described a surgical procedure. Eight main different techniques were identified: Isthmic Screw, Wiring, Butterfly-Plate, Hook-Screw Construct, Shaped-Rod, Laminar-Screw, and two combination technique (Lag Screw and Tension Band Fixation and Cortical Screws and Spinous-Process ModularLink). Our technique showed immediate postoperative clinical improvement. No surgical or perisurgical complication occurred. CONCLUSION The systematic literature review revealed a great number of surgical techniques for the spondylolysis, demonstrating the lack of consensus.SRB technique is an effective and simple treatment for pars fixation. The surgical procedure puts the pars under strong compression. The results are comparable with procedures present in the literature and seems capable to reduce the invasiveness and the risk of neurological injury. LEVEL OF EVIDENCE 2.
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Jin M, Zhang J, Shao H, Liu J, Zhao T, Huang Y. Percutaneous endoscopic-assisted direct repair of pars defect without general anesthesia could be a satisfying treatment alternative for young patient with symptomatic lumbar spondylolysis: a technique note with case series. BMC Musculoskelet Disord 2020; 21:340. [PMID: 32487055 PMCID: PMC7268338 DOI: 10.1186/s12891-020-03365-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Accepted: 05/25/2020] [Indexed: 02/08/2023] Open
Abstract
Background Multiple surgical procedures are applied in young patients with symptomatic lumbar spondylolysis when conservative treatments fail. Although the optimal surgical procedure option is controversial, the treatment paradigm has shifted from open surgery to minimally invasive spine surgery. To date, a limited number of studies on the feasibility of percutaneous endoscopic-assisted direct repair of pars defect have been carried out. Herein, for the first time, we retrospectively explore the outcomes of pars defect via percutaneous endoscopy. Methods We retrospectively examined young patients with spondylolysis treated using the percutaneous endoscopic-assisted direct repair of pars defect supplemented with autograft as well as percutaneous pedicle screw fixation between September 2014 and December 2018. Six patients with a mean age of 18.8 years were enrolled in the study. We used preoperatively computed tomographic (CT) scans to evaluate the size of pars defect, and graded disc degeneration using Pfirrmann’s classification through magnetic resonance images (MRI). We assessed the clinical outcomes using the Oswestry Disability Index (ODI), 36-Item Short-Form Health Survey (SF-36) as well as Visual Analogue Scale for back pain (VAS-B). Results Our findings revealed that pain intensity and function outcomes, including VAS-B, ODI, and SF-36 (PCS and MCS) scores, were markedly improved after surgery and at the final follow-up visit. The change in the gap distance of the pars defect was remarkably significant after surgery and during the follow-up period. Only one of the 12 pars repaired was reported as a non-union at the final follow-up visit. Moreover, no surgery-related complications were reported in any of the cases. Conclusion Percutaneous endoscopic-assisted direct repair of pars defect without general anesthesia, a minimally invasive treatment option, supplemented with autograft and percutaneous pedicle screw fixation, could be a satisfying treatment alternative for young patients with symptomatic lumbar spondylolysis.
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Affiliation(s)
- Mengran Jin
- Department of Orthopaedics, Zhejiang Provincial People's Hospital, Shangtang Road No. 158, Hangzhou, 310014, Zhejiang Province, China.,People's Hospital of Hangzhou Medical College, Zhejiang Provincial People's Hospital, Hangzhou, 310014, Zhejiang Province, China
| | - Jun Zhang
- Department of Orthopaedics, Zhejiang Provincial People's Hospital, Shangtang Road No. 158, Hangzhou, 310014, Zhejiang Province, China.,People's Hospital of Hangzhou Medical College, Zhejiang Provincial People's Hospital, Hangzhou, 310014, Zhejiang Province, China
| | - Haiyu Shao
- Department of Orthopaedics, Zhejiang Provincial People's Hospital, Shangtang Road No. 158, Hangzhou, 310014, Zhejiang Province, China.,People's Hospital of Hangzhou Medical College, Zhejiang Provincial People's Hospital, Hangzhou, 310014, Zhejiang Province, China
| | - Jianwen Liu
- Department of Orthopaedics, Zhejiang Provincial People's Hospital, Shangtang Road No. 158, Hangzhou, 310014, Zhejiang Province, China.,People's Hospital of Hangzhou Medical College, Zhejiang Provincial People's Hospital, Hangzhou, 310014, Zhejiang Province, China
| | - Tingxiao Zhao
- Department of Orthopaedics, Zhejiang Provincial People's Hospital, Shangtang Road No. 158, Hangzhou, 310014, Zhejiang Province, China.,People's Hospital of Hangzhou Medical College, Zhejiang Provincial People's Hospital, Hangzhou, 310014, Zhejiang Province, China
| | - Yazeng Huang
- Department of Orthopaedics, Zhejiang Provincial People's Hospital, Shangtang Road No. 158, Hangzhou, 310014, Zhejiang Province, China. .,People's Hospital of Hangzhou Medical College, Zhejiang Provincial People's Hospital, Hangzhou, 310014, Zhejiang Province, China.
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Takeuchi M, Tezuka F, Chikawa T, Hibino N, Takahashi Y, Yamasaki Y, Momota K, Henmi T, Maeda T, Sairyo K. Consecutive double-level lumbar spondylolysis successfully treated with the double “smiley face” rod method. THE JOURNAL OF MEDICAL INVESTIGATION 2020; 67:202-206. [DOI: 10.2152/jmi.67.202] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Makoto Takeuchi
- Department of Orthopedic Surgery, Tokushima Prefecture Naruto Hospital, Tokushima, Japan
- Department of Orthopedics, Tokushima University Graduate School, Tokushima, Japan
| | - Fumitake Tezuka
- Department of Orthopedics, Tokushima University Graduate School, Tokushima, Japan
| | - Takashi Chikawa
- Department of Orthopedic Surgery, Tokushima Prefecture Naruto Hospital, Tokushima, Japan
| | - Naohito Hibino
- Department of Orthopedic Surgery, Tokushima Prefecture Naruto Hospital, Tokushima, Japan
| | - Yoshinori Takahashi
- Department of Orthopedic Surgery, Tokushima Prefecture Naruto Hospital, Tokushima, Japan
| | - Yuhei Yamasaki
- Department of Orthopedic Surgery, Tokushima Prefecture Naruto Hospital, Tokushima, Japan
| | - Kaori Momota
- Department of Orthopedic Surgery, Tokushima Prefecture Naruto Hospital, Tokushima, Japan
| | - Tatsuhiko Henmi
- Department of Orthopedic Surgery, Tokushima Prefecture Naruto Hospital, Tokushima, Japan
| | - Toru Maeda
- Department of Orthopedics, Tokushima University Graduate School, Tokushima, Japan
| | - Koichi Sairyo
- Department of Orthopedics, Tokushima University Graduate School, Tokushima, Japan
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Mohammed N, Patra DP, Narayan V, Savardekar AR, Dossani RH, Bollam P, Bir S, Nanda A. A comparison of the techniques of direct pars interarticularis repairs for spondylolysis and low-grade spondylolisthesis: a meta-analysis. Neurosurg Focus 2019; 44:E10. [PMID: 29290131 DOI: 10.3171/2017.11.focus17581] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Spondylosis with or without spondylolisthesis that does not respond to conservative management has an excellent outcome with direct pars interarticularis repair. Direct repair preserves the segmental spinal motion. A number of operative techniques for direct repair are practiced; however, the procedure of choice is not clearly defined. The present study aims to clarify the advantages and disadvantages of the different operative techniques and their outcomes. METHODS A meta-analysis was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The following databases were searched: PubMed, Cochrane Library, Web of Science, and CINAHL ( Cumulative Index to Nursing and Allied Health Literature). Studies of patients with spondylolysis with or without low-grade spondylolisthesis who underwent direct repair were included. The patients were divided into 4 groups based on the operative technique used: the Buck repair group, Scott repair group, Morscher repair group, and pedicle screw-based repair group. The pooled data were analyzed using the DerSimonian and Laird random-effects model. Tests for bias and heterogeneity were performed. The I2 statistic was calculated, and the results were analyzed. Statistical analysis was performed using StatsDirect version 2. RESULTS Forty-six studies consisting of 900 patients were included in the study. The majority of the patients were in their 2nd decade of life. The Buck group included 19 studies with 305 patients; the Scott group had 8 studies with 162 patients. The Morscher method included 5 studies with 193 patients, and the pedicle group included 14 studies with 240 patients. The overall pooled fusion, complication, and outcome rates were calculated. The pooled rates for fusion for the Buck, Scott, Morscher, and pedicle screw groups were 83.53%, 81.57%, 77.72%, and 90.21%, respectively. The pooled complication rates for the Buck, Scott, Morscher, and pedicle screw groups were 13.41%, 22.35%, 27.42%, and 12.8%, respectively, and the pooled positive outcome rates for the Buck, Scott, Morscher, and pedicle screw groups were 84.33%, 82.49%, 80.30%, and 80.1%, respectively. The pedicle group had the best fusion rate and lowest complication rate. CONCLUSIONS The pedicle screw-based direct pars repair for spondylolysis and low-grade spondylolisthesis is the best choice of procedure, with the highest fusion and lowest complication rates, followed by the Buck repair. The Morscher and Scott repairs were associated with a high rate of complication and lower rates of fusion.
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Yabuno S, Yunoki M, Kanda T, Matsumoto A, Hirashita K, Yoshino K. A Case of Nonconsecutive Multiple-level Lumbar Spondylolysis Successfully Treated with Single-level Repair of the Pars Interarticularis. NMC Case Rep J 2019; 6:29-34. [PMID: 30701153 PMCID: PMC6350032 DOI: 10.2176/nmccrj.cr.2018-0147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 10/02/2018] [Indexed: 11/20/2022] Open
Abstract
Lumbar spondylolysis is commonly recognized at a single-level of the lumbar spine and frequently affects the L5 pars interarticularis unilaterally or bilaterally. Some reports have described multiple-level spondylolysis, most cases of which occur at consecutive lumbar segments. We herein present a rare case of lumbar spondylolysis involving nonconsecutive multiple-level segments; only eight such cases have been reported previously. A 38-year-old man presented with a 10-month history of chronic severe low back pain. Lumbar flexion–extension radiographs and computed tomography revealed spondylolysis at the level of L3 and L5, whereas no spondylolisthesis was present and the intervertebral disc spaces were maintained at all levels. Because 6 months of conservative management failed and repeated diagnostic blocks confirmed that the fracture of the L3 pars interarticularis was generating pain, repair of the bilateral L3 pars interarticularis with the smiley face rod method was performed. At the last follow-up 1 year after surgery, the patient had resumed normal life as a laborer and reported no back pain.
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Affiliation(s)
- Satoru Yabuno
- Department of Neurosurgery, Kagawa Rosai Hospital, Marugame, Kagawa, Japan
| | - Masatoshi Yunoki
- Department of Neurosurgery, Kagawa Rosai Hospital, Marugame, Kagawa, Japan
| | - Takahiro Kanda
- Department of Neurosurgery, Kagawa Rosai Hospital, Marugame, Kagawa, Japan
| | - Atsushi Matsumoto
- Department of Neurosurgery, Kagawa Rosai Hospital, Marugame, Kagawa, Japan
| | - Koji Hirashita
- Department of Neurosurgery, Kagawa Rosai Hospital, Marugame, Kagawa, Japan
| | - Kimihiro Yoshino
- Department of Neurosurgery, Kagawa Rosai Hospital, Marugame, Kagawa, Japan
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Linhares D, Cacho Rodrigues P, Ribeiro da Silva M, Matos R, Veludo V, Pinto R, Neves N. Minimum of 10-year follow-up of V-rod technique in lumbar spondylolysis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2018; 28:1743-1749. [DOI: 10.1007/s00586-018-5833-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 11/14/2018] [Indexed: 02/07/2023]
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Gagnet P, Kern K, Andrews K, Elgafy H, Ebraheim N. Spondylolysis and spondylolisthesis: A review of the literature. J Orthop 2018; 15:404-407. [PMID: 29881164 PMCID: PMC5990218 DOI: 10.1016/j.jor.2018.03.008] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 03/16/2018] [Indexed: 02/07/2023] Open
Abstract
Spondylolysis is a common diagnosis with a high prevalence in children and adolescents complaining of low back pain. It may be caused by either a defect or fracture of the pars interarticularis due to mechanical stress. Depending on the severity of the spondylolysis and symptoms associated it may be treated either conservatively or surgically, both of which have shown significant success. Conservative treatments such as bracing and decreased activity have been shown to be most effective with patients who have early diagnosis and treatment. Low-intensity pulsed ultrasound (LIPUS) in addition to conservative treatment appears to be very promising for achieving a higher rate of bony union. LIPUS requires more supporting studies, but may prove to become a standard of care in the future. Surgery may be required if conservative treatment, for at least six months, failed to give sustained pain relief for the activities of daily living. Based on studies performed on each of the major surgical treatments we suggest the use of the pedicle screw hook technique and the pedicle screw rod technique due to low rates of hardware failure, increased maintenance of mobility, and lack of a postoperative bracing requirement.
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Affiliation(s)
- Paul Gagnet
- Department of Orthopaedic Surgery, University of Toledo Medical Center, 3000 Arlington Avenue, Toledo, OH, USA
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Debnath UK, Scammell BE, Freeman BJC, McConnell JR. Predictive Factors for the Outcome of Surgical Treatment of Lumbar Spondylolysis in Young Sporting Individuals. Global Spine J 2018; 8:121-128. [PMID: 29662741 PMCID: PMC5898674 DOI: 10.1177/2192568217713008] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
STUDY DESIGN Retrospective consecutive case series. OBJECTIVES Only few sporting individuals with symptomatic lumbar pars injuries require surgical repair and it is often difficult to predict the outcome following surgery. The factors that predict the outcome after direct repair of lumbar pars defect was evaluated clinically and statistically. The preoperative background variables both subjective and objective as well as radiological evaluation were used in a multiple regression model to find the strong predictors of postoperative outcome as measured by VAS (visual analogue scores), ODI (Oswestry Disability Index) and SF-36 (Short Form). METHODS Fifty-two consecutive young sporting individuals with a mean age of 19 years (range 8-30 years) were treated surgically for lumbar pars defect confirmed on imaging studies (ie, single-photon emission computed tomography, computed tomography, and magnetic resonance imaging). Fifty patients completed the VAS, ODI, and SF-36 questionnaires as a part of their assessment. Preoperative background variables were used in a multiple regression model to find the strongest predictor of postoperative outcome as measured by ODI. Ethical approval was taken by the institutional review board. RESULTS Buck's screw repair of the pars defect was carried out in 44 patients (33 males, 11 female): unilateral in 8 patients (7 males, 1 female) and bilateral in 36 patients (26 males, 10 females). Although age at surgery showed linear colinearity (ρ = 0.32, P < .05), it was not significant in the model. The most consistent association with the preoperative VAS score were the pre- and postoperative ODI scores, that is, ρ = 0.51 (P < .01) and ρ = 0.33 (P < .05), respectively. In the bilateral group, with Buck's repair at a single level, that is, 33 of 36 (93%) patients had returned to sports at a mean time of 7.5 months (range 6-12 months). Overall, 44 of 52 (84%) individuals had returned to their sports with posttreatment ODI score of <10. The stepwise regression modeling suggested 6 independent factors (preoperative ODI, preoperative SF-36 physical component summary (PCS), Buck's repair, multiple operations, professionalism, and pars defect at L3), as the determinants of the outcome (ie, postoperative ODI) in 80.9% patients (R2 = 0.809). CONCLUSIONS The outcome after direct repair of pars defect in those younger than 25 years runs a predictable course. Professionalism in sports has a high impact on the outcome. Preoperative ODI and SF-36 PCS scores are significant predictors of good functional outcome. The regression equation can predict the outcome in 80.9% sporting individuals undergoing Buck's repair.
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Affiliation(s)
| | - B. E. Scammell
- Queens Medical Centre, University of Nottingham, Nottingham, UK
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Ishida K, Aota Y, Mitsugi N, Kuniya T, Morii T, Kawai T, Yamada K, Saito T. Spondylolysis repair using a pedicle screw hook or claw-hook system. -a comparison of bone fusion rates. Spine Surg Relat Res 2018; 2:135-139. [PMID: 31440659 PMCID: PMC6698499 DOI: 10.22603/ssrr.2017-0011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 09/10/2017] [Indexed: 11/05/2022] Open
Abstract
Introduction To assess the bone fusion rates and clinical results of two surgical methods (pedicle screw claw-hook fixation and pedicle screw hook fixation) of lumbar spondylolysis repair. Methods A multicenter database of surgical patients with lumbar spondylolysis was reviewed. All patients < 20 years old with a minimum of 6 months of follow-up and computed tomography images were included. Operation time and blood loss amount were investigated. Visual analogue scale (VAS; 0-10) scores for lower back pain were evaluated to assess clinical results. Results A total of 17 patients met the inclusion criteria. Pedicle screw hook fixation was performed in five patients (the hook group), and pedicle screw claw-hook fixation was performed in 13 patients (the claw-hook group). One patient was included in both groups because each method was performed at different lumbar levels (L4 and L5). The bone fusion rates at 3, 6, and 9 months after surgery were significantly higher in the claw-hook group than those in the hook group. Operation time and blood loss amount were not significantly different between the groups. VAS scores improved in the claw-hook group but not in the hook group because of a small number of patients. Conclusions Pedicle screw claw-hook fixation was more effective than pedicle screw hook fixation in terms of bone fusion rates.
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Affiliation(s)
- Ko Ishida
- Department of Orthopedic Surgery, Yokohama City University Medical Center, Kanagawa, Japan
| | - Yoichi Aota
- Department of Spine Surgery, Yokohama City Brain and Spine Center, Kanagawa, Japan
| | - Naoto Mitsugi
- Department of Orthopedic Surgery, Yokohama City University Medical Center, Kanagawa, Japan
| | - Takashi Kuniya
- Department of Orthopedic Surgery, Yokohama City University Medical Center, Kanagawa, Japan
| | - Takaaki Morii
- Department of Orthopedic Surgery, Yokohama City University Medical Center, Kanagawa, Japan
| | - Takuya Kawai
- Department of Spine Surgery, Yokohama City Brain and Spine Center, Kanagawa, Japan
| | - Katsutaka Yamada
- Department of Orthopedic Surgery, Yokohama City University, Kanagawa, Japan
| | - Tomoyuki Saito
- Department of Orthopedic Surgery, Yokohama City University, Kanagawa, Japan
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Raudenbush BL, Chambers RC, Silverstein MP, Goodwin RC. Indirect pars repair for pediatric isthmic spondylolysis: a case series. JOURNAL OF SPINE SURGERY 2017; 3:387-391. [PMID: 29057347 DOI: 10.21037/jss.2017.08.08] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Isthmic spondylolysis (ISY) is a common cause of back pain in the pediatric population. Historically, non-operative treatments have had a very high success rate. The purpose of this study was to review the mid-term results of an indirect pars repair technique on reducing the visual analog score for pain (VAS), spondylolysis defect healing, complication rates and rates of return to pre-surgery activity level in pediatric patients who failed conservative care for ISY. METHODS A retrospective review of all pediatric patients (<18 years old) treated surgically by one surgeon over a 5-year period was performed. Patients were treated with indirect pars repair utilizing pedicle screws and laminar hooks and local autograft. Preoperative VAS was compared to the final follow-up score, and return to activity was evaluated. Radiographs were reviewed to evaluate healing. RESULTS Nine patients (6 females, 3 males) were treated surgically. Average age at the time of surgery was 15.4 years, (range, 13 to 17 years). Average length of final follow-up was 11.9 months (range, 6 to 24 months). Preoperative VAS averaged 5.6 points (range, 2 to 8 points) compared to final follow-up of 1.2 (range, 0 to 3). Definitive bony healing was noted in 7 of 9 cases (77.8%) with at least 6 months follow-up. Eight of nine patients (88.9%) returned to preoperative competitive sports activity level. No complications were noted during the follow-up period. CONCLUSIONS Pediatric patients treated surgically with indirect pars repair appear to achieve satisfactory mid-term outcomes. This technique appears safe, and has both a high healing rate and return to competitive athletics. Further study is needed to determine durability of this procedure.
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Affiliation(s)
- Brandon L Raudenbush
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Reid C Chambers
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Michael P Silverstein
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Ryan C Goodwin
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA
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Irrigation endoscopic assisted percutaneous pars repair: technical note. Spine J 2016; 16:1276-1281. [PMID: 27345745 DOI: 10.1016/j.spinee.2016.06.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 05/03/2016] [Accepted: 06/21/2016] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Spondylolysis is a common source of low back pain in children and adolescents. Despite the benign natural history of the pathology, however, it should be noted that as part of conservative management many young individuals are forced to discontinue their routine sports activities. In cases resistant to conservative management, direct repair of a pars defect is considered a safe and effective option in young adults with preserved discs. Recently, some reports of minimally invasive pars repair have been described, aiming at preservation of the paraspinal muscles and improvement of the postoperative course. PURPOSE The study aimed to present a new minimally invasive endoscopic technique for pars repair. STUDY DESIGN This is a technical note. PATIENT SAMPLE Seven consecutive patients complaining of back pain due to spondylolysis and resistant to conservative management were included. OUTCOME MEASURES Outcome was assessed using the modified Macnab criteria, and bone union was assessed on postoperative radiographs. METHODS Two portals of 0.5 cm were used on each side, 1 cm lateral to the midline. One portal is used for the endoscope and the second for the surgical instruments. Following endoscopic debridement of the defect, the inferior portal was used for percutaneous placement of the Buck screw. There was no source for external funding for this study and no potential conflict of interest to disclose. RESULTS Outcome was excellent in six cases and good in one case. All patients returned back to their normal level of activities. Complete radiographic union was seen in all patients. The mean period of postoperative hospital stay and follow-up was 8 hours and 21 months, respectively. CONCLUSIONS The irrigation endoscopic technique has previously shown promising results in lumbar discectomy and laminectomy. Similar results were observed in the current study on the ability to achieve minimally invasive pars defect debridement and a smooth postoperative course. This is a pilot study and larger patient series and different surgeons' experience are required for further evaluation of the technique.
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Jia M, Wang J, Zhang Z, Zheng W, Zhou Y. Direct Repair of Lumbar Pars Interarticularis Defects by Utilizing Intraoperative O-Arm-Based Navigation and Microendoscopic Techniques. Spine (Phila Pa 1976) 2016; 41 Suppl 19:B6-B13. [PMID: 27488290 DOI: 10.1097/brs.0000000000001815] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A retrospective analysis of the clinical outcomes of eight patients with the lumbar pars interarticulars defects treated by direct repair with the aid of intraoperative O-arm based navigation and microendoscopic techniques. OBJECTIVE The aim of this study was to investigate the efficacy and safety of direct screw repair by using minimally invasive surgery for the lumbar pars interarticulars defects in a pilot study. SUMMARY OF BACKGROUND DATA Direct repair of pars interarticulars defects has been used to treat young adult patients. Reports concerning direct repair by minimally invasive techniques for pars interarticulars defects are quite rare. METHODS Review of medical records identified eight consecutive patients treated with intraoperative O-arm based navigation and microendoscopic techniques. Debridement and autograft of pars interarticularis defects was performed under microendoscopic procedure. Then, percutaneous bilateral intralaminar screws were inserted by utilizing intraoperative navigation. The clinical and radiological data were collected and analyzed retrospectively. RESULTS Eight patients had a mean age of 28.4 years, and five were 30 years or younger at the time of treatment. Symptoms included axial back pain in 100% of patients without concomitant radiculopathy. Autograft was used in all cases. The average follow-up duration was 27.4 months with a range of 20 to 33 months. Symptoms resolved completely or partially in all patients. Low back pain visual analog scores decrease from preoperative 6.8 to postoperative 1.4 of eight cases. Of 16 pars defects, healing was observed in 13 (81.3%) at last radiological follow-up. One patient with bilateral fusion failure refused revision surgery because of mild complaint. No complications such as dural tear, nerve root injury, and infection occurred. CONCLUSION Minimally invasive direct repair of the pars interarticularis defects with intralaminar screws by using microendoscopic system and navigation procedure can provide safe and effective treatment of spondylolysis with satisfactory clinical and radiological outcomes, which need some special tools with steep learning curve. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- Min Jia
- Department of Orthopaedic Surgery, Affiliated Xinqiao Hospital, The Third Military Medical University, Chongqing, People's Republic of China
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Posterior Dynamic Stabilization With Direct Pars Repair via Wiltse Approach for the Treatment of Lumbar Spondylolysis: The Application of a Novel Surgery. Spine (Phila Pa 1976) 2016; 41:E494-502. [PMID: 26630436 DOI: 10.1097/brs.0000000000001295] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A retrospective study to evaluate the clinical outcomes of a novel surgical method for treating patients with lumbar spondylolysis. OBJECTIVE The aim of this study was to investigate the effectiveness of posterior ISOBAR TTL stabilization of the lumbar spine with direct pars repair using Wiltse approach for the treatment of lumbar spondylolysis with or without slight spondylolisthesis and discuss the indications of this surgery. SUMMARY OF BACKGROUND DATA Surgical treatment of lumbar spondylolysis has yielded relatively good results. However, there are still many limitations of the current surgical methods, including, adjacent level degeneration, restricted indications, and soft tissue damage. METHODS Between August 2010 and January 2013, 13 (9 males and 4 females; mean age: 28.2 yrs), patients with lumbar spondylolysis with or without slight spondylolisthesis underwent posterior ISOBAR TTL stabilization of the lumbar spine, with direct pars repair via Wiltse approach. All patients were followed up for at least 24 months at outpatient visits or telephonically. Pre-operative and postoperative radiological assessments included anteroposterior, lateral and flexion extension radiographs, 3-dimensional reconstruction computed tomography (CT), and magnetic resonance imaging (MRI). Data pertaining to intraoperative blood loss, duration of operation, visual analog score (VAS), Oswestry disability index (ODI) scores, and other assessments were collected. RESULTS The median follow-up duration was 36 months (range, 24-53 months). Surgery was successful in all patients with no complications; bony fusion of pars was confirmed on CT scan at postoperative 2 years. Significant pain relief was achieved in all patients including those with discogenic pain, those >30 years of age, and those with severe disc degeneration (P < 0.01). CONCLUSION We evaluated a new surgical technique for the treatment of patients with spondylolysis with or without slight spondylolisthesis. Besides the good clinical results, the indications for this new surgery are much wider and can potentially overcome the limitations of earlier techniques. LEVEL OF EVIDENCE 4.
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Lee GW, Ryu JH, Kim JD, Ahn MW, Kim HJ, Yeom JS. Comparison of lumbar discectomy alone and lumbar discectomy with direct repair of pars defect for patients with disc herniation and spondylolysis at the nearby lumbar segment. Spine J 2015; 15:2172-2181. [PMID: 26070287 DOI: 10.1016/j.spinee.2015.06.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Revised: 05/08/2015] [Accepted: 06/01/2015] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT It is unknown whether direct repair (DR) of pars defect after lumbar discectomy (LD) for patients with lumbar disc herniation (LDH) and spondylolysis leads to better outcomes than LD alone. PURPOSE The aim was to compare two surgical methods, LD alone and LD with DR, for LDH patients with spondylolysis at a nearby lumbar segment. STUDY DESIGN This was a retrospective comparative study. PATIENT SAMPLE This study enrolled 89 patients who were diagnosed with LDH and spondylolysis at the same or adjacent lumbar segment and were followed up for at least 1 year. OUTCOME MEASURE The primary outcome was pain intensity of the lower back and lower extremities as measured with visual analog scale. Secondary outcomes included clinical outcomes as assessed with the Oswestry Disability Index and the 12-item short form health survey, radiologic outcomes as assessed with the gap distance and the union rate at the pars defect, surgical outcomes, and complications. METHODS Enrolled patients were classified into two groups: LD alone (Group A, 48 patients) and LD with DR (Group B, 41 patients). RESULTS Pain intensity of the lower back and lower extremities and clinical outcomes were significantly improved 1 year after surgery compared with preoperative scores. However, the scores in the group receiving LD alone steadily worsened during follow-up, whereas the scores in the group receiving LD with DR did not deteriorate over time. The difference in the gap distance of the pars defect between baseline and 1 year after surgery was significantly different between the groups. The fusion rate of the pars defect was 59% (24/41). With the exception of surgical time, which was longer in Group B, surgical outcomes and complications did not differ significantly between the groups. CONCLUSIONS At the 1-year follow-up, DR after LD was associated with better outcomes for LDH with spondylolysis than LD alone.
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Affiliation(s)
- Gun Woo Lee
- Department of Orthopaedic Surgery, Armed Forces Yangju Hospital, 461 Yongam-ri, Eunhyeon-myeon, Yangju, 482-863, Republic of Korea.
| | - Ji Hyun Ryu
- Department of Orthopaedic Surgery, Armed Forces Yangju Hospital, 461 Yongam-ri, Eunhyeon-myeon, Yangju, 482-863, Republic of Korea
| | - Jae-Do Kim
- Department of Orthopaedic Surgery, Kosin University Gospel Hospital, Amnam-dong, Seo-gu, Busan, 602-702, Republic of Korea
| | - Myun-Whan Ahn
- Spine Center and Department of Orthopaedic Surgery, Yeungnam University Hospital, 170, Hyeonchung-ro, Nam-gu, Daegu, 705-703, Republic of Korea
| | - Ho-Joong Kim
- Spine Center and Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro, 173beon-gil, Bundang-gu, Seongnam-si, 463-707, Republic of Korea
| | - Jin S Yeom
- Spine Center and Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro, 173beon-gil, Bundang-gu, Seongnam-si, 463-707, Republic of Korea
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Current Evidence Regarding the Surgical and Nonsurgical Treatment of Pediatric Lumbar Spondylolysis: A Report from the Scoliosis Research Society Evidence-Based Medicine Committee. Spine Deform 2015; 3:30-44. [PMID: 27927449 DOI: 10.1016/j.jspd.2014.06.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Revised: 05/29/2014] [Accepted: 06/03/2014] [Indexed: 10/24/2022]
Abstract
STUDY DESIGN Structured literature review. OBJECTIVES The Scoliosis Research Society requested an assessment of the current state of peer-reviewed evidence regarding pediatric spondylolysis with the goal of identifying both what is really known and what research remains essential to further understanding. SUMMARY OF BACKGROUND DATA Spondylolysis is common among children and adolescents and no formal synthesis of the published literature regarding treatment has been previously performed. METHODS A comprehensive literature search was performed. The researchers reviewed abstracts and analyzed by committee data from included studies. From 947 initial citations with abstract, 383 articles underwent full text review. The best available evidence for clinical questions regarding surgical and nonsurgical treatment was provided by 58 included studies. None of the studies were graded as level I or level II evidence. Two of the studies were graded as level III evidence. Fifty-six of the studies were graded as level IV evidence. No level V (expert opinion) studies were included in the final list. RESULTS Although natural history studies suggest a benign, relatively asymptomatic course for spondylolysis in most patients, both nonsurgical and surgical treatment series suggest that a substantial number of patients present with pain and activity limitations attributed to spondylolysis. Pain resolution and return to activity are common with both nonsurgical and surgical treatment (80% to 85%, respectively). Although it is implied that most surgically treated patients have failed nonsurgical treatment, the specific treatment modalities and duration required before failure is declared are not well defined. There is insufficient evidence to know which patients will benefit from specific treatment modalities (both nonsurgical and surgical). CONCLUSIONS Because of the preponderance of uncontrolled case series and the lack of comparative studies, only low-quality evidence is available to guide the treatment of pediatric spondylolysis.
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Abstract
STUDY DESIGN Analysis via computed tomography imaging software. OBJECTIVE To determine parameters for ideal intralaminar screw trajectory and the feasibility of screw placement at L3, L4, and L5 laminae for pars defect fixation. SUMMARY OF BACKGROUND DATA To our knowledge, no studies provide anatomic parameters for ideal intralaminar screw trajectory for treating spondylolysis. METHODS We used advanced imaging software for 3-dimensional interactive viewing to analyze 20 randomly selected normal adolescent lumbar computed tomographic scans. The ideal intralaminar screw trajectory was drawn from the inferior lamina, a point chosen to maximize cortical diameter at the isthmus of the lamina and bisect the pedicle. We measured and evaluated ideal trajectory parameters for percutaneous screw placement for pars defect fixation at the L3 to L5 laminae. RESULTS The ideal pathway was the thick portion of the lamina between the inferior edge of the lamina and the pedicle. This area was close to the inferior articular process (axial plane), becoming more so at progressively caudal levels. At the ideal trajectory, the mean (standard deviation) coronal angle slightly decreased (L3-L5): 7.3° (5.1°), 6.6° (3.7°), and 4.2° (2.5°), respectively. The trajectory distance increased from cranial to caudal. These parameters increased (L3-L5): mean distance (transverse plane) between the starting point and middle of the spinous process, 1.2 (0.18 cm), 1.3 (0.2 cm), and 1.6 (0.3 cm), respectively; mean screw sagittal angle with respect to the posterior skin, 15.5° (5.0°), 24.3° (6.5°), and 43° (5.8°), respectively; and mean distance for guide wire entry, 28.8 (10.6 cm), 20.1 (5.4 cm), and 11.9 (2.1 cm), respectively. CONCLUSION At the ideal screw trajectory, pars fixation by intralaminar screw is uniformly feasible at L3 to L5 laminae, where most patients can accommodate a 4.5-mm screw. LEVEL OF EVIDENCE 2.
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Lumbo-sacral motion conserved after isthmic reconstruction: long-term results. J Child Orthop 2014; 8:97-103. [PMID: 24488849 PMCID: PMC3935030 DOI: 10.1007/s11832-014-0560-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Accepted: 01/16/2014] [Indexed: 02/03/2023] Open
Abstract
PURPOSE The purpose of this study was to analyze the clinical and radiological results of repair of the interarticularis pars defect by a modified Buck's repair technique in patients with symptomatic spondylolysis with grade 1 spondylolisthesis. These patients with painful spondylolisthesis are the most eligible for direct repair of the defect rather than lumbo-sacral fusion in an attempt to save motion segments. METHODS Forty-six patients with symptomatic spondylolysis with grade 1 spondylolisthesis and normal L4-L5 and L5-S1 disks, following the failure of conservative treatment, underwent surgery between 1988 and 2010. All interventions involved direct pars repair by a modified Buck's repair technique with internal fixation of the defect using screws and cancellous bone grafting. The Oswestry Disability Index (ODI) was used to evaluate the functional outcome. Healing of the pars defect was assessed by plain radiographs and computed tomography (CT) scanning. Motion of the L4-L5 and L5-S1 segments was measured with dynamic radiographs in flexion and extension. RESULTS Thirty-five patients were evaluated. The mean follow-up period was 10 years. Functional outcome was excellent in 22 patients (ODI ≤ 10) and good for 8 patients (10 < ODI ≤ 20); five patients continued to have pain (ODI >20). Isthmus bone union occurred in 32 of 35 patients (91.4 %). L4-L5 motion was conserved with a mean angle of 11.8° (0-22); the mean lumbo-sacral angle was 9.9° (0-21). CONCLUSION Direct repair of spondylolisthesis was described to avoid fusion in young patients with slight slipping and painful symptoms. A modified Buck's repair technique allows the conservation of L4-L5 motion with a rate of consolidation comparable to other series. The anatomy and stability of the spine were normalized by restoring the continuity of the loose posterior elements using this modified Buck's technique.
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Abstract
STUDY DESIGN Prospective analysis. OBJECTIVE Our objective was to analyze clinical and functional results of patients with spondylolysis treated via direct intralaminar screw fixation and autograft, a minimally invasive and motion-preserving surgery. SUMMARY OF BACKGROUND DATA Spondylolysis is usually treated nonoperatively; multiple surgical techniques are available when nonoperative measures fail. No studies evaluate the clinical and functional outcomes and their correlation with pars defect size and disc morphology on magnetic resonance imaging. METHODS We reviewed patients with spondylolysis treated with intralaminar screw fixation and bone grafting from 2000 through 2010. Of the 31 patients (mean age, 16 yr; range, 10-37 yr), 25 (81%) were competitive athletes. Preoperative computed tomographic scans were used to measure the pars defect size, and preoperative magnetic resonance images were graded using Pfirrmann classification for correlation with postoperative outcomes. Student t test was used for analysis (significance, P < 0.05). RESULTS At a mean follow-up of 60 months (range, 24-135 mo), pain (visual analogue scale score) significantly (P < 0.01) improved: preoperative mean, 7 points (range, 1-10 points); postoperative mean, 2 points (range, 0-10 points). Of the 25 athletes, 19 (76%) returned to competitive sports with a mean postoperative visual analogue scale score of 1 point (range, 0-4 points) at a mean of 6 months (range, 3-10 mo) after surgery. One patient required L6-S2 posterior spinal fusion after spondylolysis repair for persistent pain starting 18 months after intralaminar screw fixation, 2 patients sustained unilateral intralaminar screw fractures at L5, and 1 patient required irrigation and debridement for a superficial postoperative infection. There was no correlation among preoperative magnetic resonance imaging disc morphology, defect size on computed tomography, patient age, and clinical outcomes. CONCLUSION Direct repair of spondylolysis with intralaminar screws offers a low profile, reliable treatment with good functional outcome and a low complication rate in active patients. LEVEL OF EVIDENCE 4.
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Fan J, Yu GR, Liu F, Zhao J, Zhao WD. A biomechanical study on the direct repair of spondylolysis by different techniques of fixation. Orthop Surg 2012; 2:46-51. [PMID: 22009907 DOI: 10.1111/j.1757-7861.2009.00064.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To compare the immediate stability of different fixation techniques for the direct repair of spondylolytic defects in the pars interarticularis. METHODS Eight fresh-frozen and thawed calf cadaveric lumbar spines were used for mechanical testing. A modified Scott, screw-rod-hook, screw-rod construct fixation and Buck techniques were applied to calf lumbar spines in which bilateral spondylolytic defects had been created in the L(4) vertebra. The multidirectional flexibility of each specimen was measured under flexion/extension, right/left lateral bending, and right/left axial rotation. RESULTS After creating a pars interarticularis defects at L(4), the range of movement (ROM) at both the L(3)-L(4) and L(4)-L(5) levels were increased under all loading conditions. Each fixation technique significantly increased stability and almost restored intervertebral rotation mobility to normal levels. Under flexion-extension, the screw-rod-hook and screw-rod construct techniques of fixation provided more rotational stability than did the other two techniques (P < 0.05). The screw-rod-hook, screw-rod construct and Buck techniques also provided more flexion/extension stability than the modified Scott technique. CONCLUSION The current study has shown that the ROM at the involved and upper adjacent level of spondylolysis is greater than in the intact spine. All four fixation techniques accorded with spinal biomechanical principles and restored intervertebral rotation displacements under flexion, rotation and bending loads to the intact condition. The screw-rod-hook and screw-rod construct fixation techniques provided more stability than did the modified Scott and Buck techniques, and are therefore good prospects for direct repair.
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Affiliation(s)
- Jian Fan
- Department of Orthopaedics, Tongji Hospital, Tongji University, Shanghai, China
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Repair of pars defects by segmental transverse wiring for athletes with symptomatic spondylolysis: relationship between bony union and postoperative symptoms. Spine (Phila Pa 1976) 2012; 37:802-7. [PMID: 21912322 DOI: 10.1097/brs.0b013e318232303a] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective study of surgery for spondylolysis patients. OBJECTIVE To assess clinical outcome of bony union using multislice computed tomography after segmental wiring fixation. SUMMARY OF BACKGROUND DATA How bony union affects surgical outcome of spondylolysis repair is unclear. METHODS Forty-four athletes with symptomatic spondylolysis (33 men and 11 women; mean age, 24.2 ± 5.4 years) who underwent segmental wiring fixation were evaluated retrospectively at a mean follow-up of 85 ± 17 months. The level of spondylolysis was L5 in 42 cases, and both L4 and L5 in 2 cases, giving a total of 46 operative levels of vertebrae. Bony union using axial and sagittal reconstruction images of computed tomography, the Japanese Orthopaedic Association (JOA) score for back pain, and complications were reviewed. State of bony union was classified as bilateral union, unilateral union, or nonunion. The total score and the improvement ratio of the JOA score were compared among the 3 groups. RESULTS Bilateral bony union was obtained in 29 cases (31 of 46 vertebrae, 67.4%). Six cases (13%) showed unilateral union, and 9 cases (19.6%) showed nonunion. JOA score increased significantly after surgery in all groups, average improvement rate was 78.9% in the bilateral group, 63.6% in the unilateral group, and 29.8% in the nonunion group; differences among the 3 groups were significant (P < 0.05). JOA score was significantly higher in the bilateral group than in the other 2 groups. CONCLUSION Although symptoms were significantly ameliorated in all groups, the bilateral group showed the greatest improvement ratio in JOA score showing bony union to be an important factor in clinical outcome. However, there were a few exceptional cases with contradictory clinical and radiological outcomes. Thus, further studies are required to gain a better understanding of the other multiple factors affecting clinical outcome after spondylolysis repair.
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Sharifi G, Jahanbakhshi A, Daneshpajouh B, Rahimizadeh A. Bilateral three-level lumbar spondylolysis repaired by hook-screw technique. Global Spine J 2012; 2:51-6. [PMID: 24353947 PMCID: PMC3864455 DOI: 10.1055/s-0032-1307255] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2011] [Accepted: 01/31/2012] [Indexed: 01/19/2023] Open
Abstract
We report a case of bilateral three-level lumbar spondylolysis that was directly repaired by use of hook-screw technique. The patient complained of low back pain for 2 years that progressively worsened and was exacerbated with standing and walking. He also mentioned bilateral sciatalgia. The neurological examination was normal. Interestingly, we found bilateral lumbar spondylolysis in L3, L4, and L5 levels in imaging studies. After proving that spondylolysis was the source of the low back pain by local anesthetic agent injection, we used a direct technique for correction of spondylolysis by use of a hook-screw device plus decortications of lysis area and iliac crest autograft. We assessed the patient after surgery to evaluate pain recovery and fusion rate. The results were favorable and proved the efficacy of the hook-screw technique for treatment of symptomatic multilevel lumbar spondylolysis.
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Affiliation(s)
- Guive Sharifi
- Department of Neurosurgery, Loghman Hakim Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Amin Jahanbakhshi
- Department of Neurosurgery, Loghman Hakim Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Behnam Daneshpajouh
- Department of Neurosurgery, Loghman Hakim Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Giudici F, Minoia L, Archetti M, Corriero AS, Zagra A. Long-term results of the direct repair of spondylolisthesis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2011; 20 Suppl 1:S115-20. [PMID: 21409560 DOI: 10.1007/s00586-011-1759-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2011] [Indexed: 12/29/2022]
Abstract
Direct repair of spondylolisthesis can save a functional segment in young patients with slight slipping. Since 1968 many surgeons have proposed different technical solutions to obtain the isthmic repair. Their results changed according to the technique used, the extent of listhesis and the age of the patient. The aim of our study was to perform a retrospective review on the long-term results of the direct repair of spondylolisthesis, according to the different techniques used. We operated 62 patients for isthmic repair, with three different techniques, from 1994 to 2007. We analysed the clinical and radiographic results of 52 cases, with an average follow-up of 9 ± 3 years (range 2-15). Ten patients were lost to the follow-up. The results were different depending on the technique used. Good or excellent clinical outcome by Odom's criteria were observed in the 83.3% of patients operated with the modified Scott technique. These results are better than those obtained in the group of patients operated with the Scott (62.5%) and the Buck technique (28.5%). Patients with clinical and radiological failure, who then underwent spinal fusion, were 57% with the Buck technique, 12.5% with the Scott technique and 2.7% with the Scott modified technique. The reasons for a new operation were symptomatic pseudarthrosis and progression of slipping. In conclusion, the pars defect repair is a helpful technique in lumbar spondylolisthesis, especially in young patient with slight slipping and painful symptoms resistant to conservative treatment. In our experience, the modified Scott technique seems to provide a better outcome than the Scott and Buck techniques.
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Urrútia G, Bonfill X. [Analysis of Spanish research about neck and back complaints (1992-2006)]. Med Clin (Barc) 2010; 135:215-21. [PMID: 20044103 DOI: 10.1016/j.medcli.2009.10.038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2009] [Revised: 10/26/2009] [Accepted: 10/29/2009] [Indexed: 10/20/2022]
Affiliation(s)
- Gerard Urrútia
- Servicio de Epidemiología Clínica y Salud Pública, Centro Cochrane Iberoamericano, Hospital de la Santa Creu i Sant Pau (UAB), Barcelona, España.
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Tsirikos AI, Garrido EG. Spondylolysis and spondylolisthesis in children and adolescents. ACTA ACUST UNITED AC 2010; 92:751-9. [PMID: 20513868 DOI: 10.1302/0301-620x.92b6.23014] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
A review of the current literature shows that there is a lack of consensus regarding the treatment of spondylolysis and spondylolisthesis in children and adolescents. Most of the views and recommendations provided in various reports are weakly supported by evidence. There is a limited amount of information about the natural history of the condition, making it difficult to compare the effectiveness of various conservative and operative treatments. This systematic review summarises the current knowledge on spondylolysis and spondylolisthesis and attempts to present a rational approach to the evaluation and management of this condition in children and adolescents.
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Affiliation(s)
- A I Tsirikos
- Royal Hospital for Sick Children, Edinburgh EH9 1LF, UK.
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Direct repair of spondylolysis by TSRH's hook plus screw fixation and bone grafting: biomechanical study and clinical report. Arch Orthop Trauma Surg 2010; 130:209-15. [PMID: 19440723 DOI: 10.1007/s00402-009-0897-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2009] [Indexed: 10/20/2022]
Abstract
INTRODUCTION The aim of the study was to evaluate the biomechanical performance and clinical results of TSRH's Hook plus screw fixation after direct repair of spondylolysis defects in the pars interarticularis. MATERIALS AND METHODS Biomechanical testing of eight calf cadaver lumbar spines were used to provide comparative biomechanical data on TSRH's Hook plus screw fixation, and for the intact and the destabilized spondylolytic spines, modified Scott's fixation, screw-rod construct and Buck's fixation were used. Eleven patients with bilateral spondylolysis were treated with segmental TSRH's Hook plus screw fixation and autogenous bone graft; after an average follow-up period of 28 months, the patients were reviewed. Conventional tomography and computed tomography scans were taken to assess the condition of the fixation and the healing of the bony defect separately. MR images were performed to assess the adjacent disk conditions. MacNab criteria were used to assess their pre- and postoperative status. RESULTS Each fixation technique significantly increased stiffness and returned the intervertebral rotation stiffness nearly to intact levels. TSRH's Hook plus screw technique and screw-rod construct provided more rotational stability than the other two techniques. TSRH's Hook plus screw, pedicle rod construct and Buck's technique also provided more flexion/extension stability than the modified Scott's technique. Neither complications nor instrumentation failure was observed. Retrospective follow-up of patients showed complete radiographic healing but unilateral nonunion in one on CT scans and pain relief in all patients. MR images of lumbar spine showed no significant change of disk before and after the surgery. Excellent or good results were obtained in ten cases according to MacNab criteria, but fair results were obtained in case of unilateral nonunion. CONCLUSION Biomechanical evaluation of the TSRH's Hook plus screw fixation showed excellent stability of the lumbar vertebrae. Excellent clinical results show direct repair of spondylolysis by TSRH's Hook plus screw fixation and bone grafting would be the alternative for treating patients with persistent back pain after 6 months of conservative treatment.
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Brennan RP, Smucker PY, Horn EM. Minimally invasive image-guided direct repair of bilateral L-5 pars interarticularis defects. Neurosurg Focus 2009; 25:E13. [PMID: 18673042 DOI: 10.3171/foc/2008/25/8/e13] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Lower back pain from spondylolysis historically has been treated with a variety of options ranging from conservative care to open fusion. The authors describe the novel technique of minimally invasive bilateral pars interarticularis screw placement by utilizing intraoperative 3D imaging and frameless navigation in a 17-year-old male athlete. This technique is a modification of the open technique first described in 1970 by Buck and has the advantages of minimal dissection requirements with improved screw trajectory visualization. The patient's postoperative course is discussed, followed by a brief literature review of pars interarticularis defect treatment.
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Affiliation(s)
- Ryan P Brennan
- Department of Neurological Surgery, Indiana University College of Medicine, Indianapolis, Indiana 46202-5124, USA
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Noggle JC, Sciubba DM, Samdani AF, Anderson DG, Betz RR, Asghar J. Minimally invasive direct repair of lumbar spondylolysis with a pedicle screw and hook construct. Neurosurg Focus 2008; 25:E15. [DOI: 10.3171/foc/2008/25/8/e15] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Object
Lumbar spondylolysis occurs in approximately 6% of the population and presents with localized mechanical back pain, often in young athletes. Surgical treatment may involve decompression, lumbar intersegmental fusion, or direct repair of pars defects. Although such open procedures may effectively resolve symptoms, minimal-access approaches may additionally decrease collateral damage to soft tissues, allowing young, active patients to resume athletic activities sooner. In this study, the authors review their experience repairing bilateral lumbar spondylolyses with screw and hook constructs placed via a minimal-access approach.
Methods
Five consecutive pediatric patients with bilateral L-5 spondylolysis were treated. Bilateral incisions (2.5 cm) were made over L-5. Exposure was maintained with bilateral expandable tubular retractor systems. Pedicle screws were placed in the L-5 pedicles and attached to hooks under the L-5 laminae. A direct repair was performed at the pars defect. Clinical characteristics, operative variables, and postoperative outcomes were collected.
Results
All 5 patients underwent surgery; 4 were male (80%) and 1 was female (20%), and the mean age was 15.8 years (range 15–17 years). The mean estimated blood loss and duration of surgery were 37 ml (range 15–75 ml) and 1.94 hours (range 1–3 hours), respectively. Postoperative hospital stays ranged from 1 to 3 days (mean 1.8 days). The only complication occurred in 1 patient who experienced minor superficial wound breakdown. All patients have experienced resolution of symptoms at this preliminary stage, which has continued over an 8-month follow-up period.
Conclusions
Lumbar spondylolysis can be adequately and safely treated via minimal-access surgical repair of the pars interarticularis by using pedicle screws and rod-hook constructs. This approach may decrease the collateral soft tissue damage common to open dissections, and may be ideal for young, active surgical candidates.
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Affiliation(s)
- Joseph C. Noggle
- 1Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland
| | - Daniel M. Sciubba
- 1Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland
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Debusscher F, Troussel S. Direct repair of defects in lumbar spondylolysis with a new pedicle screw hook fixation: clinical, functional and Ct-assessed study. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2007; 16:1650-8. [PMID: 17520298 PMCID: PMC2078304 DOI: 10.1007/s00586-007-0392-0] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2006] [Revised: 03/04/2007] [Accepted: 04/30/2007] [Indexed: 12/21/2022]
Abstract
Spondylolysis is a common entity, a minority of people affected by this disease need medical care, and only a few require surgery. Reconstruction of the pars interarticularis is an interesting alternative to segmental fusion; this technique has the advantage of preserving segmental motion. Most authors report good results for young patients without intervertebral disk or facet degenerative changes. Moreover Louis also showed good to excellent results with his technique carried out among people who presented a satisfactory disk height (equal to two thirds of normal height). This could extend the number of patients for whom pars interarticularis repair could be proposed. In this study, the limit of reconstruction was set at grade 3 of the Pfirrmann's classification. The fixation of the isthmus was done with a new kind of pedicle screw hook system. This stable and strong device is easy to use, allows an anatomic pars interarticularis reconstruction of spondylolysis and avoids a postoperative bracing. Twenty-three patients were assessed in this study, the mean age at operation was 34 (range 16-52 years) and the average follow-up was for 59 months (range 6-113 months). Eight patients showed moderate degenerative disk disease before the surgery and 12 patients had a grade 1 spondylolisthesis. The visual analogical scale, the Oswestry disability index (ODI) and the modified Prolo score were used for assessment of pain and clinical outcome before and after surgery. The results were from "excellent" to "good" for twenty patients (87%) and "fair" for three of them (13%). The consolidation of the isthmus was assessed at the end of the study (CT-scan); the fusion rate was observed in 91%. Among patients aged less than 30 years results are from "good", to "excellent" in all cases and consolidation was always observed. All of them showed normal disc signal before the surgery. In the group aged more than 30 years, the results varied from "good" to "excellent' in 73% and fusion of the defect was discovered in 82% of cases. Eight of them (73%) had moderate disk signal modification before the surgery. All people with fair results displayed moderate disk degeneration signs at MRI before surgery; but two of those three patients had a failure of defect consolidation too and it is also associated with poor results by several authors. No complication was found in this series. According to the good results reported by Louis and upto the current finding, the authors believe that pars interarticularis repair can be carried out on patients with moderate degenerative disk disease; the stage 3 of Pfirrmann's classification seems a good limit. The Bone and joint research (B.J.R. system) is readily usable by any surgeon using pedicle screw systems and having a short learning curve. No device failure has been observed in this series.
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Affiliation(s)
- Felix Debusscher
- Department of Orthopaedic Surgery, Centre Hospitalier Notre Dame Reine Fabiola, Grand Rue 3, 6000, Charleroi, Hainaut, Belgium.
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Chung CH, Chiu HM, Wang SJ, Hsu SY, Wei YS. Direct Repair of Multiple Levels Lumbar Spondylolysis by Pedicle Screw Laminar Hook and Bone Grafting: Clinical, CT, and MRI-Assessed Study. ACTA ACUST UNITED AC 2007; 20:399-402. [PMID: 17607107 DOI: 10.1097/01.bsd.0000211253.67576.90] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
INTRODUCTION A prospective analysis of 6 cases with multiple-level spondylolysis treated by direct repair with pedicle screw laminar hook is presented. The objective of the study was to evaluate the clinical outcome, plain radiographs, computed tomography (CT) scan, and magnetic resonance imaging to demonstrate the result of direct repair in the treatment of multiple-level spondylolysis. MATERIALS AND METHODS Ten patients with multiple-level spondylolysis of lumbar spine were treated with segmental pedicle screw hook fixation and autogenous bone graft. Four patients had lost follow-up. Six patients were followed up for a minimum of 2 years (mean 34.3 mo, range 24 to 55 mo). Patient's average age was 22 years old (range from 20 to 25 y old). All lytic defects were bilateral and located at 2 different lumbar vertebras (levels). CT scans and MR images were obtained at the latest follow-up postoperatively to assess the healing of the bony defects and the adjacent disc conditions. Fusion was considered to be presented when trabecula across the lytic defect was detected. RESULTS The union rate was 87% (21 pars/24 pars) on plain radiographs and 75% (18 pars/24 pars) on CT scans. Follow-up magnetic resonance imaging of lumbar spine showed no disc degeneration. All patients were satisfied (either excellent or good) with the postoperative outcomes. CONCLUSIONS Direct repair of multiple-level spondylolysis by pedicle screw laminar hook and autogenous bone graft would be the alternative of treating patients with persistent back pain after 6 months of conservative treatment The favorable clinical outcome was correlated with bony healing rate in this series.
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Affiliation(s)
- Chen-Han Chung
- Department of Orthopedic Surgery, Kaohsiung Military General Hospital, Kaohsiung City, Taiwan, Republic of China.
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Abstract
Low back pain, specifically "spondylo" conditions, has traditionally been misunderstood and often times ill-treated. A thorough understanding of the function of pars interarticularis and its relationship to the entire vertebral unit and low back health are essential for successful treatment and rehabilitation outcomes. Lifestyle awareness and controlled progression through the inflammation, stabilization, strength, and functional rehabilitation phases provide primary guidance for patients. In addition, a broad spectrum of pharmacological, psychological, therapeutic modality, and newer surgical techniques must be considered in the overall treatment plan. Having a strong understanding of the anatomy, biomechanics, treatment, and rehabilitation of this condition, will help the allied healthcare provider better meet the individualized needs of spondylolysis patients.
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Mac-Thiong JM, Labelle H. A proposal for a surgical classification of pediatric lumbosacral spondylolisthesis based on current literature. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2006; 15:1425-35. [PMID: 16758151 DOI: 10.1007/s00586-006-0101-4] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2005] [Revised: 01/18/2006] [Accepted: 03/06/2006] [Indexed: 10/24/2022]
Abstract
The classification presented in this paper is the first specifically designed to guide surgical treatment of L5-S1 spondylolisthesis in children and adolescents. It also presents objective criteria to differentiate between low- and high-dysplastic spondylolisthesis and incorporates recent knowledge in the study of sagittal spinopelvic balance. The proposed classification is based on the following: (1) the degree of slip, (2) the degree of dysplasia, and (3) the sagittal spinopelvic balance. To classify a patient, the degree of slip is quantified first to determine if it is low-grade, high-grade, or a spondyloptosis. Then, the degree of dysplasia is evaluated based on seven criteria, in order to separate patients with low- and high-dysplastic spondylolisthesis. Finally, the sagittal spinopelvic balance is assessed from the measurement of the pelvic incidence (PI), sacral slope (SS), and pelvic tilt (PT). For low-grade spondylolisthesis, it is classified as low PI/low SS (nutcracker type) or high PI/high SS (shear type). For high-grade spondylolisthesis, it is classified as high SS/low PT (balanced pelvis) or low SS/high PT (retroverted pelvis). Such a comprehensive classification could allow to better evaluate and compare available surgical techniques, and to optimize the treatment of L5-S1 spondylolisthesis. Because the classification was designed so that groups are organized in an ascending order of severity, it becomes easier and more intuitive to develop an associated surgical algorithm because the complexity of the surgery should increase as the severity of the spondylolisthesis increases. A tentative treatment algorithm is proposed but it is not definitive because further studies are required to define the most appropriate treatment for each group.
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