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Tatsumura M, Ikezawa S, Okuwaki S, Gamada H, Funayama T. Combined Transforaminal Lumbar Interbody Fusion and Smiley Face Rod Technique Using Dual-Headed Pedicle Screws for L4 Isthmic Spondylolisthesis and L5 Spondylolysis. Cureus 2024; 16:e60756. [PMID: 38903306 PMCID: PMC11188700 DOI: 10.7759/cureus.60756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2024] [Indexed: 06/22/2024] Open
Abstract
Spondylolysis with pseudarthrosis may be treated surgically by repairing the spondylolysis using the smiley face rod (SFR) technique. The SFR technique can avoid adjacent segmental disease caused by transforaminal lumbar interbody fusion (TLIF), which is one of the main surgical techniques to treat isthmic lumbar spondylolisthesis. A 59-year-old woman had been playing softball since she was 12 years old and was a member of a prefectural representative team. She sought treatment because of numbness in her left lower limb and difficulty playing softball. Despite conservative treatment for a year, her symptoms did not improve. Physical examination revealed decreased patellar tendon reflexes and numbness and pain from the front of the thigh to the lower leg without muscle weakness. Imaging showed L4 isthmic spondylolisthesis with Meyerding classification grade 2 anterior slip and L5 spondylolysis with pseudarthrosis. We diagnosed L4 radiculopathy caused by L4/5 foraminal stenosis and L4 isthmic spondylolisthesis with L5 spondylolysis. She underwent surgery combining the TLIF of L4/5 and the SFR technique of L5 using dual-headed pedicle screws that can fix two types of rods with L5 pedicle screws. Three months after surgery, fusion between L4/5 and fusion of the L5 pars cleft were confirmed. She resumed sports, and one year postoperatively, she was able to participate in softball games. Two years postoperatively, she could bat, run, and play defense without adjacent segmental disease. Two-segment TLIF increases adjacent segmental disease more than single-segment TLIF. Because the L5 spondylolysis had not slipped, we chose the SFR technique to preserve mobility at L5/S1. The dual-headed pedicle screw fastens two-type rods at the head of the pedicle screw, making it a suitable design for this procedure.
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Affiliation(s)
- Masaki Tatsumura
- Department of Orthopaedic Surgery and Sports Medicine, Tsukuba University Hospital Mito Clinical Education and Training Center/Mito Kyodo General Hospital, Mito, JPN
| | - Shunsuke Ikezawa
- Department of Orthopaedic Surgery and Sports Medicine, Tsukuba University Hospital Mito Clinical Education and Training Center/Mito Kyodo General Hospital, Mito, JPN
| | - Shun Okuwaki
- Department of Orthopaedic Surgery, University of Tsukuba, Tsukuba, JPN
| | - Hisanori Gamada
- Department of Orthopaedic Surgery, University of Tsukuba, Tsukuba, JPN
| | - Toru Funayama
- Department of Orthopaedic Surgery, University of Tsukuba, Tsukuba, JPN
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Zhang T, Ma L, Liu H, Yang C, Li S. Comparing the Wiltse approach and classical approach of pedicle screw and hook internal fixation system for direct repair of lumbar spondylolysis in young patients: A case-control study. Medicine (Baltimore) 2023; 102:e34813. [PMID: 37713869 PMCID: PMC10508563 DOI: 10.1097/md.0000000000034813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 07/27/2023] [Indexed: 09/17/2023] Open
Abstract
The aim of this study was to investigate the clinical effect of direct isthmus repair via Wiltse approach and classical approach in the treatment of simple lumbar spondylolysis in young patients. Thirty-three patients with simple lumbar spondylolysis underwent direct isthmic repair via the Wiltse approach (n = 17) or the classical approach (n = 16). The operation time, intraoperative blood loss, postoperative drainage volume, hospital stay, fusion rate, visual analogue scale (VAS), and the Oswestry disability index were evaluated and compared between the 2 groups. The amount of intraoperative blood loss, postoperative drainage volume, and the duration of hospital stay in the Wiltse group were lower than those in the classical group (P < .05). There was no significant difference in Oswestry disability index score between the Wiltse group and the classical group at 3 months, 6 months, and 1 year after operation, but the visual analogue scale score in the Wiltse group was lower than that in the classical group at 6 months after surgery (P < .05). The Wiltse approach was comparable to the classical approach in terms of bone graft fusion time and fusion rate. The Wiltse approach for isthmus repair can achieve the same or even better clinical effect than the classical approach, and the Wiltse approach is more minimally invasive. Pedicle screw-hook internal fixation system combined with autogenous iliac bone graft via Wiltse approach is a feasible, safe, and effective minimally invasive surgical method for the repair of isthmic spondylolysis in young patients.
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Affiliation(s)
- Tao Zhang
- Department of Spine Surgery, The 940th Hospital of Joint Logistics Support Force of Chinese PLA, Lanzhou, China
| | - Lihua Ma
- The First Hospital of Lanzhou University, Lanzhou, China
| | - Hua Liu
- Department of Spine Surgery, The 940th Hospital of Joint Logistics Support Force of Chinese PLA, Lanzhou, China
| | - Chengwei Yang
- Department of Spine Surgery, The 940th Hospital of Joint Logistics Support Force of Chinese PLA, Lanzhou, China
| | - Songkai Li
- Department of Spine Surgery, The 940th Hospital of Joint Logistics Support Force of Chinese PLA, Lanzhou, China
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Tatsumura M, Okuwaki S, Gamada H, Asai R, Eto F, Nagashima K, Takeuchi Y, Funayama T, Yamazaki M. A Novel Technique for Pars Defect Direct Repair with a Modified Smiley Face Rod for Spondylolysis and Isthmic Spondylolisthesis. Spine Surg Relat Res 2023; 7:396-401. [PMID: 37636143 PMCID: PMC10447201 DOI: 10.22603/ssrr.2023-0021] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 03/27/2023] [Indexed: 08/29/2023] Open
Abstract
Introduction Lumbar spondylolysis is a common fatigue fracture of the pars interarticularis of the lamina of the lumbar spine in adolescent athletes presenting with pars clefts. Some pseudarthrotic lumbar spondylolysis causes low back pain or radiculopathy. This study presents a case of pseudarthrotic lumbar spondylolysis that was successfully treated using a modified smiley face rod technique. Technical Note We developed a modified smiley face rod technique, which places pedicle screws in the lateral edge of the pedicle to preserve the erector spinae muscles and inserts a U-shaped rod between the spinous processes to preserve the supraspinous ligament. When a U-shaped rod penetrates the interspinous ligament subcutaneously, the resection of the supraspinous ligaments can be avoided. When the screw head is positioned more anterolaterally, a compression force is applied perpendicular to the surface of the pars cleft by rod clamping. This intrasegmental fusion technique preserves the mobile segment and simultaneously repairs the pars cleft. It is less invasive and more appropriate than interbody fusion for young athletes to avoid the possibility of future adjacent segment disorders. Conclusions This is a minimally invasive procedure that can easily achieve bone fusion and should be introduced for patients who are suffering from the symptoms of pseudarthrotic lumbar spondylolysis.
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Affiliation(s)
- Masaki Tatsumura
- Department of Orthopaedic Surgery and Sports Medicine, Tsukuba University Hospital Mito Clinical Education and Training Center, Mito Kyodo General Hospital, Mito, Japan
| | - Shun Okuwaki
- Department of Orthopaedic Surgery, Institute of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Hisarnori Gamada
- Department of Orthopaedic Surgery, Institute of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Reo Asai
- Department of Orthopaedic Surgery, Institute of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Fumihiko Eto
- Department of Orthopaedic Surgery, Institute of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Katsuya Nagashima
- Department of Orthopaedic Surgery and Sports Medicine, Tsukuba University Hospital Mito Clinical Education and Training Center, Mito Kyodo General Hospital, Mito, Japan
| | - Yosuke Takeuchi
- Department of Orthopaedic Surgery and Sports Medicine, Tsukuba University Hospital Mito Clinical Education and Training Center, Mito Kyodo General Hospital, Mito, Japan
| | - Toru Funayama
- Department of Orthopaedic Surgery, Institute of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Masashi Yamazaki
- Department of Orthopaedic Surgery, Institute of Medicine, University of Tsukuba, Tsukuba, Japan
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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: 0.3] [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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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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