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Ye Y, Yang H, Ma T, Zhu K, Xu G, Han Z, Zhang Z, Wu N, Guo X, Li H, Zhou P, Bao Z, Zhang C. Buck technique supplemented by temporary intersegmental pedicle screw fixation to repair lumbar spondylolysis in youth. J Orthop Surg Res 2024; 19:340. [PMID: 38849937 PMCID: PMC11161947 DOI: 10.1186/s13018-024-04823-8] [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: 03/31/2024] [Accepted: 05/29/2024] [Indexed: 06/09/2024] Open
Abstract
BACKGROUND Lumbar spondylolysis is a bone defect in the pars interarticularis of the lumbar vertebral, which is a common cause of low back pain in youth. Although non-surgical treatment is a mainstream option, surgery is necessary for patients with persistent symptoms. Buck technique is widely used as a classical direct repair technique, but it cannot achieve reduction of low-grade spondylolisthesis and reconstruction of lumbosacral sagittal balance. We have described a novel surgical procedure based on Buck technique with temporary intersegmental pedicle screw fixation, and report a series of clinical outcomes in 5 patients to provide a reference for the clinical treatment of young lumbar spondylolysis. METHODS Five young patients with symptomatic lumbar spondylolysis with a mean age of 19.20 ± 5.41 years underwent surgical treatment after an average of 7.60 ± 1.52 months of failure to respond to conservative treatment, using a new surgical procedure based on Buck technique combined with temporary intersegmental pedicle screw fixation. RESULTS Five patients were successfully operated without serious complications such as nerve and vascular injury. The average operation time was 109.00 ± 7.42 min, the interpretative average blood loss was 148.00 ± 31.14 ml, and the average fusion time was 11.20 ± 1.64 months. All patients were followed up for 2 years after surgery, and the visual analogue score (VAS) of low back pain and Oswestry disability index (ODI) scores were significantly improved compared with those before surgery, and the Henderson's evaluation were rated excellent or good. After the removal of the internal fixation, it was observed that temporary intersegmental fixation could repair the isthmus, reduce lumbar spondylolisthesis, and reconstruct the sagittal balance of the lumbosacral vertebrae while preserving lumbar motion and preventing intervertebral disc degeneration. Postoperative MRI indicated the Pfirrmann classification of the affected discs: 1 case from grade III to grade II, 3 cases from grade II to grade I, and 1 case remained grade II. CONCLUSIONS Buck technique supplemented by temporary intersegmental pedicle screw fixation is a highly applicable and effective method for the treatment of adolescent lumbar spondylolysis. The isthmic fusion is accurate, and temporary intersegmental fixation can effectively prevent disc degeneration and reconstruct the sagittal balance of lumbosacral vertebra.
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Affiliation(s)
- Yuchen Ye
- Department of Orthopaedics, The First Affiliated Hospital of Bengbu Medical University, 287 Changhuai Road, Bengbu, 233004, China
- Anhui Province Key Laboratory of Tissue Transplantation, Bengbu Medical University, 2600 Donghai Road, Bengbu, 233030, China
| | - Huiwen Yang
- Department of Orthopaedics, The First Affiliated Hospital of Bengbu Medical University, 287 Changhuai Road, Bengbu, 233004, China
- Anhui Province Key Laboratory of Tissue Transplantation, Bengbu Medical University, 2600 Donghai Road, Bengbu, 233030, China
| | - Tao Ma
- Department of Orthopaedics, The First Affiliated Hospital of Bengbu Medical University, 287 Changhuai Road, Bengbu, 233004, China
- Anhui Province Key Laboratory of Tissue Transplantation, Bengbu Medical University, 2600 Donghai Road, Bengbu, 233030, China
| | - Kun Zhu
- Department of Orthopaedics, The First Affiliated Hospital of Bengbu Medical University, 287 Changhuai Road, Bengbu, 233004, China
- Anhui Province Key Laboratory of Tissue Transplantation, Bengbu Medical University, 2600 Donghai Road, Bengbu, 233030, China
| | - Gang Xu
- Department of Orthopaedics, The First Affiliated Hospital of Bengbu Medical University, 287 Changhuai Road, Bengbu, 233004, China
- Anhui Province Key Laboratory of Tissue Transplantation, Bengbu Medical University, 2600 Donghai Road, Bengbu, 233030, China
| | - Zhongbing Han
- Department of Orthopaedics, The First Affiliated Hospital of Bengbu Medical University, 287 Changhuai Road, Bengbu, 233004, China
- Anhui Province Key Laboratory of Tissue Transplantation, Bengbu Medical University, 2600 Donghai Road, Bengbu, 233030, China
| | - Zhili Zhang
- Department of Orthopaedics, The First Affiliated Hospital of Bengbu Medical University, 287 Changhuai Road, Bengbu, 233004, China
- Anhui Province Key Laboratory of Tissue Transplantation, Bengbu Medical University, 2600 Donghai Road, Bengbu, 233030, China
| | - Nan Wu
- Department of Orthopaedics, The First Affiliated Hospital of Bengbu Medical University, 287 Changhuai Road, Bengbu, 233004, China
- Anhui Province Key Laboratory of Tissue Transplantation, Bengbu Medical University, 2600 Donghai Road, Bengbu, 233030, China
| | - Xuan Guo
- The First Affiliated Hospital of Bengbu Medical University, 287 Changhuai Road, Bengbu, 233004, China
| | - Huanyu Li
- Department of Orthopaedics, The First Affiliated Hospital of Bengbu Medical University, 287 Changhuai Road, Bengbu, 233004, China
- Anhui Province Key Laboratory of Tissue Transplantation, Bengbu Medical University, 2600 Donghai Road, Bengbu, 233030, China
| | - Pinghui Zhou
- Department of Orthopaedics, The First Affiliated Hospital of Bengbu Medical University, 287 Changhuai Road, Bengbu, 233004, China
- Anhui Province Key Laboratory of Tissue Transplantation, Bengbu Medical University, 2600 Donghai Road, Bengbu, 233030, China
| | - Zhengqi Bao
- Department of Orthopaedics, The First Affiliated Hospital of Bengbu Medical University, 287 Changhuai Road, Bengbu, 233004, China
- Anhui Province Key Laboratory of Tissue Transplantation, Bengbu Medical University, 2600 Donghai Road, Bengbu, 233030, China
| | - Changchun Zhang
- Department of Orthopaedics, The First Affiliated Hospital of Bengbu Medical University, 287 Changhuai Road, Bengbu, 233004, China.
- Anhui Province Key Laboratory of Tissue Transplantation, Bengbu Medical University, 2600 Donghai Road, Bengbu, 233030, China.
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Meng H, Gao Y, Zhao G, Sun T, Li F. Use of Recombinant Human Bone Morphogenetic Protein-2 With Iliac Crest Bone Graft Instead of Iliac Crest Bone Graft Alone in Lumbar Spondylolysis. Clin Spine Surg 2022; 35:E314-E319. [PMID: 34654776 DOI: 10.1097/bsd.0000000000001251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 09/15/2021] [Indexed: 11/25/2022]
Abstract
STUDY DESIGN A retrospective study. OBJECTIVE The aim of this study was to evaluate the clinical and radiographic effect of recombinant human bone morphogenetic protein-2 (rhBMP-2) in pars repair of lumbar spondylolysis. SUMMARY OF BACKGROUND DATA BMP-2 is a growth factor that plays a role in the formation of bone and promotes bone healing. However, few studies of using rhBMP-2 in pars repair have been reported. METHODS Direct pars repair and pedicle screw fixation was performed, which were added with 1 mg of rhBMP-2 and iliac crest bone graft in the study group (rhBMP-2 group, n=32) and iliac crest bone graft alone in the autograft group (n=36). Patients completed the visual analog scale and the Oswestry Disability Index preoperation, 3, 6, and 12 months after the operation. Computed tomography scans with axial and sagittal reconstructions were performed at 6, 9, 12, 18, and 24 months postoperatively. RESULTS Baseline demographic data showed no significant difference between 2 groups. There were significant differences for the Oswestry Disability Index score at 3 and 6 months postoperatively, which were higher in the autograft group. There was no significant difference between the groups with respect to the overall union status. As for union speed, the trabecular bone appeared earlier and union rates were higher in rhBMP-2 group than in the autograft group at 9, and 12 months postoperatively. No complications were identified in either group. One case in the rhBMP-2 group and 2 cases in the autograft group underwent revision surgery. CONCLUSION Compared with iliac crest bone graft alone, the use of rhBMP-2 can accelerate fusion in pars repair for young patients with spondylolysis. The union rates were significantly different at 9 and 12 months after surgery. This study showed no clinical difference when adding rhBMP-2 compared with iliac crest bone graft alone.
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Affiliation(s)
- Hao Meng
- Department of Orthopaedics, The 7th Medical Center of Chinese PLA General Hospital
| | - Yuan Gao
- Department of Gynecology and Obstetrics, The 1st Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Guangmin Zhao
- Department of Orthopaedics, The 7th Medical Center of Chinese PLA General Hospital
| | - Tiansheng Sun
- Department of Orthopaedics, The 7th Medical Center of Chinese PLA General Hospital
| | - Fang Li
- Department of Orthopaedics, The 7th Medical Center of Chinese PLA General Hospital
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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: 1.3] [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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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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Abstract
INTRODUCTION Direct repair of the pars defect in lumbar spondylolysis is an effective surgical procedure, but it is technically challenging. We assessed the feasibility of a new robotic system for intralaminar screw fixation of spondylolysis. PATIENT CONCERNS A 26-year-old man complained about frequent low back pain after failed conservative treatments. DIAGNOSIS The lumbar computed tomography images demonstrated the presence of bilateral spondylolysis at the L5 level, with no spondylolisthesis. INTERVENTIONS We performed one surgery of direct intralaminar screw fixation under the guidance of the TiRobot system. The trajectory of the screw was planned based on intraoperative 3-dimensional radiographic images. Then, the robotic arm spontaneously moved to guide the guide wires and screw insertion. OUTCOMES Bilateral L5 intralaminar screws were safely and accurately placed. No intraoperative complications occurred. Postoperative computed tomography showed good radiological results, without cortical perforation. CONCLUSION We report the first case of robot-assisted direct intralaminar screw fixation for spondylolysis using the TiRobot system. Robotic guidance for direct repair of spondylolysis could be feasible.
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Affiliation(s)
- Wei Tian
- Department of Spine Surgery, Beijing Jishuitan Hospital
- Department of Spine Surgery, Peking University Fourth School of Clinical Medicine, Beijing, China
| | - Qi Zhang
- Department of Spine Surgery, Beijing Jishuitan Hospital
- Department of Spine Surgery, Peking University Fourth School of Clinical Medicine, Beijing, China
| | - Xiao-Guang Han
- Department of Spine Surgery, Beijing Jishuitan Hospital
- Department of Spine Surgery, Peking University Fourth School of Clinical Medicine, Beijing, China
| | - Qiang Yuan
- Department of Spine Surgery, Beijing Jishuitan Hospital
- Department of Spine Surgery, Peking University Fourth School of Clinical Medicine, Beijing, China
| | - Da He
- Department of Spine Surgery, Beijing Jishuitan Hospital
- Department of Spine Surgery, Peking University Fourth School of Clinical Medicine, Beijing, China
| | - Ya-Jun Liu
- Department of Spine Surgery, Beijing Jishuitan Hospital
- Department of Spine Surgery, Peking University Fourth School of Clinical Medicine, Beijing, China
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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: 31] [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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Tan JH, Liu G, Ng R, Kumar N, Wong HK, Liu G. Is MIS-TLIF superior to open TLIF in obese patients?: A systematic review and meta-analysis. 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; 27:1877-1886. [PMID: 29858673 DOI: 10.1007/s00586-018-5630-0] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Revised: 04/15/2018] [Accepted: 05/06/2018] [Indexed: 12/19/2022]
Abstract
PURPOSE Obesity is a global health problem. It increases the risk of surgical complications and re-operations. While both MIS-TLIF and O-TLIF are reported to have comparably good long-term outcomes for non-obese patients, no consensus has been reached for obese patients. METHODS A comprehensive search of the published literature was performed: PubMed, Scopus, Web of Science and Cochrane Central Register of Controlled Trials database in accordance to the PRISMA 2009 checklist. Data were collected with attention to baseline demographics, intra-operative blood loss, duration of surgery, surgical complications, hospitalization stay, VAS and Oswestry disability index (ODI) pre- and postoperatively. RESULTS A total of 863 abstracts were identified from the databases, of which 4 articles were included in the meta-analysis. A total of 430 patients were identified, of which 217(50.5%) underwent the O-TLIF, while 213(49.5%) underwent MIS-TLIF. One hundred and ninety-four (45.1%) patients were males, while 236(54.9%) were females. The average age was 54.8 ± 12.0 years. The pooled BMI was 33.4 ± 4.7 for the open-TLIF group, and 32.7 ± 3.9 for MIS-TLIF group (p = 0.22). When comparing O-TLIF to MIS-TLIF: Patients who underwent O-TLIF had 383 mls more blood loss (95% CI: 329.5-437.4, p < 0.00001), 1.2-day longer hospitalization stay (95% CI: 0.80-1.62, p < 0.00001) and 3.8 times higher risk of dural tear (95% CI: 1.61-9.87, p = 0.003) when compared to MIS-TLIF patients. A trend toward higher postoperative wound infection rates (O-TLIF: 4.5%, MIS-TLIF: 2.4%) and an inferior improvement in ODI score (O-TLIF: 39.3, MIS-TLIF: 44.1) was found in O-TLIF patients when compared to MIS-TLIF patients. However, these were not statistically significant. CONCLUSION MIS-TLIF is safe and may be a better option for lumbar fusion in obese patients. These slides can be retrieved under Electronic Supplementary Material.
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Affiliation(s)
- Jun Hao Tan
- Department of Orthopaedic Surgery, University Spine Centre, National University Hospital, National University Health System, 1E Kent Ridge Road, Singapore, 119228, Singapore
| | - Gabriel Liu
- Department of Orthopaedic Surgery, University Spine Centre, National University Hospital, National University Health System, 1E Kent Ridge Road, Singapore, 119228, Singapore
| | - Ruimin Ng
- Department of Orthopaedic Surgery, University Spine Centre, National University Hospital, National University Health System, 1E Kent Ridge Road, Singapore, 119228, Singapore
| | - Nishant Kumar
- Department of Orthopaedic Surgery, University Spine Centre, National University Hospital, National University Health System, 1E Kent Ridge Road, Singapore, 119228, Singapore
| | - Hee-Kit Wong
- Department of Orthopaedic Surgery, University Spine Centre, National University Hospital, National University Health System, 1E Kent Ridge Road, Singapore, 119228, Singapore
| | - Gabriel Liu
- Department of Orthopaedic Surgery, University Spine Centre, National University Hospital, National University Health System, 1E Kent Ridge Road, Singapore, 119228, Singapore.
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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: 0.9] [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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Mo J, Zhang W, Zhong D, Xu H, Wang L, Yu J, Luo Z. Is Preventative Long-Segment Surgery for Multi-Level Spondylolysis Necessary? A Finite Element Analysis Study. PLoS One 2016; 11:e0149707. [PMID: 26918333 PMCID: PMC4769328 DOI: 10.1371/journal.pone.0149707] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2015] [Accepted: 02/04/2016] [Indexed: 01/31/2023] Open
Abstract
Objective For multi-level spondylolysis patients, surgeons commonly choose to fix all the segments with pars interarticularis defect even those without slippage and not responsible for clinical symptoms. In this study, we tried to study the necessity of the preventative long-segment surgery for the defected segment without slippage in treatment of multi-level spondylolysis patients from a biomechanical perspective. Method We established a bi-level spondylolysis model with pars defects at L4 and L5 segments, and simulated posterior lumbar interbody fusion (PLIF) and pedicle screw fixation at L5-S1 level. Then we compared the biomechanical changes at L4 segment before and after surgery in neutral, flexion, extension, lateral bending and axial rotation position. Results The stress on L4 pars interarticularis was very similar before and after surgery, and reached the highest in axial rotation. The L3-L4 intradiscal pressure was almost the same, while L4-L5 intradiscal pressure changed a little in lateral bending (increase from 1.993 to 2.160 MPa) and axial rotation (decrease from 1.639 to 1.307 MPa) after surgery. The PLIF surgery caused a little increase of range of motion at adjacent L4-L5 and L3-L4 levels, but the change is very tiny (1 degree). Conclusion The PLIF surgery will not cause significant biomechanical change at adjacent segment with pars defect in multi-level spondylolysis. On the contrary, excessive long-segment surgery will damage surrounding soft tissues which are important for maintaining the stability of spine. So a preventative long-segment surgery is not necessary for multi-level spondylolysis as long as there are no soft tissue degeneration signs at adjacent level.
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Affiliation(s)
- Jianqiang Mo
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, Orthopedic Institute, Medical College, Soochow University, Suzhou, Jiangsu, People’s Republic of China
| | - Wen Zhang
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, Orthopedic Institute, Medical College, Soochow University, Suzhou, Jiangsu, People’s Republic of China
| | - Dongyan Zhong
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, Orthopedic Institute, Medical College, Soochow University, Suzhou, Jiangsu, People’s Republic of China
| | - Hao Xu
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, Orthopedic Institute, Medical College, Soochow University, Suzhou, Jiangsu, People’s Republic of China
| | - Lan Wang
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, Orthopedic Institute, Medical College, Soochow University, Suzhou, Jiangsu, People’s Republic of China
| | - Jia Yu
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, Orthopedic Institute, Medical College, Soochow University, Suzhou, Jiangsu, People’s Republic of China
| | - Zongping Luo
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, Orthopedic Institute, Medical College, Soochow University, Suzhou, Jiangsu, People’s Republic of China
- * E-mail:
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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; 15:2172-81. [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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Lee GW, Lee SM, Ahn MW, Kim HJ, Yeom JS. Comparison of surgical treatment with direct repair versus conservative treatment in young patients with spondylolysis: a prospective, comparative, clinical trial. Spine J 2015; 15:1545-53. [PMID: 25687414 DOI: 10.1016/j.spinee.2015.02.019] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2014] [Revised: 12/27/2014] [Accepted: 02/06/2015] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Although direct repair (DR) with screw fixation at the pars defect is a common surgical treatment for lumbar spondylolysis, it is unknown whether DR leads to better outcomes for young patients with spondylolysis than traditional nonsurgical treatment. PURPOSE The purpose of the study was to investigate whether DR was associated with better outcomes for lumbar spondylolysis in young patients than traditional conservative treatment. STUDY DESIGN This is a prospective cohort study. PATIENT SAMPLE Of 1,784 patients with low back pain in the reference period, 149 young patients with spondylolysis who followed up for at least 1 year were enrolled in the study. OUTCOME MEASURES The primary outcome was pain intensity at the lower back measured with a Visual Analog Scale. Secondary outcomes included the functional outcome as measured with the Oswestry disability index (ODI) and the 12-item short-form health survey (SF-12) consisting of the physical component summary (PCS) and mental component summary (MCS) scores, the radiologic outcome as measured with lumbar spine radiographs and computed tomography scans, and complications of treatment. METHODS This was a prospective comparative study between two groups of patients who were treated with either conservative treatment or surgery for lumbar spondylolysis. Enrolled patients self-selected their own treatment and were allocated to either the traditional care group with conservative treatment (87 patients) or the surgery group (62 patients). All patients were followed up for at least 1 year. RESULTS Pain intensity at the lower back did not differ significantly between groups at the final follow-up. Likewise, the ODI and SF-12 (PCS and MCS) scores did not differ significantly between groups (p=.13, .71, and .68, respectively). The change in the gap distance of the pars defect at the final follow-up was significantly different between groups (traditional care group: +0.8±0.4 mm; surgery group: -0.7±0.5; p=.01). The union rate at 1 year after surgical treatment was 52% (32/61). The rate of complications was significantly higher in the surgery group (31%) than the traditional care group (20%) (p=.02). CONCLUSIONS Conservative treatment for young patients with spondylolysis may produce similar clinical outcomes and fewer complications over 12-month follow-up than surgical treatment with DR.
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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.
| | - Sun-Mi Lee
- Department of Family Medicine, Myongji Hospital, 55 Hwasu-ro, Deogyang-gu, Goyang 412-270, 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 and Seoul National University Bundang Hospital, Gumi-dong, Budang-gu, Sungnam 463-707, Republic of Korea
| | - Jin S Yeom
- Spine Center and Department of Orthopaedic Surgery, Seoul National University College of Medicine and Seoul National University Bundang Hospital, Gumi-dong, Budang-gu, Sungnam 463-707, Republic of Korea
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12
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Barbagallo GMV, Piccini M, Alobaid A, Al-Mutair A, Albanese V, Certo F. Bilateral tubular minimally invasive surgery for low-dysplastic lumbosacral lytic spondylolisthesis (LDLLS): analysis of a series focusing on postoperative sagittal balance and review of the 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 2014; 23 Suppl 6:705-13. [PMID: 25228107 DOI: 10.1007/s00586-014-3543-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Revised: 09/03/2014] [Accepted: 09/03/2014] [Indexed: 11/30/2022]
Abstract
PURPOSE To report our early experience with minimally invasive surgery (MIS) in low-dysplastic lumbosacral lytic spondylolisthesis (LDLLS), and to analyze the impact of surgery on postoperative spino-pelvic and sacro-pelvic parameters. METHODS Eight patients (mean age 47.6 years) underwent MIS for LDLLS involving in all but one the L5-S1 level. VAS and ODI were used for clinical assessment. Imaging included pre-operative X-rays, CT and MRI scans. Post-operatively, all patients underwent X-rays and CT-scans. Pelvic incidence (PI), pelvic tilt (PT) and sacral slope (SS) values as well as lumbar lordosis (LL) have been derived from pre- and post-operative standard X-rays. RESULTS Mean follow-up is 30.12 months (range 15-42). No complications related to the surgical procedure were observed. Patients reported a satisfactory clinical outcome, as demonstrated by variation in mean VAS (from 9.1 to 3.6) and ODI (from 70.50 to 28.25 %) scores. Comparison between pre- and post-operative sacro-pelvic parameters documented moderate changes, with reduction of PT and increase of SS in all but one patient. Overall sagittal balance of the spine has been evaluated using the sagittal vertical axis (SVA), obtained from post-operative X-rays. Mean value of SVA demonstrated a good sagittal balance of the spine. CONCLUSION This series demonstrates that MIS is feasible and effective for LDLLS, as witnesses by the satisfactory clinical results maintained at medium-term follow-up. We submit that TLIF is a valid option but an adequately sized and positioned interbody cage is a key factor to allow satisfactory restoration of segmental lordosis.
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Affiliation(s)
- Giuseppe M V Barbagallo
- Neurosurgery Department, Policlinico "G. Rodolico" University Hospital, Viale XX Settembre 45, 95129, Catania, Italy,
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Minimally invasive direct repair of bilateral lumbar spine pars defects in athletes. Case Rep Med 2013; 2013:659078. [PMID: 23737800 PMCID: PMC3657441 DOI: 10.1155/2013/659078] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Accepted: 04/12/2013] [Indexed: 12/13/2022] Open
Abstract
Spondylolysis of the lumbar spine has traditionally been treated using a variety of techniques ranging from conservative care to fusion. Direct repair of the defect may be utilized in young adult patients without significant disc degeneration and lumbar instability. We used minimally invasive techniques to place pars interarticularis screws with the use of an intraoperative CT scanner in three young adults, including two athletes. This technique is a modification of the original procedure in 1970 by Buck, and it offers the advantage of minimal muscle dissection and optimal screw trajectory. There were no intra- or postoperative complications. The detailed operative procedure and the postoperative course along with a brief review of pars interarticularis defect treatment are discussed.
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