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Li J, Tang Z, Feng F, Liang J, Shao N, Wang Y, Cai Z, Tang H, Zhou T, Xu Y, Cui Y. Development and biomechanical analysis of an axially controlled compression spinal rod for lumbar spondylolysis. Medicine (Baltimore) 2024; 103:e38520. [PMID: 38847663 PMCID: PMC11155568 DOI: 10.1097/md.0000000000038520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Accepted: 05/17/2024] [Indexed: 06/10/2024] Open
Abstract
BACKGROUND To elucidate the differences in mechanical performance between a novel axially controlled compression spinal rod (ACCSR) for lumbar spondylolysis (LS) and the common spinal rod (CSR). METHODS A total of 36 ACCSRs and 36 CSRs from the same batch were used in this study, each with a diameter of 6.0 mm. Biomechanical tests were carried out on spinal rods for the ACCSR group and on pedicle screw-rod internal fixation systems for the CSR group. The spinal rod tests were conducted following the guidelines outlined in the American Society for Testing and Materials (ASTM) F 2193, while the pedicle screw-rod internal fixation system tests adhered to ASTM F 1798-97 standards. RESULTS The stiffness of ACCSR and CSR was 1559.15 ± 50.15 and 3788.86 ± 156.45 N/mm (P < .001). ACCSR's yield load was 1345.73 (1297.90-1359.97) N, whereas CSR's was 4046.83 (3805.8-4072.53) N (P = .002). ACCSR's load in the 2.5 millionth cycle of the fatigue four-point bending test was 320 N. The axial gripping capacity of ACCSR and CSR was 1632.53 ± 165.64 and 1273.62 ± 205.63 N (P = .004). ACCSR's torsional gripping capacity was 3.45 (3.23-3.47) Nm, while CSR's was 3.27 (3.07-3.59) Nm (P = .654). The stiffness of the pedicle screws of the ACCSR and CSR group was 783.83 (775.67-798.94) and 773.14 (758.70-783.62) N/mm (P = .085). The yield loads on the pedicle screws of the ACCSR and CSR group was 1345.73 (1297.90-1359.97) and 4046.83 (3805.8-4072.53) N (P = .099). CONCLUSION Although ACCSR exhibited lower yield load, stiffness, and fatigue resistance compared to CSR, it demonstrated significantly higher axial gripping capacity and met the stress requirement of the human isthmus. Consequently, ACCSR presents a promising alternative to CSR for LS remediation.
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Affiliation(s)
- Jingyuan Li
- Clinical Medical College of Dali University, Dali, China
- Department of Orthopaedic Surgery, 920th Hospital of Joint Logistics Support Force, Kunming, China
| | - Zhifang Tang
- Clinical Medical College of Dali University, Dali, China
- Department of Orthopaedic Surgery, 920th Hospital of Joint Logistics Support Force, Kunming, China
| | - Fanzhe Feng
- Department of Orthopaedic Surgery, 920th Hospital of Joint Logistics Support Force, Kunming, China
| | - Jinlong Liang
- Department of Orthopaedic Surgery, 920th Hospital of Joint Logistics Support Force, Kunming, China
| | - Nengqi Shao
- Clinical Medical College of Dali University, Dali, China
- Department of Orthopaedic Surgery, 920th Hospital of Joint Logistics Support Force, Kunming, China
| | - Yulei Wang
- Clinical Medical College of Dali University, Dali, China
- Department of Orthopaedic Surgery, 920th Hospital of Joint Logistics Support Force, Kunming, China
| | - Zhijun Cai
- Department of Orthopaedic Surgery, 920th Hospital of Joint Logistics Support Force, Kunming, China
| | - Hui Tang
- Department of Orthopaedic Surgery, 920th Hospital of Joint Logistics Support Force, Kunming, China
| | - Tianhua Zhou
- Department of Orthopaedic Surgery, 920th Hospital of Joint Logistics Support Force, Kunming, China
| | - Yongqing Xu
- Department of Orthopaedic Surgery, 920th Hospital of Joint Logistics Support Force, Kunming, China
| | - Yi Cui
- Department of Orthopaedic Surgery, 920th Hospital of Joint Logistics Support Force, Kunming, China
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Wang W, Liu Z, Lyu P, Zhang S, Bai H. Biportal endoscopic bone graft repair and percutaneous screw fixation for lumbar spondylolysis-technical note and clinical outcomes. Acta Neurochir (Wien) 2024; 166:58. [PMID: 38302625 DOI: 10.1007/s00701-024-05944-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 12/02/2023] [Indexed: 02/03/2024]
Abstract
BACKGROUND Lumbar spondylolysis involves a bony defect in the vertebral pars interarticularis, predominantly affecting the lower lumbar spine. This condition is a significant etiological factor in lumbar instability and recurrent lower back pain, particularly in young individuals. While conservative treatments are the primary intervention, they often fail to provide relief, necessitating surgical approaches. Notwithstanding, executing bone grafting and fixation in the pars interarticularis defect simultaneously through minimally invasive surgery remains challenging. METHOD This study elucidates the biportal endoscopic spinal surgery (BESS) technique, innovatively applied for bone graft repair and percutaneous cannulated screw fixation in a patient with lumbar spondylolysis. We offer a detailed walkthrough of the technical procedures supplemented with follow-up radiographic evidence. RESULTS The BESS technique facilitated meticulous clearance of the defect site, coupled with bone grafting and cannulated screw fixation, effectively addressing lumbar spondylolysis through a minimally invasive approach. This method holds promise for achieving substantial osseous fusion at the vertebral pars interarticularis defect site. CONCLUSION The BESS procedure for lumbar spondylolysis ensures a clean and prepared defect site for grafting and encourages successful osseous fusion, spotlighting its potential as a viable surgical strategy in managing this condition.
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Affiliation(s)
- Wenlong Wang
- Department of Orthopedics, Peking University Shougang Hospital, Shijingshan District, No. 9, Jinyuanzhuang Rd, Beijing, 100144, China
| | - Zheng Liu
- Department of Orthopedics, Peking University Shougang Hospital, Shijingshan District, No. 9, Jinyuanzhuang Rd, Beijing, 100144, China.
| | - Pengfei Lyu
- Department of Orthopedics, Peking University Shougang Hospital, Shijingshan District, No. 9, Jinyuanzhuang Rd, Beijing, 100144, China
| | - Shuo Zhang
- Department of Orthopedics, Peking University Shougang Hospital, Shijingshan District, No. 9, Jinyuanzhuang Rd, Beijing, 100144, China
| | - Haibin Bai
- Department of Orthopedics, Peking University Shougang Hospital, Shijingshan District, No. 9, Jinyuanzhuang Rd, Beijing, 100144, China
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Minor A, Klein BR, Sowah MN, Etienne K, Levi AD. Pars Interarticularis Fractures Treated with Minimally Invasive Surgery: A Literature Review. J Clin Med 2024; 13:581. [PMID: 38276087 PMCID: PMC10817087 DOI: 10.3390/jcm13020581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 01/09/2024] [Accepted: 01/12/2024] [Indexed: 01/27/2024] Open
Abstract
Recurrent stress on the isthmic pars interarticularis often leads to profound injury and symptom burden. When conservative and medical management fail, there are various operative interventions that can be used. The current review details the common clinical presentation and treatment of pars injury, with a special focus on the emerging minimally invasive procedures used in isthmic pars interarticularis repair. PubMed and Google Scholar database literature reviews were conducted. The keywords and phrases that were searched include but were not limited to; "history of spondylolysis", "pars interarticularis", "pars defect", "conventional surgical repair of pars", and "minimally invasive repair of pars". The natural history, conventional presentation, etiology, risk factors, and management of pars interarticularis injury are discussed by the authors. The surgical interventions described include the Buck's repair, Morscher Screw-Hook repair, Scott's Wiring technique, and additional pedicle screw-based repairs. Minimally invasive techniques are also reviewed, including the Levi technique. Surgical intervention has been proven to be safe and effective in managing pars interarticularis fractures. However, minimally invasive techniques often provide additional benefit to patients such as reducing damage of surrounding structures, decreasing postoperative pain, and limiting the time away from sports and other activities.
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Affiliation(s)
- Adrienne Minor
- School of Medicine Greenville, University of South Carolina, Greenville, SC 29605, USA; (A.M.); (M.N.S.)
- Department of Neurological Surgery, Miller School of Medicine, University of Miami, Miami, FL 33146, USA; (B.R.K.); (K.E.)
| | - Benjamin R. Klein
- Department of Neurological Surgery, Miller School of Medicine, University of Miami, Miami, FL 33146, USA; (B.R.K.); (K.E.)
- College of Medicine and Life Sciences, University of Toledo, Toledo, OH 43560, USA
| | - Mareshah N. Sowah
- School of Medicine Greenville, University of South Carolina, Greenville, SC 29605, USA; (A.M.); (M.N.S.)
- Department of Neurological Surgery, Miller School of Medicine, University of Miami, Miami, FL 33146, USA; (B.R.K.); (K.E.)
| | - Kayla Etienne
- Department of Neurological Surgery, Miller School of Medicine, University of Miami, Miami, FL 33146, USA; (B.R.K.); (K.E.)
- School of Medicine, Tufts University, Boston, MA 02108, USA
| | - Allan D. Levi
- Department of Neurological Surgery, Miller School of Medicine, University of Miami, Miami, FL 33146, USA; (B.R.K.); (K.E.)
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Tsukada M, Takiuchi T, Ichinoseki-Sekine N. Factors associated with return to play following conservative treatment for lumbar spondylolysis among young athletes: A retrospective case series using structural equation modeling. J Bodyw Mov Ther 2024; 37:51-56. [PMID: 38432841 DOI: 10.1016/j.jbmt.2023.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 07/15/2023] [Accepted: 11/06/2023] [Indexed: 03/05/2024]
Abstract
INTRODUCTION Lumbar spondylolysis is the most common underlying cause of lower back pain (LBP) in young athletes. Conservative treatment methods are often used to reduce pain and promote healing. Several parameters may affect the duration of conservative treatment, such as the time to return to play (RTP), patient behavior, and physical parameters; however, no study has comprehensively assessed the factors that affect the time to RTP. OBJECTIVES This study aimed to determine the factors associated with the time required for RTP among young athletes with early-stage spondylolysis receiving conservative treatment using structural equation modeling (SEM). METHODS In this retrospective case series, 137 young athletes (128 males and 9 females, aged 9-18 years) with early-stage lumbar spondylolysis were enrolled. All patients were examined using plain radiography and magnetic resonance imaging and treated conservatively (sports cessation, wearing a corset, therapeutic exercises, and low-intensity pulsed ultrasound radiation). SEM was used to investigate the factors affecting the time to RTP in these patients. RESULTS The final model included the following factors: spondylolysis laterality, symptom duration, lower-extremity flexibility, treatment interval, patient adherence, and residual LBP. SEM revealed that patient adherence to physician orders (p < 0.01), treatment interval (p < 0.001), and spondylolysis laterality (p < 0.001) contributed directly to shortened RTP. CONCLUSION Patient adherence is essential for reducing the time to RTP among young athletes receiving conservative treatment for early-stage spondylolysis.
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Affiliation(s)
- Masahiro Tsukada
- Graduate School of Arts and Sciences, The Open University of Japan, Chiba, Japan; Department of Rehabilitation, Takiuchi Orthopedic and Sports Clinic, Sapporo, Japan.
| | - Toshiro Takiuchi
- Department of Orthopedic Surgery, Takiuchi Orthopedic and Sports Clinic, Sapporo, Japan
| | - Noriko Ichinoseki-Sekine
- Graduate School of Arts and Sciences, The Open University of Japan, Chiba, Japan; School of Health and Sports Science, Juntendo University, Inzai, Japan
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