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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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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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Ye Y, Jin S, Zou Y, Fang Y, Xu P, Zhang Z, Wu N, Zhang C. Biomechanical evaluation of lumbar spondylolysis repair with various fixation options: A finite element analysis. Front Bioeng Biotechnol 2022; 10:1024159. [DOI: 10.3389/fbioe.2022.1024159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 10/05/2022] [Indexed: 11/13/2022] Open
Abstract
Objective: This study was designed to compare the biomechanical properties of lumbar spondylolysis repairs using different fixation methods by using three-dimensional finite element analysis.Methods: Five finite element models (A, B, C, D, and E) of L4-S1 vertebral body were reconstructed by CT images of a male patient (A: intact model; B: spondylolysis model; C: spondylolysis model with intrasegmental direct fixation by Buck screw; D: spondylolysis model with intersegmental indirect fixation by pedicle screw system; E: spondylolysis model with hybrid internal fixation). L5-S1 level was defined as the operative level. After the intact model was verified, six physiological motion states were simulated by applying 500 N concentrated force and 10 Nm torque on the upper surface of L4. The biomechanical properties of the three different internal fixation methods were evaluated by comparing the range of motion (ROM), maximum stress, and maximum displacement.Results: Compared with Model B, the ROM and maximum displacement of Model C, D, and E decreased. The maximum stress on L5/S1 disc in models A, B, and C was much higher than that in Model D and E under extension and lateral bending conditions. Under axial rotation and lateral bending conditions, the maximum stress of interarticular muscle and internal fixation system in Model B and Model C was significantly higher than that in Model D and Model E. In contrast to Model D, the stress in Model E was distributed in two internal fixation systems.Conclusion: In several mechanical comparisons, hybrid fixation had better biomechanical properties than other fixation methods. The experimental results show that hybrid fixation can stabilize the isthmus and reduce intervertebral disc stress, which making it the preferred treatment for lumbar spondylolysis.
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