A comparison of the techniques of direct pars interarticularis repairs for spondylolysis and low-grade spondylolisthesis: a meta-analysis

Abstract

<jats:sec><jats:title>OBJECTIVE</jats:title><jats:p>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.</jats:p></jats:sec><jats:sec><jats:title>METHODS</jats:title><jats:p>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 (<jats:italic>Cumulative Index to Nursing and Allied Health Literature</jats:italic>). 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 I<jats:sup>2</jats:sup> statistic was calculated, and the results were analyzed. Statistical analysis was performed using StatsDirect version 2.</jats:p></jats:sec><jats:sec><jats:title>RESULTS</jats:title><jats:p>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.</jats:p></jats:sec><jats:sec><jats:title>CONCLUSIONS</jats:title><jats:p>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.</jats:p></jats:sec>

Repair of symptomatic bilateral L5 spondylolysis with autogenous iliac crest graft and temporary intersegmental pedicle screw fixation in youth

“…It is very important for healing of spondylolysis and symptoms recovery. The union rate of this method was higher than those described in previous reports [ 4 ]. With reference of CT classification, all the type I cases healed at 9 months, but the slowest healing occurred in type III cases.…”

“…Surgical methods for lumbar spondylolysis could be roughly divided into two categories, fusion and repair. Meaningless sacrifice of fairly normal disc and segmental motion make stricter indication for fusion [ 4 – 7 ]. The concept of repair surgery is similar to osteosynthesis.…”

Historical Note: The Evolution of Cortical Bone Trajectory and Associated Techniques

“…Indeed, in the years following Buck's conception of bilateral screw trajectory, other techniques for internal vertebral fixation have also emerged, such as the use of cerclage wires as proposed by Scott and published by Bradford (1976) and the securing of hooks underneath the lamina as conceptualized by Morscher (1984) [13][14][15] . However, a comparative meta-analysis of Buck's, Scott's, and Morscher's technique has revealed that Buck's technique had the highest rate of fusion (83.53%), followed by Scott's (81.57%) and finally Morcher's (77.72%) 16 .…”

Isolated and Multilevel Spondylolysis (Literature Review)

“…Практически все исследователи единодушны во мнении, что наличие спондилолиза является фактором высокой степени риска формирования спондилолистеза, который в этих случаях, по используемым в настоящее время классификациям, следует относить к спондилолизному (истмическому) [11,12,32,38,[47][48][49][55][56][57][58]. Вероятность формирования такой формы спондилолистеза при наличии спондилолиза составляет не менее 50-70% [47,48,59,60].…”

“…Основной целью операции является удаление фиброзной ткани из зоны спондилолиза и достижение в этой области костного сращения посредством применения костной аутопластики и (или) остеосинтеза различными металлоконструкциями [38,71]. В случае оперативного лечения спондилолизного спондилолистеза в настоящее время «золотым стандартом» принято считать транспедикулярный спондилодез в сочетании с передним спондилодезом имплантатами различных конструкций после удаления дегенеративно измененного межпозвонкового диска и замыкательных пластин тел смежных позвонков [11,47,56,75,76]. Превентивное оперативное лечение зоны спондилолиза, в том числе многоуровневого, по мнению j. Mo с соавторами, нецелесообразно, так как может привести к «биомеханическим сдвигам и потере устойчивости позвоночника» [77].…”