A Universal Pedicle Screw and V-Rod System for Lumbar Isthmic Spondylolysis: A Retrospective Analysis of 21 Cases

Abstract

ObjectiveTo investigate the surgical outcome of a universal pedicle screw-V rod system and isthmic bone grafting for isthmic spondylolysis.MethodsTwenty-four patients with isthmic spondylolysis at L5 and grade 0–I spondylolisthesis (Meyerding classification) received isthmic bone graft and stabilization using the universal pedicle screw-V rod system. Back pain was evaluated using the visual analog scale (VAS) and time to bone healing, improvement in spondylolisthesis and intervertebral space height at L5/S1 and L4/L5 were assessed.ResultsTwenty-one patients were followed up for 24 months and included in the analysis. Back pain was markedly improved at 3 months postoperatively with a statistical difference in VAS scores compared with preoperative VAS scores (P<0.001). The VAS scores were 0 to 3 at 6 months postoperatively in all patients and no back pain was reported in all patients except 2 patients who complained of back pain after prolonged sitting. X-ray examination showed a bone graft healing time of 3 to 12 months. Grade I spondylolisthesis improved to grade 0 in 4 patients and no noticeable change was observed in the remaining 17 cases. The intervertebral space height at L5/S1 was statistically increased (P<0.05) while no statistically significant change was seen at L4/L5. There was no statistically significant difference in the ROM of the intervertebral disks of L5/S1 and L4/5 before and after surgery.ConclusionsThe universal pedicle screw-V rod system and isthmic bone grafting directly repairs isthmic spondylolysis and reduces back pain, prevents anterior displacement of the diseased segment and maintains intervertebral space height, thus offering a promising alternative to current approaches for isthmic spondylolysis.

Retrospective Comparative Study of Pedicle Screw Fixation via Quadrant Retractor and Buck's Technique in the Treatment of Adolescent Spondylolysis

“…There was a hypothesis from this study that the pedicle screw fixation did not harm to the index disc and the adjacent disc. This hypothesis was similar to the reporting of Chen et al The pedicle screw‐V rod system directly repairs the isthmus of the vertebra and the procedure does not impact on adjacentvertebral segments and causes no injury to the diseased intervertebral disc 9 . Furthermore, the Quadrant retractor can provide good illumination, a good visual field and minimal damage to the surrounding tissues, resulting in a faster recovery and pain relief postoperatively.…”

“…Chen et al . reported that pedicle screw fixation using the pedicle screw and V‐rod system successfully fused the fracture sites of the pars interarticularis in all 21 patients in their study and that the average VAS scores for LBP decreased from 7.5 (5–9) preoperatively to 3.04 (2–5) postoperatively and 1.43 (0–3) 6 months postoperatively 9 . A retrospective study of the screw hook system for pedicle fixation by Debusscher and Troussel showed that approximately 91% of patients achieved good fusion results and that the VAS scores for LBP decreased from an average of 7.75 preoperatively to 1.7 at the 4‐year follow‐up 10 .…”

“…Magnetic resonance imaging (MRI) can be used to detect disc degeneration in the involved segments and adjacent segments. Spondylolysis is primarily treated with open surgery, which includes Buck's technique, fixation with a pedicle screw and V‐rod system, fixation with a pedicle screw hook system, etc 7–11 …”

“…Spondylolysis is primarily treated with open surgery, which includes Buck's technique, fixation with a pedicle screw and V‐rod system, fixation with a pedicle screw hook system, etc. 7 , 8 , 9 , 10 , 11 .…”

Percutaneous screw placement in the lumbar spine with a modified guidance technique based on 3D CT navigation system

“…According to the literature, there is a slight preference for percutaneous PS techniques versus open and minimally-open techniques due to reduced operative time, blood loss, and incision length as well as the optimal positioning of the screws with this procedure (6). The percutaneous placement of PS in the lumbar spine for various conditions, such as pars interarticularis defects (7), traumatic or osteoporotic vertebral fractures (8)(9)(10)(11), restoration and/or preservation of lumbar lordosis during correction procedures for severe kyphoscoliosis (12,13), spondylolysis (14)(15)(16), spondylolisthesis (17,18), and finally to provide supplemental stabilization for lumbar interbody fusion procedures (19)(20)(21)(22). Another relatively new indication for percutaneous PS placement is in obese patients with spinal deformities and severe degenerative lumbar disease as it reduces the operative site exposure, surgical time, and hospitalization and decreases the postoperative infection rate (23)(24)(25).…”