Analysis of clinical and radiological outcomes of posterior dynamic stabilization for direct repair of bilateral l5 pars interarticularis defect: dynamic assessment of pars fusion

Abstract

AIM:To evaluate the satisfactory clinical and radiological outcomes of posterior dynamic stabilization for the direct repair of bilateral L5 pars interarticularis defects and pars fusion. MATERIAL and METHODS:This is a retrospective evaluation of postoperative follow-up results of 13 patients with bilateral L5 pars interarticularis defects without spondylolisthesis. The patients underwent dynamic transpedicular stabilization between 2013 and 2018. Our surgical criteria included unilateral or bilateral L5 spondylolysis; excessive low back pain; low back pain accompanied by leg pain without neurological findings; symptoms lasting at least six months despite conservative treatments, age <50 years; and lack of significant adjacent disc degeneration.RESULTS: There were seven female and six male patients with a mean age of 38.9 years. All patients achieved satisfactory postoperative results during a mean follow-up period of 22 months. Preoperative visual analog scale score and Oswestry Disability Index value were 8.85 ± 0.69 and 54.46 ± 7.62, respectively, which decreased to 1.31 ± 0.48 and 9.85 ± 3.51, respectively, at the postoperative 24 th month. In all patients, the bony fusion of the pars interarticularis at the stabilized segment was confirmed on the computed tomography scan at an average of 22 months postoperatively. CONCLUSION:The posterior dynamic system ensures that the spine moves within physiological limits and carries the load by sharing it with the spine. The advantages of direct pars repair using our technique are the restoration of the posterior structures' normal anatomy, protection of the functional mobility segment, and early functional recovery without degeneration in the adjacent segment. Therefore, when there is no significant instability, patients with spondylolysis can be treated with posterior dynamic stabilization techniques with satisfactory clinical and radiological results.

Comparing the Wiltse approach and classical approach of pedicle screw and hook internal fixation system for direct repair of lumbar spondylolysis in young patients: A case-control study

“…[3,17] At present, the commonly used surgical methods for repair isthmus defects include modified Buck method, [6,18] screw-rod technique, [19,20] screw-hook fixation technology, [7,21] and screwrod-screw short-segment fixation with direct repair of isthmus. [8,22] Screw-rod-screw short-segment fixation affects the spinal motor unit and limits local movement, especially in the lumbosacral region. Short-segment applications are rare.…”

“…At present, the commonly used isthmus defects surgical repair methods include the modified Buck method [6] and the pedicle screw-based method. [7,8] However, Buck technology is less stable than pedicle screw-based methods, [9] thus the pedicle screw-based methods are more prevalent. The classical midline approach requires extensive dissection of the paraspinal muscles, which is easy to lead to scar formation in the operative area, postoperative low back pain, lumbar weakness, and TZ and LM contributed equally to this work.…”