Comparison of surgical treatment with direct repair versus conservative treatment in young patients with spondylolysis: a prospective, comparative, clinical trial

Lee, Gun Woo; Lee, Sun Mi; Ahn, Myun Whan; Kim, Ho-Joong; Yeom, Jin Sup

doi:10.1016/j.spinee.2015.02.019

Cited by 19 publications

(8 citation statements)

References 19 publications

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“…Furthermore, it was shown that spondylolisthesis apexes in adolescence and declines in adulthood. Consistent findings have been posited by various studies, providing support for the comparatively benign history of spondylosis, calling for non-operative management [9,16]. Thus, conservative managements, including physiotherapy with rigid braces, nonsteroidal anti-inflammatory medications, steroidal injections, and avoidance of exacerbating injuries constitute the primary treatment and could be successful for a considerable number of symptomatic patients.…”

Section: Discussionsupporting

confidence: 53%

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Percutaneous endoscopic-assisted direct repair of pars defect without general anesthesia could be a satisfying treatment alternative for young patient with symptomatic lumbar spondylolysis: a technique note with case series

Jin

Zhang

Shao

et al. 2020

BMC Musculoskelet Disord

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Background: Multiple surgical procedures are applied in young patients with symptomatic lumbar spondylolysis when conservative treatments fail. Although the optimal surgical procedure option is controversial, the treatment paradigm has shifted from open surgery to minimally invasive spine surgery. To date, a limited number of studies on the feasibility of percutaneous endoscopic-assisted direct repair of pars defect have been carried out. Herein, for the first time, we retrospectively explore the outcomes of pars defect via percutaneous endoscopy. Methods: We retrospectively examined young patients with spondylolysis treated using the percutaneous endoscopic-assisted direct repair of pars defect supplemented with autograft as well as percutaneous pedicle screw fixation between September 2014 and December 2018. Six patients with a mean age of 18.8 years were enrolled in the study. We used preoperatively computed tomographic (CT) scans to evaluate the size of pars defect, and graded disc degeneration using Pfirrmann's classification through magnetic resonance images (MRI). We assessed the clinical outcomes using the Oswestry Disability Index (ODI), 36-Item Short-Form Health Survey (SF-36) as well as Visual Analogue Scale for back pain (VAS-B). Results: Our findings revealed that pain intensity and function outcomes, including VAS-B, ODI, and SF-36 (PCS and MCS) scores, were markedly improved after surgery and at the final follow-up visit. The change in the gap distance of the pars defect was remarkably significant after surgery and during the follow-up period. Only one of the 12 pars repaired was reported as a non-union at the final follow-up visit. Moreover, no surgery-related complications were reported in any of the cases.

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Section: Discussionsupporting

confidence: 53%

“…However, divergent findings have been reported regarding the efficacy of DR techniques. Union rate after DR is only approximately 52% due to insufficient manipulation of the pars defect and segmental instability [9,10]. Besides, most of the aforementioned surgical techniques are performed under general anesthesia.…”

Section: Introductionmentioning

confidence: 99%

Percutaneous endoscopic-assisted direct repair of pars defect without general anesthesia could be a satisfying treatment alternative for young patient with symptomatic lumbar spondylolysis: a technique note with case series

Jin

Zhang

Shao

et al. 2020

BMC Musculoskelet Disord

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“…Lee et al 31 performed a prospective study on 149 young patients with spondylolysis. 87 of the patients were treated conservatively and the other 62 were treated surgically.…”

Section: Treatmentmentioning

confidence: 99%

Spondylolysis and spondylolisthesis: A review of the literature

Gagnet

Kern

Andrews

et al. 2018

Journal of Orthopaedics

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Spondylolysis is a common diagnosis with a high prevalence in children and adolescents complaining of low back pain. It may be caused by either a defect or fracture of the pars interarticularis due to mechanical stress. Depending on the severity of the spondylolysis and symptoms associated it may be treated either conservatively or surgically, both of which have shown significant success. Conservative treatments such as bracing and decreased activity have been shown to be most effective with patients who have early diagnosis and treatment. Low-intensity pulsed ultrasound (LIPUS) in addition to conservative treatment appears to be very promising for achieving a higher rate of bony union. LIPUS requires more supporting studies, but may prove to become a standard of care in the future. Surgery may be required if conservative treatment, for at least six months, failed to give sustained pain relief for the activities of daily living. Based on studies performed on each of the major surgical treatments we suggest the use of the pedicle screw hook technique and the pedicle screw rod technique due to low rates of hardware failure, increased maintenance of mobility, and lack of a postoperative bracing requirement.

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“…A previous study of patients with disc herniation and spondylolysis at the same or adjacent level demonstrated inferior results after discectomy without fusion compared with decompression and direct repair of the isthmic spondylolysis. 7 However, considering that most cases of lumbar spondylolysis are asymptomatic 8,9 and that minimally invasive decompression is associated with less slip progression in patients with degenerative spondylolisthesis, 10 we speculated whether surgery to repair spondylolysis may be unnecessary in patients with apparent disc herniation and sciatica. Microendoscopic discectomy (MED) is a minimally invasive technique for LDH that preserves posterior supporting muscles.…”

Section: Introductionmentioning

confidence: 99%

“…However, considering that most cases of lumbar spondylolysis are asymptomatic 8 , 9 and that minimally invasive decompression is associated with less slip progression in patients with degenerative spondylolisthesis, 10 we speculated whether surgery to repair spondylolysis may be unnecessary in patients with apparent disc herniation and sciatica. Microendoscopic discectomy (MED) is a minimally invasive technique for LDH that preserves posterior supporting muscles.…”

Section: Introductionmentioning

confidence: 99%

Is Microendoscopic Discectomy Effective for Patients With Concomitant Lumbar Disc Herniation and Spondylolysis?

Oshima

Inanami²,

Iwai³

et al. 2019

Global Spine Journal

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Study Design: A retrospective cohort study. Objective: Although it is controversial whether to choose only discectomy or fusion surgery in patients with disc herniation and spondylolysis, we expected that aggravation of the spondylolysis may be prevented if posterior supporting muscles can be wellpreserved without extensive exploration. The purpose of this study was to investigate the influence of L5 spondylolysis on surgical outcomes following microendoscopic discectomy (MED) in patients with concomitant lumbar disc herniation and spondylolysis. Methods:We reviewed 811 patients who underwent MED for L4/5 or L5/S1 disc herniation. Patients with spondylolisthesis were excluded. We compared surgical outcomes of patients with and without L5 spondylolysis, whose age, sex, and surgical level were matched.Results: A total of 655 patients (80.7%) with complete data were considered eligible for the study. MED was performed at L4/5 and L5/S1 in 338 and 317 patients, respectively. A total of 20 patients (3.1%) had concomitant L5 spondylolysis and disc herniation at L4/5 (9 patients) or L5S1 (11 patients). As we compared each outcome of the 20 patients having L5 spondylolysis with 40 matched patients without L5 spondylosis, there were no significant differences in preoperative or postoperative outcomes between the 2 groups, and no patient with spondylolysis had undergone additional surgery during the mean follow-up period of 24 months.Conclusions: MED demonstrated good surgical results regardless of the presence or absence of spondylolysis. In patients with sciatica with concomitant disc herniation and spondylolysis, but without spondylolisthesis, fusion surgery may not be always necessary.

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Comparison of surgical treatment with direct repair versus conservative treatment in young patients with spondylolysis: a prospective, comparative, clinical trial

Cited by 19 publications

References 19 publications

Percutaneous endoscopic-assisted direct repair of pars defect without general anesthesia could be a satisfying treatment alternative for young patient with symptomatic lumbar spondylolysis: a technique note with case series

Percutaneous endoscopic-assisted direct repair of pars defect without general anesthesia could be a satisfying treatment alternative for young patient with symptomatic lumbar spondylolysis: a technique note with case series

Spondylolysis and spondylolisthesis: A review of the literature

Is Microendoscopic Discectomy Effective for Patients With Concomitant Lumbar Disc Herniation and Spondylolysis?

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