Direct reduction and repair of spondylolysis with grade 1 slip using the          smiley face rod: a case report

Okuwaki, Shun; Tatsumura, Masaki; Gamada, Hisanori; Ogawa, Tomoya; Mammoto, Takeo; Hirano, Atsushi; Yamazaki, Masashi

doi:10.2185/jrm.2020-039

Cited by 7 publications

(10 citation statements)

References 17 publications

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“…In lesions that are expected to have a particularly low rate of bone union as they have many negative factors for bone union, if conservative treatment failed to achieve bone union, pain control with oral painkillers or interventional pain injections, early surgery due to pain, or repair surgery for lesions that became pseudoarthrosis may be effective depending on age and sports level [ 6 – 8 , 22 – 25 ]. To further develop the treatment of lumbar spondylolysis, prospective studies on the ability to predict the rate of bone union at the time of the initial visit are a future prospect and challenge.…”

Section: Discussionmentioning

confidence: 99%

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Main and contralateral side stages of lesion affected bone union in the conservative treatment of adolescent lumbar spondylolysis: a multivariable analysis of 217 patients and 298 lesions in a retrospective cohort study

et al. 2023

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Background Factors affecting bone union in the conservative treatment of adolescent lumbar spondylolysis remain controversial. We aimed to examine these factors along with advances in diagnostic imaging using multivariable analysis of a sufficient number of patients and lesions. Methods In this retrospective study, high-school-aged patients or younger (n = 514) who were diagnosed with lumbar spondylolysis from 2014 to 2021 were investigated. We included patients with acute fractures who showed signal changes around the pedicle on magnetic resonance imaging and who completed conservative treatment. The following factors were investigated at the initial visit: age, sex, level of lesion, main side stage, presence and stage of contralateral side lesion, and presence of spina bifida occulta. The association of each factor with bone union was evaluated through a multivariable analysis. Results Altogether, 298 lesions in 217 patients (174 boys and 43 girls; mean age: 14.3 years) were included in this study. Multivariable logistic regression analysis of all factors showed that the main side progressive stage was more likely associated with nonunion as compared to the pre-lysis (OR: 5.86; 95% confidence interval [CI]: 2.00–18.8; p = 0.0011) and early stages (OR: 3.77; 95% CI: 1.72–8.46; p = 0.0009). Regarding the contralateral side stage, the terminal stage was more likely to be associated with nonunion. Conclusion In the conservative treatment of lumbar spondylolysis, the factors affecting bone union were the main and contralateral side stages. Sex, age, level of lesion, or spina bifida occulta had no significant effects on bone union. The main, progressive, and contralateral side terminal stages were negative predictors of bone union. Trial registration This study was retrospectively registered.

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Section: Discussionmentioning

confidence: 99%

“…This results in successful bone union in 77–100% of patients [ 1 , 3 – 5 ]. However, while this bone union rate is high, surgery may be required in cases where bone union is not achieved, leading to pseudoarthrosis [ 6 – 8 ]. With conservative treatment, the factor most likely to affect bone union is the lesion stage.…”

Section: Introductionmentioning

confidence: 99%

Main and contralateral side stages of lesion affected bone union in the conservative treatment of adolescent lumbar spondylolysis: a multivariable analysis of 217 patients and 298 lesions in a retrospective cohort study

et al. 2023

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“…Various surgical methods have been reported for lumbar spondylolysis, including the Buck method, the Scott method, pedicle screw and segmental wire fixation, pedicle screw-rod-hook fixation, and recently, the Smiley face rod method. All of these methods have been reported to be effective in treating pseudarthrosis [2][3][4][5]. Among them, there are various reports of screw fixation, including robot assistance and navigation.…”

Section: Discussionmentioning

confidence: 99%

“…Conservative treatment is the first choice when the fracture is acute [1]. In cases of pseudarthrosis of the lesion, various surgical techniques have been described [2][3][4][5]. On the other hand, there are reports of surgery being performed in a very limited number of cases with acute fractures that do not respond to conservative treatment and are in persistent pain [6][7].…”

Section: Introductionmentioning

confidence: 99%

Minimally Invasive Screw Fixation of Non-Pseudoarthorotic Lumbar Spondylolysis for Early Return to Sports

Gamada

Tatsumura

Okuwaki

et al. 2021

Cureus

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Lumbar spondylolysis is a fatigue fracture that occurs most frequently in middle and high school athletes. Conservative treatment is the first choice when the fracture is fresh. Surgical treatment of lumbar spondylolysis is often reported for pseudarthrosis cases, but surgery for cases of fresh fractures is rare. We report a case of a 16-year-old male, high jump athlete, with recurrent non-pseudoarthorotic lumbar spondylolysis.He presented to our hospital with a chief complaint of back pain, and was diagnosed as right L5, pre-lysisstage lumbar spondylolysis. After 3 months of conservative treatment, bone union was achieved with no obvious worsening of the fracture. His back pain also disappeared and he was able to return to exercise. At 6 months after the first examination, the lesion recurred and he could no longer continue playing sports, so surgical treatment was indicated.Minimally invasive screw fixation was performed by combining Buck's method and the cortical bone trajectory. After the surgery, he started jogging at 5 weeks, resumed jumping practice at 7 weeks, and returned to competition at 2 months. He set a new personal best in a competition 3 months post-surgery. Bone union was achieved at 4 months. This technique is minimally invasive and does not involve debridement or bone grafting, which provides early pain relief and return to sports.

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“…Ulibarri et al reported that biomechanical evaluation of this method showed excellent stability of a spondylolysis defect compared with other types of direct repair surgery 7) . The smiley face rod method can produce promising results, has the possibility of repairing grade-1 spondylolisthesis, and the implant can be removed after the bone union 8) . However, bone union cannot be achieved in some patients.…”

Section: Introductionmentioning

confidence: 99%

Association of Pars Defect Type with Clinical Outcome after Smiley Face Rod Methods for Terminal-Stage Spondylolysis

Okuwaki,

Tatsumura,

Gamada

et al. 2024

Spine Surg Relat Res

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Background:The smiley face rod method is an effective treatment for symptomatic terminal-stage spondylolysis. However, the risk factors for treatment failure are unknown. We investigated the association of pars defect type with the treatment outcomes of this method. Methods:We retrospectively examined data from 34 patients (18.0 ± 6.7 years) with terminal-stage spondylolysis who underwent surgery using the smiley face rod method.The mean follow-up period was 44.9 ± 21.4 months. The patients were divided into 2 groups: pars defect without bone atrophy or sclerosis (group A; 18 patients), and with bone atrophy and sclerosis (group B; 16 patients). We defined atrophy as a defect with a depression in the defect line that causes the defect to expand and the edge to become asymmetrical. We evaluated and compared the visual analog scale (VAS) score for back pain, bone union rate, and time to return to preinjury level athletics between the groups.Fisher exact and paired Student t tests were used to compare the variables between groups. The VAS score between the groups was compared using a 2-factor repeatedmeasures analysis of variance.Results: Within groups, the VAS score was significantly different over time (p < 0.001). The VAS scores between groups were not significantly different. Patients in Group A had a significantly higher bone union rate per pars at 6 months (group A, 65.7%; and group B, 37.5%, p = 0.028) and 24 months after surgery (group A, 97.1%; and group B, 75.0%, p = 0.011). All patients returned to their respective sports, and no significant differences were observed in the time to return to preinjury level athletics between the groups (p = 0.055). Conclusion:Pars sclerosis defects are associated with bone nonunion, but have little

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Direct reduction and repair of spondylolysis with grade 1 slip using the smiley face rod: a case report

Cited by 7 publications

References 17 publications

Main and contralateral side stages of lesion affected bone union in the conservative treatment of adolescent lumbar spondylolysis: a multivariable analysis of 217 patients and 298 lesions in a retrospective cohort study

Main and contralateral side stages of lesion affected bone union in the conservative treatment of adolescent lumbar spondylolysis: a multivariable analysis of 217 patients and 298 lesions in a retrospective cohort study

Minimally Invasive Screw Fixation of Non-Pseudoarthorotic Lumbar Spondylolysis for Early Return to Sports

Association of Pars Defect Type with Clinical Outcome after Smiley Face Rod Methods for Terminal-Stage Spondylolysis

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