Direct repair of spondylolysis

Direct repair of defect in lumbar spondylolysis and mild isthmic spondylolisthesis by bone grafting, with or without facet joint fusion

“…However, patients with highgrade spondylolisthesis are not candidates for direct repair. Following Kimura's initial introduction of the direct repair technique, screw [2,11,12,21,23,25,30,31], wire [3,9,13,20], hook-screw [1,10,18], rod-screw [8], and plate [16] fixation and some variations [14] were used to stabilize the repaired defects. These techniques allow the patients up as soon as possible postoperatively, but reoperation is required to remove the internal fixation device.…”

Minimally invasive direct pars repair with cannulated screws and recombinant human bone morphogenetic protein: case series and review of the literature

“…10,57,61 Overall, complication rates have been reported to be as high as 40% with the Buck technique, 14% with Scott's wiring, and 44% with Morscher's technique. 4,5,11,27,43,44,60 The authors report no intraoperative complications in the present series. In 1 case, screw backout was noted in a patient in whom intraoperative repositioning of the threaded guidewire was required prior to drilling and tapping of the cortical bone.…”

“…8,9,18 This can be compared with 86%-100% using Scott's technique, 56%-82% with the Morscher technique (a pedicle screw-hook construct introduced by Hefti and colleagues 20,21 ), and 83% with screw-rod-hook constructs. 4,11,17,18,20,21,27,39,[42][43][44]55,59,60,62 Hardcastle 18 identified 23 patients who reported a preferred pitching-style in cricket termed "fast bowling," which is a technique requiring lumbar extension and thoracolumbar rotation, occurring approximately 600 times per week for 6 months a year. Of the 23 patients with low-back pain, 50% had a pars defect (5 unilateral and 5 bilateral) and 10 were successfully treated with direct pars screw repair and posterior iliac crest graft placement, leading to fusion in all 10 cases.…”

Lumbar pars injury or spondylolysis – diagnosis and management

“…[58][59][60][61][62][63][64][65][66][67] Good results of screw fixation have been reported in both non sporting and sporting populations. 51,[68][69][70][71][72] Biomechanical basis of surgical treatment Artificially induced bilateral pars defects in fresh frozen calf lumbar spines increase the intervertebral mobility not only at the involved level but also at the upper level adjacent to the lysis. 73 The increased mobility of both the spondylolytic segment and the adjacent level are significantly reduced by Buck's screw repair.…”

“…Although technically difficult, it provides a safe, reliable method and is reproducible (Figures 2a-i). 10,22,51,53,57,58,68,69,71,72 Predictors of successful outcome following surgery It was established that the predictors of successful surgical outcome include age less than 25 years, spondylolysis of less than 4 mm, absence of disc degeneration, positive response to local anaesthetic infiltration of the pars defect, method of surgical repair and psychological motivation of the individual undergoing surgery. 22,53 Further evaluation of studies at Nottingham suggests that results of direct repair of a PI defect in a patient over the age of 25 years old may sometimes run an unpredictable course.…”