Percutaneous Direct Repair of a Pars Defect Using Intraoperative Computed Tomography Scan

Nourbakhsh, Ali; Preuss, Fletcher R.; Hadeed, Michael M.; Shimer, Adam L.

doi:10.1097/brs.0000000000001929

Cited by 9 publications

(3 citation statements)

References 21 publications

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“…In both reports, surgery was performed for pseudoarthorotic lesions after 6 to 60 months of conservative treatment, with debridement of the lesion or bone graft [2,[16][17][18]. However, even in fresh lesions without pseudarthrosis, surgery may be indicated in cases that are resistant to conservative treatment and persistent in pain [6][7].…”

Section: Discussionmentioning

confidence: 99%

“…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]. We report a case of recurrent non-pseudoarthorotic lumbar spondylolysis, in which a minimally invasive screw fixation was performed by combining Buck's method and the cortical bone trajectory (CBT) [8].…”

Section: Introductionmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 99%

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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“…Another modification of an old technique involves the use of the translaminar screw from a contralateral percutaneous entry with intraoperative CT guidance. 40 This is not much different from the starting approach with the translaminar facet screw initially popularized for the treatment of spondylolisthesis, 15,22,34 with the exception that the trajectory limits placement of bilateral pars screws, greatly limiting the utility of their technique.…”

Section: Discussionmentioning

confidence: 99%

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

Ghobrial

Crandall

Lau

et al. 2017

Neurosurgical Focus

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OBJECTIVEThe objective of this study was to describe the use of a minimally invasive surgical treatment of lumbar spondylolysis in athletes by a fluoroscopically guided direct pars screw placement with recombinant human bone morphogenetic protein–2 (rhBMP-2) and to report on clinical and radiographic outcomes.METHODSA retrospective review was conducted of all patients treated surgically for lumbar spondylolysis via a minimally invasive direct pars repair with cannulated screws. Demographic information, clinical features of presentation, perioperative and intraoperative radiographic imaging, and postoperative data were collected. A 1-cm midline incision was performed for the placement of bilateral pars screws utilizing biplanar fluoroscopy, followed by placement of a fully threaded 4.0-mm-diameter titanium cannulated screw. A tubular table-mounted retractor was utilized for direct pars fracture visualization and debridement through a separate incision. The now-visualized pars fracture could then be decorticated, with care taken not to damage the titanium screw when using a high-speed drill. Local bone obtained from the curettage was then placed in the defect with 1.05 mg rhBMP-2 divided equally between the bilateral pars defects.RESULTSNine patients were identified (mean age 17.7 ± 3.42 years, range 14–25 years; 6 male and 3 female). All patients had bilateral pars fractures of L-4 (n = 4) or L-5 (n = 5). The mean duration of preoperative symptoms was 17.22 ± 13.2 months (range 9–48 months). The mean operative duration was 189 ± 29 minutes (range 151–228 minutes). The mean intraoperative blood loss was 17.5 ± 10 ml (range 10–30 ml). Radiographic follow-up was available in all cases; the mean length of time from surgery to the most recent imaging study was 30.8 ± 23.3 months (range 3–59 months). The mean hospital length of stay was 1.13 ± 0.35 days (range 1–2 days). There were no intraoperative complications.CONCLUSIONSLumbar spondylolysis treatment with a minimally invasive direct pars repair is a safe and technically feasible option that minimizes muscle and soft-tissue dissection, which may particularly benefit adolescent patients with a desire to return to a high level of physical activity.

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Lumbosacral Spondylolysis and Spondylolisthesis

Chung

Shimer

2021

Clinics in Sports Medicine

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Percutaneous Direct Repair of a Pars Defect Using Intraoperative Computed Tomography Scan

Abstract: 5.

Cited by 9 publications

References 21 publications

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

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

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

Lumbosacral Spondylolysis and Spondylolisthesis

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