Repair of Pars Interarticularis Defect by Segmental Wire Fixation in Young Athletes with Spondylolysis

Nozawa, Satoshi; Shimizu, Katsuji; Miyamoto, Kei; Tanaka, M.

doi:10.1177/03635465030310030601

Cited by 59 publications

(47 citation statements)

References 17 publications

(18 reference statements)

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“…7,9,10,12,17,18,21,31,34 Ivanic et al 18 evaluated CT scans only in cases of doubtful fusion. The remaining studies did not mention the method used for assessing fusion.…”

Section: Fusion Ratementioning

confidence: 99%

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A comparison of the techniques of direct pars interarticularis repairs for spondylolysis and low-grade spondylolisthesis: a meta-analysis

Mohammed¹,

Patra²,

Narayan³

et al. 2018

Neurosurgical Focus

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OBJECTIVESpondylosis with or without spondylolisthesis that does not respond to conservative management has an excellent outcome with direct pars interarticularis repair. Direct repair preserves the segmental spinal motion. A number of operative techniques for direct repair are practiced; however, the procedure of choice is not clearly defined. The present study aims to clarify the advantages and disadvantages of the different operative techniques and their outcomes.METHODSA meta-analysis was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The following databases were searched: PubMed, Cochrane Library, Web of Science, and CINAHL (Cumulative Index to Nursing and Allied Health Literature). Studies of patients with spondylolysis with or without low-grade spondylolisthesis who underwent direct repair were included. The patients were divided into 4 groups based on the operative technique used: the Buck repair group, Scott repair group, Morscher repair group, and pedicle screw–based repair group. The pooled data were analyzed using the DerSimonian and Laird random-effects model. Tests for bias and heterogeneity were performed. The I2 statistic was calculated, and the results were analyzed. Statistical analysis was performed using StatsDirect version 2.RESULTSForty-six studies consisting of 900 patients were included in the study. The majority of the patients were in their 2nd decade of life. The Buck group included 19 studies with 305 patients; the Scott group had 8 studies with 162 patients. The Morscher method included 5 studies with 193 patients, and the pedicle group included 14 studies with 240 patients. The overall pooled fusion, complication, and outcome rates were calculated. The pooled rates for fusion for the Buck, Scott, Morscher, and pedicle screw groups were 83.53%, 81.57%, 77.72%, and 90.21%, respectively. The pooled complication rates for the Buck, Scott, Morscher, and pedicle screw groups were 13.41%, 22.35%, 27.42%, and 12.8%, respectively, and the pooled positive outcome rates for the Buck, Scott, Morscher, and pedicle screw groups were 84.33%, 82.49%, 80.30%, and 80.1%, respectively. The pedicle group had the best fusion rate and lowest complication rate.CONCLUSIONSThe pedicle screw–based direct pars repair for spondylolysis and low-grade spondylolisthesis is the best choice of procedure, with the highest fusion and lowest complication rates, followed by the Buck repair. The Morscher and Scott repairs were associated with a high rate of complication and lower rates of fusion.

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“…7,9,10,12,17,18,21,31,34 Ivanic et al 18 evaluated CT scans only in cases of doubtful fusion. The remaining studies did not mention the method used for assessing fusion.…”

Section: Fusion Ratementioning

confidence: 99%

“…1 In our analysis, the main problem noted in most series employing the Scott method was wire breakage. 2,5,13,17,19,31,32,43 There were 14 such instances reported. The fusion rates ranged from 43% 43 to 100%, 2,31 and the overall pooled favorable outcome of the Scott repair was 82.49%.…”

Section: Scott Repairmentioning

confidence: 99%

A comparison of the techniques of direct pars interarticularis repairs for spondylolysis and low-grade spondylolisthesis: a meta-analysis

Mohammed¹,

Patra²,

Narayan³

et al. 2018

Neurosurgical Focus

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“…Although excellent result had been reported, extensive dissection to completely expose the transverse process, proximity of the wire path to the nerve roots and the fixation depending on relatively weak bony elements of the spine (transverse and spinous processes) were problematic. Nozawa et al [17] used the segmental wiring fixation in 20 athletes. Bony union could be achieved in all cases with return to sport activities.…”

Section: Discussionmentioning

confidence: 99%

The Use of Cable-Screw Construct as an Effective Method for Direct Pars Repair

Arafa¹,

Zahlawy²,

Abdelrady³

2018

MOJOR

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Background: The aim of this study is to assess the use of cable-wire construct together with bone grafting for direct repair of pars defects in spondylolysis. Patient and methods:Thirty patients with bilateral pars defect in complaining of low back pain were included in this prospective study. A cable-screw construct was used for pars repair after failure of conservative measures. Patients were assessed radiologically for union and clinically by Oswestry disability index (ODI) and VAS for back pain. Demographic data and any complications were noted. Results:The mean follow up period was 22 months. The mean preoperative ODI and VAS were 67.77 and 8.2 respectively. This improved to 11.07 and 1.33 at final follow up. The improvements were statistically significant. At the final follow up, radiological healing could be achieved bilaterally in all patients (86.6%) but four. Three of them had initial defects >3mm and 1 from 2-3mm. For the healed cases, the mean time to union was 4.7 months. Conclusion:The cable-screw construct appears to be a rigid, low profile construct with high success rates in treating pars defects both radiologically and clinically.Citation: Arafa AM, Zahlawy HE, Abdelrady AM (2017) The Use of Cable-Screw Construct as an Effective Method for Direct Pars Repair. MOJ Orthop Rheumatol 9(5): 00372.

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“…36 The surgical literature specifies removing fibrous tissue at the pars defect before performing repair of the defect. 63,64 Also, excessive vertebral body translation would indicate the presence of instability and thereby contraindicate high velocity, low amplitude spinal manipulation.…”

Section: Conservative Managementmentioning

confidence: 99%

“…63 The methods of stabilization are varied and multiple. [64][65][66][67][68] Evaluation of which surgical methods yield the best results is beyond the scope of this paper.…”

Section: Conservative Managementmentioning

confidence: 99%

Spondylolysis and spondylolisthesis: a narrative review of etiology, diagnosis, and conservative management

Haun

Kettner

2005

Journal of Chiropractic Medicine

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Repair of Pars Interarticularis Defect by Segmental Wire Fixation in Young Athletes with Spondylolysis

Abstract: We recommend this technique in cases of lumbar spondylolysis in athletes who hope to resume their sports activities.

Cited by 59 publications

References 17 publications

A comparison of the techniques of direct pars interarticularis repairs for spondylolysis and low-grade spondylolisthesis: a meta-analysis

A comparison of the techniques of direct pars interarticularis repairs for spondylolysis and low-grade spondylolisthesis: a meta-analysis

The Use of Cable-Screw Construct as an Effective Method for Direct Pars Repair

Spondylolysis and spondylolisthesis: a narrative review of etiology, diagnosis, and conservative management

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