Repair of symptomatic bilateral L5 spondylolysis with autogenous iliac crest graft and temporary intersegmental pedicle screw fixation in youth

Abstract

Background When symptomatic spondylolysis fail to respond to nonoperative treatment, surgical management may be required. A number of techniques have been described for repair by intrasegmental fixation with good results; however, there are still some problems. We reported a repair technique with temporary intersegmental pedicle screw fixation and autogenous iliac crest graft. The aim of present study is to assess the clinical outcomes of L5 symptomatic spondylolysis with this technique. Methods A retrospective analysis of 128 patients with L5 spondylolysis treated with this method was performed. According to CT scan, the spondylolysis were classified into 3 categories: line, intermediate, and sclerosis type. The diagnostic block test of L5 bilateral pars defect was done in all patients preoperatively. The sagittal and axial CT images were used to determine the bone union. The healing time, complications, number of spina bifida occulta, Japanese Orthopedic Association (JOA) score, and VAS for back pain were recorded. After fixation removal, the rate of ROM preservation at L5S1 was calculated. Results There were 97 patients (194 pars) followed with mean follow-up of 23 months (range, 12–36 months). The union rate of pars was 82.0% at 12 months and 94.3% at 24 months postoperatively. Low back pain VAS significantly (P < 0.05) improved from preoperative mean value of 7.2 to 1.3 at the final follow-up postoperatively (P < 0.05). JOA score increased significantly postoperatively (P < 0.05) with average improvement rate of 79.3%. The rates of L5S1 ROM preservation were 79.8% and 64.0% after fixation removal at 1 and 2 years postoperatively. There were 3 patients of delayed incision healing without other complications. Conclusions Although sacrificing L5S1 segment motion temporarily, more stability was obtained with intersegmental fixation. This technique is reliable for spondylolysis repair which has satisfactory symptom relief, high healing rate, low incidence of complications, and preserve a large part of ROM for fixed segment.

Association of pars defect type with clinical outcome after smiley face rod methods for terminal-stage spondylolysis

“…Third, because some patients have disc degeneration and spondylolisthesis preoperatively, postoperative pain assessment is di cult due to these confounding factors. However, although patients with these factors have been excluded in previous reports [12,18], they had good outcomes in the present study. Multiple regression analysis including these factors with a larger number of patients is needed in the future.…”

“…We categorized the pars defect based on the axial CT [12] as follows: type I (line type), in which the gap is almost hairline; type II (intermediate type) shows a clear bone gap with no signs of bone atrophy or sclerosis at the edge of the bony defect; type III (sclerosis type) shows an enlarged bony gap with manifestations of bone atrophy and sclerosis. In the present study, types I and II were included in group A; and type III was included in group B (Fig.…”

“…Atrophic nonunion refers to an inadequate or poorly vascularized mesenchymal tissue with very limited potential for successful healing of the bone union [11]. In patients with spondylolysis, the sclerotic or atrophic change in the pars defect is a risk factor for nonunion after direct repair surgery [12]. However, it remains unclear whether surgical outcomes of smiley face rod methods differ according to the type of pars defect.…”

Biomechanical evaluation of lumbar spondylolysis repair with various fixation options: A finite element analysis

“…Currently, there are two common methods of internal fixation in clinical practice. One is Buck's technique, proposed by Buck in 1970, to directly fix the isthmus repair, (JE, 1970;Snyder et al, 2014) , and the other is the indirect fixation of the isthmus with the intersegmental pedicle screw internal fixation system used by various scholars (Huang et al, 2019;Zhang et al, 2021). Extensive studies have confirmed the effectiveness and safety of both methods.…”

“…Another pedicle screw system ameliorated the low postoperative fusion rate. The strong grip of the pedicle screw itself and the squeezing effect of the screw system on the isthmic bone graft ensure isthmic fusion (Huang et al, 2019;Zhang et al, 2021). However, the above two fixation methods also have certain defects.…”