Retrospective Comparative Study of Pedicle Screw Fixation via Quadrant Retractor and Buck's Technique in the Treatment of Adolescent Spondylolysis

Abstract

Objective To compare the effectiveness and practicality of pedicle screw fixation via the Quadrant retractor and Buck's technique in the treatment of adolescent spondylolysis. Methods A total of 31 patients who underwent pedicle screw fixation or Buck's technique at our hospital from 2012 to 2017 were selected for this retrospective study. The patients were divided into a pedicle screw group (16 patients) and a Buck's technique group (15 patients) according to surgical procedure. Age, sex, disease duration, involved segments, preoperative Oswestry disability index (ODI) scores, visual analogue scale (VAS) scores for low back pain (LBP), intraoperative blood loss, incision length, operative time and length of hospital stay were documented. ODI scores, VAS scores for LBP and fusion rates at 1 month, 6 months, 1 year and 3 years postoperatively were used to evaluate surgical outcomes. Results The average follow‐up period was 32.75 ± 11.99 months in the pedicle screw group and 31.02 ± 9.64 months in the Buck's technique group. No significant differences in demographic data and perioperative data were found between the two groups (P > 0.05). The ODI scores and VAS scores for LBP in both groups were significantly improved at 3 years postoperatively compared with the values before surgery (ODI%: 45.74 ± 2.47 vs 10.99 ± 3.00; 45.29 ± 6.94 vs 15.73 ± 6.89. VAS: 5.94 ± 0.68 vs 1.50 ± 0.52; 6.13 ± 0.74 vs 2.13 ± 0.92, P < 0.05). The ODI scores of the patients in the pedicle screw group at 1 month to 3 years postoperatively were lower than those of the patients in the Buck's technique group (P < 0.05). Moreover, the VAS scores for LBP of the patients in the pedicle screw group at 6 months and 3 years postoperatively were lower than those of the patients in the Buck's technique group (P < 0.05). No significant difference in the VAS scores for LBP was found between the two groups at 1 month postoperatively (3.88 ± 0.50 vs 4.20 ± 0.56, P = 0.10). Three years postoperatively, good fusion of the pars interarticularis was achieved in all patients in the pedicle screw group, but four patients in the Buck's technique group did not achieve good fusion (P = 0.02). Conclusion Both pedicle screw fixation and Buck's technique can achieve good outcomes in the treatment of adolescent spondylolysis. Pedicle screw fixation via the Quadrant retractor for the treatment of spondylolysis is associated with more satisfactory effects in terms of LBP relief and fusion results.

Endoscopic Fixation of Bilateral L5 Spondylolysis Based on a New Technique: A Case Report

“…Widi et al [7] reported mean duration of 65 minutes (range, 55-80 minutes) for surgery performed based on the percutaneous direct pars repair technique. Ghobrial et al [8] reported mean duration of 189±29 minutes for the direct pars repair technique, based on minimally invasive approach, whereas Li et al [9] described mean surgery time of 216.67±62.60 minutes for procedure based on the conventional Buck technique. Surgeon's experience with endoscopic procedures, and the fact that minimally invasive techniques require shorter surgical time, are some of the explanations for the herein addressed difference in surgical time.…”

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

“…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.…”

Pars Interarticularis Fractures Treated with Minimally Invasive Surgery: A Literature Review

“…Buck provided one of the first descriptions of bilateral screw fixation across the pars interarticularis defect [39]. Advantages of Buck's technique include preservation of segment motion, rapid postoperative recovery, and minimal blood loss [40]. Further studies detailing utilization of Buck's technique demonstrated satisfactory results in 78-90% of patients [41].…”