Spondylolysis and spondylolisthesis. Treatment by internal fixation and bone-grafting of the defect.

Pedersen, Asger Ken; Hagen, Robert

doi:10.2106/00004623-198870010-00004

Cited by 77 publications

(34 citation statements)

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“…Using radiological criteria, the pseudarthrosis rate in our study was 10%, which is consistent with the previously reported large series [2,10,12,13]. However, incidence of non-union was as high as 50% when CT examination was used.…”

Section: Discussionsupporting

confidence: 91%

Repair of spondylolytic defect with a cable screw reconstruction

Pai

Hodgson

2007

International Orthopaedics (SICO

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We present the clinical and radiological results of surgical repair for refractory spondylolysis in 20 patients at a minimum follow-up of 2 years. Seventeen of them were reassessed after 5 years. The Oswestry scores revealed good to excellent results in 90% (18/20 patients), indicating a good outcome with surgical repair using two techniques: the Scott procedure or pedicle screw and wire technique. Radiological pseudarthosis was 10%, which was quite consistent with reported series. CT scanning of the 14 patients after a mean of 13 months revealed complete healing of the fracture in 7 patients, partial in 2 and frank non-union in 5. Overall, CT examination with reversed gantry showed only 7/14 (50%) healing, indicating that radiological healing on plain X-ray is not always suggestive of complete bony healing. However, CT healing is not a sine qua non of good to excellent clinical outcome.Résumé Nous présentons les résultats cliniques et radiologiques des 20 patients présentant une récidive de spondylolyse avec un minimum de recul de 5 ans (7.5 ans). Le score d'Oswestry a montré un bon et un excellent résultat chez 90% des patients (18/20) en utilisant deux techniques, la technique de Scott ou la technique des vis pédiculaires avec fil métallique. La pseudarthrose radiologique est de 10%. Un scanner réalisé chez 14 patients avec un recul de 13 mois a montré une guérison complète de la fracture chez 7 patients, partielle chez 2 et une pseudarthrose dans 5 cas. L'examen au scanner a mis en évidence que le taux de guérison radiologique n'était que de 50%, néanmoins cette consolidation scannographique n'est pas nécessaire pour avoir un bon résultat final sur le plan clinique.

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Section: Discussionsupporting

confidence: 91%

Repair of spondylolytic defect with a cable screw reconstruction

Pai

Hodgson

2007

International Orthopaedics (SICO

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“…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.…”

Section: Discussionmentioning

confidence: 99%

“…The results of direct defect repair depend, to a considerable degree, upon the degree of degeneration of the intervertebral disc involved. Although some authors [2,9] have reported satisfactory results with direct repair even in older patients, most experiences have shown that younger patients have a better clinical outcome than older patients [1,10,13,20,23,31]. These latter studies found that adult patients require a segmental fusion rather than direct repair, which was deemed to be a suitable method only in juvenile patients.…”

Section: Discussionmentioning

confidence: 99%

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

Dai

Jia

Yuan

et al. 2001

European Spine Journal

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“…The safe use of intralaminar direct screw placement across the pars was reported by Buck,5 and then in 1988 by Pedersen et al 44 in 18 patients. It has been proposed by Kakiuchi 29 as well as by Pederson and colleagues that the cause of the high pseudarthrosis rate (33%) seen with intralaminar screw placement was hardware positioning.…”

Section: Discussionmentioning

confidence: 85%

“…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.…”

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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Spondylolysis and spondylolisthesis. Treatment by internal fixation and bone-grafting of the defect.

Cited by 77 publications

References 0 publications

Repair of spondylolytic defect with a cable screw reconstruction

Repair of spondylolytic defect with a cable screw reconstruction

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

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

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