Clinical and Radiographic Outcomes of Repair of Spondylolitic Spondylolisthesis Through Direct Pars Repair.

Abstract

A retrospective chart review. The objective of this study is to investigate whether direct pars repair achieves bone healing and symptom relief in patients with spondylolitic spondylolisthesis. While most cases of spondylolysis can be managed nonoperatively, a small percentage of patients require surgical intervention. The outcome of direct pars repair through a standard pedicle-screw with wiring technique is controversial in patients with lumbar spondylolitic spondylolisthesis. Medical records of patients who had undergone an open surgical pars repair were retrospectively reviewed. Standard demographic and surgical parameters were collected. All patients underwent a primary repair of the pars with an autograft or bone morphogenetic protein and instrumentation using a pedicle-screw with spinous process wiring. At 6 to 12 months after the surgery, patient's pain symptoms, and postoperative computed tomography (CT) scans were independently reviewed to assess healing; which was graded as nonunion, partial union, or solid union. There were 68 patients identified (33 male and 35 female), with an average age of 18.6 years. The mean estimated blood loss was 139 ml, and the mean length of hospital stay was 3.7 days. CT evaluation revealed 35 (52%) solid unions, 21 (31%) partial unions, and 12 (18%) nonunions requiring revisions. Thirty-four (50%) patients had no postoperative pain, 24 (35%) had mild pain, and 10 (15%) had persistent pain. The majority of patients with nonunions on CT had mild or persistent pain. Patients with no or mild pain tended to be younger than those with persistent pain (17.5 vs. 24.6 yr, P =0.163). This study demonstrated a partial or complete union rate of 82% and a postoperative persistent pain rate of 15%. These figures are comparable to the previous study, and this pedicle-screw with wiring technique can be worth trying before interbody fusion for spondylolytic spondylolisthesis to preserve anatomical lumbar motion.