P.095 Soft tissue preserving direct multilevel pars repair using the ‘Smiley Face’ technique with 3D optical imaging based intraoperative spinal navigation

Abstract

Background: Two broad categories for the surgical management of symptomatic spondylolysis exist: decompression, or direct reduction and fixation. Direct fixation can maintain mobility and leads to improved outcomes over spinal fusion. The ‘smiley face’ technique is a direct fixation method of pars defect repair that uses one bent rod to reduce the number of linkage points and simplify the construct. Methods: Bilateral pars defects at L3 and L5 were repaired using the ‘smiley face’ technique. Patient reported outcomes, including the Oswestry Disability Index (ODI) and visual analog scale (VAS) scores for back and leg pain were assessed preoperatively and again at 6 weeks postoperatively. Results: The patient underwent a soft tissue preserving multi-level bilateral L3 and L5 pars defect repair using the smiley face technique while utilizing radiation-free 3D optical imaging to capture multiple points for registration despite minimal laminar exposure. The patient’s ODI and lower back VAS scores decreased from 25 to 8 and 7.5 to 4 respectively, after surgery, correlating to an excellent outcome on ODI. Conclusions: The smiley face technique can be used with soft tissue preserving techniques to achieve adequate bony reduction while maintaining intersegmental mobility in patients with multi-level pars defects. 3D imaging allows soft tissue preservation with increased registration points for intraoperative navigation.