Abstract
BackgroundMultiple surgical procedures are applied in young patients with symptomatic lumbar spondylolysis when conservative treatments fail. Although the optimal surgical procedure option is controversial, the treatment paradigm has shifted from open surgery to minimally invasive spine surgery. To date, a limited number of studies on the feasibility of percutaneous endoscopic-assisted direct repair of pars defect have been carried out. Herein, for the first time, we retrospectively explore the outcomes of pars defect via percutaneous endoscopy.MethodsWe retrospectively examined young patients with spondylolysis treated using the percutaneous endoscopic-assisted direct repair of pars defect supplemented with autograft as well as percutaneous pedicle screw fixation between September 2014 and December 2018. Six patients with a mean age of 18.8 years were enrolled in the study. We used preoperatively computed tomographic (CT) scans to evaluate the size of pars defect, and graded disc degeneration using Pfirrmann’s classification through magnetic resonance images (MRI). We assessed the clinical outcomes using the Oswestry Disability Index (ODI), 36-Item Short-Form Health Survey (SF-36) as well as Visual Analogue Scale for back pain (VAS-B).ResultsOur findings revealed that pain intensity and function outcomes, including VAS-B, ODI, and SF-36 (PCS and MCS) scores, were markedly improved after surgery and at the final follow-up visit. The change in the gap distance of the pars defect was remarkably significant after surgery and during the follow-up period. Only one of the 12 pars repaired was reported as a non-union at the final follow-up visit. Moreover, no surgery-related complications were reported in any of the cases.ConclusionPercutaneous endoscopic-assisted direct repair of pars defect without general anesthesia, a minimally invasive treatment option, supplemented with autograft and percutaneous pedicle screw fixation, could be a satisfying treatment alternative for young patients with symptomatic lumbar spondylolysis.
Highlights
Multiple surgical procedures are applied in young patients with symptomatic lumbar spondylolysis when conservative treatments fail
Percutaneous endoscopic-assisted direct repair of pars defect without general anesthesia, a minimally invasive treatment option, supplemented with autograft and percutaneous pedicle screw fixation, could be a satisfying treatment alternative for young patients with symptomatic lumbar spondylolysis
We described a retrospective analysis of collected data to analyze the clinical outcomes of six patients who underwent percutaneous endoscopic-assisted repair of the pars defect supplemented with percutaneous pedicle screw fixation of spondylolysis
Summary
Multiple surgical procedures are applied in young patients with symptomatic lumbar spondylolysis when conservative treatments fail. A limited number of studies on the feasibility of percutaneous endoscopic-assisted direct repair of pars defect have been carried out. The disease affects approximately 3–6% of the general population, and notably, 15% of athletes [1,2,3]. Nonsurgical managements, including physical therapy, activity modification, and bracing, remain the primary form of treatment of symptomatic lumbar spondylolysis and are successful in a considerable number of patients. Multiple techniques and some modifications have been reported for the surgical fixation of pars defects [3, 5,6,7,8]. Most of the aforementioned surgical techniques are performed under general anesthesia
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