Abstract
BackgroundWhen symptomatic spondylolysis fail to respond to nonoperative treatment, surgical management may be required. A number of techniques have been described for repair by intrasegmental fixation with good results; however, there are still some problems. We reported a repair technique with temporary intersegmental pedicle screw fixation and autogenous iliac crest graft. The aim of present study is to assess the clinical outcomes of L5 symptomatic spondylolysis with this technique.MethodsA retrospective analysis of 128 patients with L5 spondylolysis treated with this method was performed. According to CT scan, the spondylolysis were classified into 3 categories: line, intermediate, and sclerosis type. The diagnostic block test of L5 bilateral pars defect was done in all patients preoperatively. The sagittal and axial CT images were used to determine the bone union. The healing time, complications, number of spina bifida occulta, Japanese Orthopedic Association (JOA) score, and VAS for back pain were recorded. After fixation removal, the rate of ROM preservation at L5S1 was calculated.ResultsThere were 97 patients (194 pars) followed with mean follow-up of 23 months (range, 12–36 months). The union rate of pars was 82.0% at 12 months and 94.3% at 24 months postoperatively. Low back pain VAS significantly (P < 0.05) improved from preoperative mean value of 7.2 to 1.3 at the final follow-up postoperatively (P < 0.05). JOA score increased significantly postoperatively (P < 0.05) with average improvement rate of 79.3%. The rates of L5S1 ROM preservation were 79.8% and 64.0% after fixation removal at 1 and 2 years postoperatively. There were 3 patients of delayed incision healing without other complications.ConclusionsAlthough sacrificing L5S1 segment motion temporarily, more stability was obtained with intersegmental fixation. This technique is reliable for spondylolysis repair which has satisfactory symptom relief, high healing rate, low incidence of complications, and preserve a large part of ROM for fixed segment.
Highlights
When symptomatic spondylolysis fail to respond to nonoperative treatment, surgical management may be required
A study in Japan described 70% of patients with bilateral pars defects are associated with varying degrees of vertebral spondylolisthesis, and some cases need surgery [3]
Symptomatic spondylolysis should be first treated by nonoperative care, despite several operative options available
Summary
When symptomatic spondylolysis fail to respond to nonoperative treatment, surgical management may be required. The aim of present study is to assess the clinical outcomes of L5 symptomatic spondylolysis with this technique. Lumbar spondylolysis is a bony defect in the pars interarticularis. A study in Japan described 70% of patients with bilateral pars defects are associated with varying degrees of vertebral spondylolisthesis, and some cases need surgery [3]. Symptomatic spondylolysis should be first treated by nonoperative care, despite several operative options available. When they fail to respond to conservative treatment, surgical interventions may be required. The aims of surgery are to reduce pain, stabilize affected segment, promote healing of pars defect, and control spondylolisthesis development effectively
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