Treatment Of Lumbar Spondylolysis Research Articles

Diagnostic performance of SPECT in lumbar spondylolysis: a systematic review and meta-analysis

To evaluate the diagnostic value and clinical applicability of single-photon-emission computed tomography (SPECT) for lumbar spondylolysis using meta-analysis. Stata 12.0, was used to test the heterogeneity, and the pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio, and other effect sizes were collected to generate the summary receiver operating characteristic (SROC) curve for comprehensive evaluation. Meta-regression analysis was used to explore the source of heterogeneity, and subgroup analysis was performed. Funnel plots, Fagan's line diagrams, and likelihood ratio dot plots were drawn to evaluate publication bias and clinical applicability. Eight studies involving 785 patients were included. The pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, odds ratio, and area under the SROC curve of SPECT for the diagnosis of lumbar spondylolysis were 0.85 (95% confidence interval [CI]: 0.70 0.93), 0.92 (95% CI: 0.60 0.99), 11.01 (95% CI: 1.61 75.18), 0.17 (95% CI: 0.08 0.35), 0.92 (95% CI: 0.90 0.94). Meta-regression analysis showed that the sources of heterogeneity were region and age. Subgroup analysis showed that the specificity of the child and adolescent subgroup was significantly higher than that of the middle-aged and elderly subgroups. Deek's funnel plots showed no significant publication bias. The pooled effect of the likelihood ratio dot plot for diagnosis is in the upper-right quadrant. As a diagnostic tool for spondylolysis, SPECT has a high degree of specificity, moderate sensitivity, and relatively high diagnostic effectiveness. It can be used as an auxiliary sign in the diagnosis and treatment of lumbar spondylolysis.

Rate and Duration of Bone Union for Conservative Treatment in Pediatric Lumbar Spondylolysis.

Retrospective case series. To report the detailed bone fusion rates and duration of treatment in unilateral and bilateral cases of pediatric lumbar spondylolysis (LS). Early diagnosis and optimal conservative management for LS are crucial for achieving bony healing without surgery. However, existing research on the conservative treatment of pediatric LS, particularly regarding bone union rates and treatment duration for each stage of bilateral spondylolysis, is limited. We retrospectively analyzed 590 pediatric patients (522 boys and 68 girls) under 18 years of age diagnosed with LS and treated conservatively from 2015 to 2021. The diagnosis was based on computed tomography scans and magnetic resonance imaging findings, with stages classified as very early, early, progressive, or terminal. Patient background, sports history, level and stage of spondylolysis, presence of spina bifida occulta, bone union rate, duration of conservative treatment, and recurrence rate were retrospectively analyzed. The overall bone union rate was 81.9%, with a mean conservative treatment duration of 53.7 days. Unilateral LS cases showed decreased bone union rates with stage advancement (very early; 98.2%, early; 96.0%, progressive; 64.3%). Bilateral LS cases with progressive or terminal stage demonstrated low bone union rates (very early/very early; 100%, early/very early; 94.1%, progressive/very early; 66.7%, early/early; 82.9%, progressive/early; 32.3%, progressive/progressive; 23.7%, very early/terminal; 0%, early/terminal; 50.0%, progressive/terminal; 11.1%). The duration of conservative treatment extended as the stage of the main and contralateral lesions progressed, ranging from 39.1 days (very early/none) to 105 days (progressive/terminal). The recurrence rate after bone fusion was 16.6%, with no differences based on lesion stage. In this series of 590 patients, conservative treatment yielded high bone union rates for pediatric LS. However, union rates decreased with stage advancement, especially in bilateral cases. These findings provide valuable insights for prognosticating natural history and outcome regarding LS treatment, bone union, and return to activity.

Application of a new anatomic hook-rod-pedicle screw system in young patients with lumbar spondylolysis: A pilot study.

BACKGROUNDThe pedicle screw-laminar hook system has strong fixation and is conducive to bone graft fusion for lumbar spondylolysis. However, the current pedicle screw-laminar hook fixation system is not specifically designed for lumbar spondylolysis.AIMTo investigate the clinical effects of a new anatomical hook-rod-pedicle screw system in the treatment of lumbar spondylolysis in young adults.METHODSWe designed a new anatomic hook-rod-pedicle screw system for young patients with lumbar spondylolysis. The isthmus and the corresponding pedicle screw entry point were exposed through the intermuscular approach. Autogenous iliac bone graft was obtained to bridge the isthmus defect, and then the anatomic hook-rod-pedicle screw system was used to fix the isthmus in 15 young patients.RESULTSAt 24 mo follow-up, the visual analogue scale score of low back pain decreased from 6.73 ± 0.88 to 0.73 ± 0.59, and the Oswestry disability index score decreased from 58.20 ± 8.99 to 7.87 ± 4.97. Computed tomography showed bilateral isthmic bone healing in 14 cases and unilateral isthmic bone healing in 1 case. Magnetic resonance imaging showed that the lumbar disc signal of diseased segment and adjacent segments had no change compared with that before surgery. The pain visual analogue scale score of the donor site was 0.20 ± 0.41 at the last follow-up. According to the Modified Macnab score, the excellent and good rate was 100%.CONCLUSIONThe application of this new anatomical hook-rod-pedicle screw system to treat young patients with lumbar spondylolysis has the advantages of less trauma, a simple operation and satisfactory clinical effects.

Lumbar Spondylolysis Reconstruction–Stabilization Using a Motion-Preserving Technique

Conservative methods are the traditional options in the management of lumber spondylolysis whereas surgery is indicated for symptomatic patients not responding to medical treatment and cases with a multilevel pars defect. The aim of this prospective study was to evaluate the clinical, functional, and radiologic results of using bone graft and fixation with pedicular screw-rod-laminar hook construct in treatment of lumber spondylolysis. Between October 2017 and January 2020, 20 patients with symptomatic lumbar spondylolysis not responding to conservative treatment for more than 6 months were treated by defect reconstruction fixation using bone block autografting and pedicular screw laminar hook construct. The mean follow-up time was 12.5 ± 03.5 months. All patients were examined pre- and postoperatively and followed up clinically (pain [visual analog scale]), functionally (Oswestry Disability Index, Modified Prolo Functional Economic Scales, and Macnab criteria), and radiologically (pars defect healing). Perioperative outcomes and complications were documented. Clinical, radiologic, and functional outcomes were significantly improved. Bony union was evident in all patients (100%). Blood loss, operative time, and hospital stay increased in cases with a multilevel pars defect and cases with associated injuries. Two cases reported complications in this study as misplaced pedicular screw and superficial wound infection. Reconstruction fixation of pars defect using this construct is an effective, feasible procedure in the treatment of Lumbar spondylolysis regarding the preservation of lumbar motion and avoidance of adjacent-segment problems after fusion.

Long term outcome of posterior lumbar pedicle screw fixation combined with isthmic bone graft fusion in the treatment of lumbar spondylolysis in young patients

To investigate the long-term effect of posterior lumbar pedicle screw fixation combined with isthmus bone grafting and fusion in young patients with spondylolysis. A retrospective study was carried out, consisting of 16 young patients with lumbar spondylolysis without spondylolisthesis treated by lumbar posterior pedicle screw fixation combined with isthmic bone grafting fusion from January 2006 to July 2014. There were 11 males and 5 females, aged from 18 to 21 years old, with an average age of 19.3 years old, and the course of disease ranged from 12 to 26 months, with an average of 22 months. All the patients suffered from lumbar pain and difficulty in getting out of bed. Preoperative CT confirmed 12 cases of L₅ isthmus fissure and 4 cases of L₄ isthmus fissure. Bone graft fusion was confirmed and internal fixation was removed after operation. Lumbar spondylolysis was evaluated by lumbago visual analogue scoring method at preoperative and postoperative time points. Lumbar isthmic fusion was evaluated by lumbar CT, and degeneration of fixed and adjacent segments of lumbar intervertebral disc was evaluated by lumbar MRI. Of the 16 patients, 13 patients (26 sides) were followed up, with a mean duration of 96 months. The operation time ranged from 80 to 105 minutes, with an average of 95 minutes. The intraoperative bleeding volume ranged from 150 to 300 ml, with an average of 225 ml. All the patients were successfully operated without any complications related to the operation. VAS scores at each time point after operation were improved compared with those before operation(P<0.01). Postoperative CT scans of lumbar spine showed osseous fusion at 6 to 14 months, with an average of 12 months. There were no changes of adjacent segment degeneration, fixed segment disc degeneration and protrusion on lumbar spine MRI, and no symptomatic recurrence or recurrent spondylolysis in the long term. The posterior lumbar pedicle screw fixation combined with isthmic bone grafting and fusion is safe and effective in the treatment of young spondylolysis. The fusion rate is high and the interference of normal physiological range is reduced. The long-term effect is satisfactory.

Outcomes of Direct Lumbar Spondylolysis Reconstruction by Bone Graft and Fixation Using Pedicular Screw Rod Laminar Hook Construct

Background Data: Lumbar spondylolysis is often managed by conservative methods in most patients. Operative interference is indicated in symptomatic patients not responding to medical treatment or patients with multilevel pars defect. Purpose: To evaluate the clinical, functional, and radiological results of bone graft and pedicular screw fixation and rod laminar hook construct in treatment of lumbar spondylolysis. Study Design: A prospective clinical case cohort study. Patients and Methods: Between October 2017 and January 2019, fifteen patients with symptomatic lumbar spondylolysis not responding to conservative treatment for more than 6 months were treated by reconstruction of pars defect by bone block autografting and fixation using pedicular screw laminar hook construct. The mean follow-up was 9.47±3.07 months. All patients were examined pre- and postoperatively and they were followed up clinically; for measuring their pain scale, Visual Analogue Scale (VAS); functionally, Oswestry Disability Index (ODI); radiologically (pars defect healing). Perioperative outcomes and complications were documented. Results: Clinical, radiological, and functional outcomes were significantly improved. Bony union was evident in all patients (100%). Blood loss, operative time, and hospital stay were reported. Two cases reported complications in this study: misplaced pedicular screw and superficial wound infection. Conclusion: Direct reconstruction of pars defect by bone graft and fixation using pedicular screw rod laminar hook constructis an effective feasible procedure in treating lumbar spondylosis. It preserves lumbar motion and hence may decrease adjacent segment problems. (2019ESJ194) Background context: Lumber Spondylolysis is often managed by conservative methods or the operative interference which is indicated for symptomatic not responding patients to medical treatment and cases with multilevel pars defect. Purpose: The goal of this study is to evaluate the clinical, functional and radiological results of using bone graft and fixation with pedicular screw rod laminar hook construct in treatment of Lumber Spondylolysis. Study Design: A prospective clinical study. Patients and methods: Between October 2017 and January 2019, fifteen patients with symptomatic lumbar spondylolysis not responding to conservative treatment more than 6 months were treated by reconstruction of pars defect by bone block autografting and fixation using pedicular screw laminar hook construct. The mean follow-up time was 9.47±3.07months. All patients were examined pre, postoperative and followed up clinically {pain (Visual Analogue Scale VAS)}, functionally {Oswestry Disability Index (ODI), Modified Prolo Functional Economic Scales (MPFES) and Macaneb's criteria}, radiologically (pars defect healing). Perioperative outcomes and complications were documented. Results: Clinical, radiological and functional outcomes were significantly improved. Bony union was evident in all patients (100%). Blood loss, operative time and hospital stay increased in case with multilevel pars defect and cases with associated injuries. Two cases reported complications in this study as misplaced pedicular screw and superficial wound infection. Conclusion: Direct reconstruction of pars defect by bone graft and fixation using pedicular screw rod laminar hook construct is an effective feasible procedure in treatment of lumbar spondylosis concerning to preservation of lumbar motion and avoidance of adjacent segment problems after spinal fusion.

Transpedicular Hook Screw Fixation in the Treatment of Lumbar Spondylolysis in Young Patients

Objectives: In spondylolysis, there is a defect in the pars interarticularis. Most patients with spondylolysis, and even some with spondylolisthesis are asymptomatic, and they grow up not even aware of their condition. However, back pain is the most common symptom. Most patients with lumbar spondylolysis and low-grade spondylolisthesis can be treated conservatively. Surgical treatment is indicated when any type of spondylolisthesis is accompanied by a neurological deficit. Materials and Methods: We reviewed records obtained in patients treated surgically between 2000 and 2004 at Cathay Medical Center. We found a total of eight patients with a diagnosis of lumbar spondylolysis (pars fracture). In these patients-six men and two women, with ages ranging from 17 to 37 years. The diagnosis was made according to plain radiography, CT scan and MRI imaging. For patients with spinal instability, instrumentation included the trans-pedicular screws to secure the hook. Sufficient amounts of onlay autogenous cancellous bone graft across the spondylolytic defect were performed in all our patients. The final outcome was assessed by the following criteria:(1) whether instruments remained intact;(2)whether the postoperative fracture reduction was maintained;(3)whether the functional outcome was satisfactory; and(4)preoperative and postoperative plain radiographs. Results: We found a total of eight patients with a diagnosis of lumbar spondylolysis (pars fracture). Instrumentation included the trans-pedicular screws to secure the hook. Sufficient amounts of onlay autogenous cancellous bone graft across the spondylolytic defect were performed in all our patients. Follow-up plain radiography was done every 3 months after the operation. All our patients experienced significant pain relief from low back pain and radiculopathy. No screw pullout or loosening of the instrument was observed. No pseudoarthrosis was noted and all our patients had a bilateral union. In this article, we examine the effectiveness and advantages of transpedicular hook screws in the treatment of lumbar spondylolysis. Conclusions: Direct repair of spondylolysis with transpedicular hook screws can be recommended for patients with young age, a slight slip, an instability, or failure of conservative treatment.