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Xu JN, Li Y, Zhao TX, Wu WY, Yang XW, Zhang HW, Chen Q, Xia C, Zhang J. Mapping the field of spondylolisthesis: A bibliometric analysis. World J Clin Cases 2025; 13:99221. [DOI: 10.12998/wjcc.v13.i22.99221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2024] [Revised: 10/22/2024] [Accepted: 04/18/2025] [Indexed: 05/14/2025] Open
Abstract
BACKGROUND In recent years, the number of studies on spondylolisthesis has been increasing, and there are many publications on this disorder. To our knowledge, there is no bibliometric analysis of spondylolisthesis to date.
AIM To investigate emerging directions in Spondylolisthesis research and systematically evaluate the academic literature with the highest citation impact within this field.
METHODS All data were collected from the Web of Science Core Collection database. Years of publications, countries, journals, institutions and total number of citations were extracted and analyzed by VOSviewer software. In addition, we analyzed the top 100 most-cited articles on spondylolisthesis.
RESULTS A total of 1831 articles related to spondylolisthesis were identified. The frequency of publications on spondylolisthesis has increased dramatically over time. Among all countries, United States has contributed the most publications on spondylolisthesis (n = 574). The institution with the most articles was the University of California, San Francisco (n = 52). Spine topped the list of journals and has published 291 spondylolisthesis-related reports. The hotspot of research changed from posterolateral fusion to interbody fusion.
CONCLUSION In recent years, academic investigations on spondylolisthesis have exhibited significant growth. As the inaugural bibliometric evaluation in this domain, our research establishes a methodological framework for synthesizing the historical progression and current advancements of spondylolisthesis studies.
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Affiliation(s)
- Jiong-Nan Xu
- The Second School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou 310051, Zhejiang Province, China
- Center for Plastic & Reconstructive Surgery, Department of Orthopedics, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou 310011, Zhejiang Province, China
| | - Yong Li
- Department of Orthopedics, Qingtian People's Hospital, Lishui 323000, Zhejiang Province, China
| | - Ting-Xiao Zhao
- Center for Plastic & Reconstructive Surgery, Department of Orthopedics, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou 310011, Zhejiang Province, China
| | - Wei-Yi Wu
- The Second School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou 310051, Zhejiang Province, China
- Center for Plastic & Reconstructive Surgery, Department of Orthopedics, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou 310011, Zhejiang Province, China
| | - Xin-Wen Yang
- School of Basic Medicine and Forensic Sciences, Hangzhou Medical College, Hangzhou 310013, Zhejiang Province, China
| | - Heng-Wei Zhang
- Department of Pathology and Laboratory Medicine and Center for Musculoskeletal Research, University of Rochester Medical Center, Rochester, MA 02770, United States
| | - Qi Chen
- Center for Plastic & Reconstructive Surgery, Department of Orthopedics, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou 310011, Zhejiang Province, China
| | - Chen Xia
- Center for Plastic & Reconstructive Surgery, Department of Orthopedics, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou 310011, Zhejiang Province, China
| | - Jun Zhang
- The Second School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou 310051, Zhejiang Province, China
- School of Basic Medicine and Forensic Sciences, Hangzhou Medical College, Hangzhou 310013, Zhejiang Province, China
- Department of Orthopedics, Zhejiang Provincial People's Hospital Bijie Hospital, Bijie 551700, Guizhou Province, China
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Huang X, Teng Y, Ma R, An W, Liu T, Qiang L, Hui X, Kai Y. Evaluation of V-type titanium cable internal fixation for the treatment of young adult fifth lumbar spondylolysis: technical notes and a retrospective clinical study. J Orthop Surg Res 2024; 19:747. [PMID: 39533313 PMCID: PMC11559233 DOI: 10.1186/s13018-024-05197-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2024] [Accepted: 10/20/2024] [Indexed: 11/16/2024] Open
Abstract
BACKGROUND Various strategies, each with its own set of limitations, are available for managing lumbar spondylolysis. In response, our department has developed an innovative solution: a V-shaped titanium cable integrated with a pedicle screw internal fixation system specifically designed for lumbar spondylolysis in young adults. AIM The objective of this study was to thoroughly investigate the long-term efficacy of V-type titanium cable internal fixation for the management of spondylolysis, especially in young adults. METHODS Twenty-one patients with fifth lumbar spondylolysis were treated using V-shaped titanium cables and pedicle screw internal fixation at the General Hospital Xinjiang Military Command. The duration of low back pain before surgery was 6 ~ 48 (15.85 ± 11.57) months. The Medtronic (S7) navigation system was used during surgery to guide the placement of pedicle screws, aiming to avoid damaging the L4-5 facet joint by positioning the screws lower and further to the side. Intraoperative indices (operative time and intraoperative blood loss) were recorded. The visual analog scale (VAS), Oswestry Disability Index (ODI), pelvic incidence (PI), and intraoperative imaging measurements of screw accuracy were meticulously recorded and assessed in a comprehensive manner. This thorough evaluation was conducted both intraoperatively and throughout the follow-up period, which lasted for at least one year.The Macnab efficacy criteria were used to assess postoperative outcomes during the final follow-up period. RESULTS All patients successfully completed the 1-year follow-up on time. Two patients experienced postoperative wound liquefaction and successfully recovered after undergoing dressing changes. The average duration of the surgical procedure was 113.09 ± 6.97 min, and an intraoperative blood loss of 50.47 ± 21.32 millilitres was observed. Significant differences were noted in visual analog scale (VAS) scores before and after surgery at various time intervals, indicating improvement with the progression of rehabilitation exercises. No significant changes were found in the pelvic incidence (PI), and there were no notable differences between the preoperative and postoperative periods. No loosening, breakage, or failure of the internal fixation was found during the long-term follow-up. Furthermore, there were no serious complications, such as infection or vascular or nerve injuries. occurred during the procedure. A patient who presented with a considerable cryptic fissure of sacrum 1 experienced dural injury during the surgical procedure. Intraoperatively, dural sutures were skillfully applied, and the adjacent muscles were fortified. Remarkably, the patient achieved successful healing in a single stage. On the first day postsurgery, a gradual improvement in mobility was noted. CONCLUSIONS The use of a V-shaped titanium cable in conjunction with a pedicle screw internal fixation system for the management of fifth lumbar spondylolysis in young individuals is characterized by its ease of execution and ability to yield favorable outcomes. This approach relies on the prerequisite that patients with minimal intervertebral disc injury or mild lumbar spondylolisthesis demonstrate high overall success rates but experience low failure rates associated with internal fixation. Most significantly, this technique involves segmental internal fixation, which safeguards the functional spinal unit (FSU).
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Affiliation(s)
- Xiaoxia Huang
- Department of Spine Surgery, General Hospital of Xinjiang Military Command, Urumqi, Xinjiang, China
- Graduate School of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Yong Teng
- Department of Spine Surgery, General Hospital of Xinjiang Military Command, Urumqi, Xinjiang, China.
| | - Rui Ma
- Department of Spine Surgery, General Hospital of Xinjiang Military Command, Urumqi, Xinjiang, China
| | - Wei An
- Department of Spine Surgery, General Hospital of Xinjiang Military Command, Urumqi, Xinjiang, China
| | - Tao Liu
- Department of Spine Surgery, General Hospital of Xinjiang Military Command, Urumqi, Xinjiang, China
| | - Li Qiang
- Department of Spine Surgery, General Hospital of Xinjiang Military Command, Urumqi, Xinjiang, China
| | - Xiao Hui
- Department of Spine Surgery, General Hospital of Xinjiang Military Command, Urumqi, Xinjiang, China
| | - Ye Kai
- Department of Spine Surgery, General Hospital of Xinjiang Military Command, Urumqi, Xinjiang, China
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Nagata K, Dimar JR, Smith NS, Puno RM, Glassman SD, Djurasovic M, Carreon LY. Clinical and Radiographic Outcomes of Repair of Spondylolitic Spondylolisthesis Through Direct Pars Repair. Spine (Phila Pa 1976) 2024; 49:1235-1240. [PMID: 38014734 DOI: 10.1097/brs.0000000000004886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 11/15/2023] [Indexed: 11/29/2023]
Abstract
STUDY DESIGN A retrospective chart review. OBJECTIVE The objective of this study is to investigate whether direct pars repair achieves bone healing and symptom relief in patients with spondylolitic spondylolisthesis. SUMMARY OF BACKGROUND DATA 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. MATERIALS AND METHODS 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. RESULTS 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). CONCLUSION 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.
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Affiliation(s)
- Kosei Nagata
- Department of Orthopaedic Surgery, University of Louisville School of Medicine, Louisville, KY
- Norton Leatherman Spine Center, Louisville, KY
| | - John R Dimar
- Department of Orthopaedic Surgery, University of Louisville School of Medicine, Louisville, KY
- Norton Leatherman Spine Center, Louisville, KY
| | - Nolan Sledge Smith
- Department of Orthopaedic Surgery, University of Louisville School of Medicine, Louisville, KY
| | | | - Steven D Glassman
- Department of Orthopaedic Surgery, University of Louisville School of Medicine, Louisville, KY
- Norton Leatherman Spine Center, Louisville, KY
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Li J, Tang Z, Feng F, Liang J, Shao N, Wang Y, Cai Z, Tang H, Zhou T, Xu Y, Cui Y. Development and biomechanical analysis of an axially controlled compression spinal rod for lumbar spondylolysis. Medicine (Baltimore) 2024; 103:e38520. [PMID: 38847663 PMCID: PMC11155568 DOI: 10.1097/md.0000000000038520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Accepted: 05/17/2024] [Indexed: 06/10/2024] Open
Abstract
BACKGROUND To elucidate the differences in mechanical performance between a novel axially controlled compression spinal rod (ACCSR) for lumbar spondylolysis (LS) and the common spinal rod (CSR). METHODS A total of 36 ACCSRs and 36 CSRs from the same batch were used in this study, each with a diameter of 6.0 mm. Biomechanical tests were carried out on spinal rods for the ACCSR group and on pedicle screw-rod internal fixation systems for the CSR group. The spinal rod tests were conducted following the guidelines outlined in the American Society for Testing and Materials (ASTM) F 2193, while the pedicle screw-rod internal fixation system tests adhered to ASTM F 1798-97 standards. RESULTS The stiffness of ACCSR and CSR was 1559.15 ± 50.15 and 3788.86 ± 156.45 N/mm (P < .001). ACCSR's yield load was 1345.73 (1297.90-1359.97) N, whereas CSR's was 4046.83 (3805.8-4072.53) N (P = .002). ACCSR's load in the 2.5 millionth cycle of the fatigue four-point bending test was 320 N. The axial gripping capacity of ACCSR and CSR was 1632.53 ± 165.64 and 1273.62 ± 205.63 N (P = .004). ACCSR's torsional gripping capacity was 3.45 (3.23-3.47) Nm, while CSR's was 3.27 (3.07-3.59) Nm (P = .654). The stiffness of the pedicle screws of the ACCSR and CSR group was 783.83 (775.67-798.94) and 773.14 (758.70-783.62) N/mm (P = .085). The yield loads on the pedicle screws of the ACCSR and CSR group was 1345.73 (1297.90-1359.97) and 4046.83 (3805.8-4072.53) N (P = .099). CONCLUSION Although ACCSR exhibited lower yield load, stiffness, and fatigue resistance compared to CSR, it demonstrated significantly higher axial gripping capacity and met the stress requirement of the human isthmus. Consequently, ACCSR presents a promising alternative to CSR for LS remediation.
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Affiliation(s)
- Jingyuan Li
- Clinical Medical College of Dali University, Dali, China
- Department of Orthopaedic Surgery, 920th Hospital of Joint Logistics Support Force, Kunming, China
| | - Zhifang Tang
- Clinical Medical College of Dali University, Dali, China
- Department of Orthopaedic Surgery, 920th Hospital of Joint Logistics Support Force, Kunming, China
| | - Fanzhe Feng
- Department of Orthopaedic Surgery, 920th Hospital of Joint Logistics Support Force, Kunming, China
| | - Jinlong Liang
- Department of Orthopaedic Surgery, 920th Hospital of Joint Logistics Support Force, Kunming, China
| | - Nengqi Shao
- Clinical Medical College of Dali University, Dali, China
- Department of Orthopaedic Surgery, 920th Hospital of Joint Logistics Support Force, Kunming, China
| | - Yulei Wang
- Clinical Medical College of Dali University, Dali, China
- Department of Orthopaedic Surgery, 920th Hospital of Joint Logistics Support Force, Kunming, China
| | - Zhijun Cai
- Department of Orthopaedic Surgery, 920th Hospital of Joint Logistics Support Force, Kunming, China
| | - Hui Tang
- Department of Orthopaedic Surgery, 920th Hospital of Joint Logistics Support Force, Kunming, China
| | - Tianhua Zhou
- Department of Orthopaedic Surgery, 920th Hospital of Joint Logistics Support Force, Kunming, China
| | - Yongqing Xu
- Department of Orthopaedic Surgery, 920th Hospital of Joint Logistics Support Force, Kunming, China
| | - Yi Cui
- Department of Orthopaedic Surgery, 920th Hospital of Joint Logistics Support Force, Kunming, China
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Bredow J, Prasse T, Beyer F, Budde S, Sobottke R. [Slipped vertebrae (Spondylolysis): the underestimated weak point of the (pre)professional football player-an algorithm]. ORTHOPADIE (HEIDELBERG, GERMANY) 2024; 53:427-437. [PMID: 38777842 DOI: 10.1007/s00132-024-04510-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/22/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND Isthmic spondylolysis represents the most common cause of spinal pain in adolescent athletes. This article provides an overview of the classification, diagnosis, and treatment options for these conditions, including conservative and operative measures. It also provides a treatment pathway to how young athletes with spondylolysis should be treated. DIAGNOSTICS Diagnostic imaging techniques are essential for an accurate diagnosis, with CT scans providing additional information for surgical planning. TREATMENT Conservative treatment focuses on activity modification and physiotherapy, with a phased approach tailored to individual patient needs. Operative intervention may be considered if conservative measures fail, with minimally invasive techniques such as Buck's screw fixation showing promising results. The decision between conservative and operative management should consider factors of the patients' individual profile. In this paper, we present the first treatment algorithm for the treatment of isthmic spondylolysis. Long-term prognosis varies, with most athletes able to return to sport following treatment.
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Affiliation(s)
- Jan Bredow
- Klinik für Orthopädie und Unfallchirurgie, Krankenhaus Porz am Rhein gGmbH, Urbacher Weg 19, 51149, Köln, Deutschland.
| | - Tobias Prasse
- Klinik für Orthopädie, Unfallchirurgie und Plastisch-Ästhetische Chirurgie, Uniklinik Köln, Köln, Deutschland
| | - Frank Beyer
- Klinik für Orthopädie und Unfallchirurgie, Krankenhaus Porz am Rhein gGmbH, Urbacher Weg 19, 51149, Köln, Deutschland
| | - Stefan Budde
- Klinik für Unfallchirurgie und Orthopädie, Evangelisches Klinikum Bethel, Universitätsklinikum OWL der Universität Bielefeld, Bielefeld, Deutschland
| | - Rolf Sobottke
- Klinik für Wirbelsäulenchirurgie, Neurochirurgie und Spezielle Orthopädie Rhein-Maas Klinikum GmbH, Würselen, Deutschland
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Kim DY, Jin SR, Hur SM, Chung JH, Lee SM, Kim P. Direct Repair of Symptomatic Lumbar Spondylolysis Using Rod-Screw-Cable System. World Neurosurg 2024; 183:e625-e631. [PMID: 38191055 DOI: 10.1016/j.wneu.2023.12.155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 12/28/2023] [Accepted: 12/29/2023] [Indexed: 01/10/2024]
Abstract
OBJECTIVE To assess the efficacy of a new direct lysis repair technique using internal fixation with rod, screws, and Songer cable in symptomatic lumbar spondylolysis. METHODS Between December 2015 and January 2020, patients who were diagnosed with symptomatic lumbar spondylolysis and surgically treated with a rod-screw-cable system were recruited. Pedicle screwing by the Magerl technique was performed in all included patients, followed by direct lysis repair with bone allograft and demineralized bone matrix by stabilizing the posterior lamina and spinous process using a rod-screw-cable system. Clinical outcome was measured using the visual analog scale and Oswestry disability index preoperatively and 6 weeks, 3 months, 6 months, 1 year, and 2 years postoperatively. RESULTS Sixteen patients were included in this study-11 men and 5 women (mean age: 47 years; range, 26-67 years). The lytic defects were at L4 and L5 in 6 and 10 patients, respectively. The mean follow-up period was 41 months (24-62 months). The visual analog scale values were 7.3, 6.1, 4.3, 3.3, 2.1, and 1.9 preoperatively and 6 weeks, 3 months, 6 months, 1 year, and 2 years postoperatively, respectively. The Oswestry disability index values were 59.8%, 55.4%, 41.7%, 32.4%, 21.1%, and 16.9% for the same periods, respectively. No patient had an increase in the slip after surgery. There were no significant complications such as implant failure. CONCLUSIONS Our technique provides rigid intra-segmental repair of spondylolysis without intersegmental motion interference, even if the patient is older or has disc degeneration.
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Affiliation(s)
- Dae-Yong Kim
- Department of Neurosurgery, JeonJu Wooridul Hospital, JeonJu, Korea
| | - Sang-Ryul Jin
- Department of Neurosurgery, JeonJu Wooridul Hospital, JeonJu, Korea
| | - Sung-Min Hur
- Department of Neurosurgery, JeonJu Wooridul Hospital, JeonJu, Korea
| | - Ji-Hun Chung
- Department of Neurosurgery, JeonJu Wooridul Hospital, JeonJu, Korea
| | - Seung Myung Lee
- Department of Neurosurgery, College of Medicine, Chosun University, Gwangju, Korea
| | - Pius Kim
- Department of Neurosurgery, College of Medicine, Chosun University, Gwangju, Korea.
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Lima MVD, Caffaro MFS, Santili C, Watkins IV RG. Spondylolysis and Spondylolisthesis in Athletes. Rev Bras Ortop 2024; 59:e10-e16. [PMID: 38524709 PMCID: PMC10957283 DOI: 10.1055/s-0043-1777435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 05/29/2023] [Indexed: 03/26/2024] Open
Abstract
This article is an update on spondylolysis and spondylolisthesis in athletes, from diagnosis to treatment, based on our service experience and a literature review.
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Affiliation(s)
- Marcos Vaz de Lima
- Grupo de Traumatologia do Esporte, Departamento de Ortopedia e Traumatologia, Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, SP, Brasil
- Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, SP, Brasil
| | - Maria Fernanda Silber Caffaro
- Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, SP, Brasil
- Departamento de Ortopedia e Traumatologia, Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, SP, Brasil
| | - Claudio Santili
- Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, SP, Brasil
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Li Q, Hu B, Zhang Z, Kong Q, Gong Q, Liu L, Yang H, Wang L, Song Y. Clinical Outcomes of Isobar TTL System with Isthmic Bone Grafting and Pedicle Screw-Vertebral Plate Hook with Direct Repair of Defect for Lumbar Spondylolysis: A Matched-Pair Case Control Study. Orthop Surg 2023; 15:2582-2590. [PMID: 37580850 PMCID: PMC10549859 DOI: 10.1111/os.13837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 06/13/2023] [Accepted: 06/18/2023] [Indexed: 08/16/2023] Open
Abstract
OBJECTIVE Although direct isthmic repair, such as PSVPH, did not affect the mobility of the fixed segment and adjacent segment, it has a relatively low rate of isthmic fusion compared with conventional fusion. The Isobar TTL dynamic internal fixation system has been widely used in clinical practice and has achieved satisfactory clinical results. However, the use of the Isobar TTL system in combination with direct isthmic repair for lumbar spondylolysis has rarely been reported. The aim of this study was to compare the clinical and radiologic outcomes between patients who underwent Isobar TTL system and PSVPH with direct repair of defect for lumbar spondylolysis. METHODS Stepwise propensity score matching (PSM) for age and sex were performed to keep comparable clinical data between groups in this retrospective and matched-pair case control study. A total of 50 patients diagnosed with lumbar spondylolysis underwent surgical implantation of the Isobar TTL group (n = 25) or PSVPH group (n = 25) from June 2009 to June 2016. Clinical outcomes were assessed using the Oswestry disability index (ODI), and visual analog score (VAS). Radiographic evaluations included range of motion (ROM) and the disc heights of stabilized segment and adjacent segment, adjacent segment degeneration (ASD) and bony fusion. Three-dimensional reconstruction of lumbar CT scan was obtained to evaluate bone fusion of the isthmic at final follow-up. The independent Student's t test and chi-square test were applied to compare the differences between groups. RESULTS A total of 25 patients from TTL group were matched to 25 patients in PSVPH group for age, sex, body mass index (BMI), defect side, spondylolisthesis meyerding, and follow-up duration. The intervertebral space height (IH) of stabilized segment at postoperative 1 week and final follow-up in the TTL group was higher than those in the PSVPH group, respectively (P = 0.030; P = 0.013). The ROM of stabilized segment at final follow-up in the TTL group was significantly lower than that in the PSVPH group (P < 0.001). The bony fusion rate at the final follow-up was 88.0% (22/25 cages) in the TTL group and 80.0% (20/25 cages) in the PSVPH group. The ODI score at final follow-up in the TTL group was significantly lower than that in the PSVPH group (P = 0.007). CONCLUSION Overall, our data suggest that the Isobar TTL system outcomes are comparable to those in the PSVPH, with a similar high bony fusion rate as PSVPH, especially its wider indications as a new surgery.
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Affiliation(s)
- Qiujiang Li
- Department of Orthopaedics, Orthopaedic Research Institute, West China HospitalSichuan UniversityChengduChina
| | - Bowen Hu
- Department of Orthopaedics, Orthopaedic Research Institute, West China HospitalSichuan UniversityChengduChina
| | - Zhuang Zhang
- Department of Orthopaedics, Orthopaedic Research Institute, West China HospitalSichuan UniversityChengduChina
| | - Qingquan Kong
- Department of Orthopaedics, Orthopaedic Research Institute, West China HospitalSichuan UniversityChengduChina
| | - Quan Gong
- Department of Orthopaedics, Orthopaedic Research Institute, West China HospitalSichuan UniversityChengduChina
| | - Limin Liu
- Department of Orthopaedics, Orthopaedic Research Institute, West China HospitalSichuan UniversityChengduChina
| | - Huiliang Yang
- Department of Orthopaedics, Orthopaedic Research Institute, West China HospitalSichuan UniversityChengduChina
| | - Lei Wang
- Department of Orthopaedics, Orthopaedic Research Institute, West China HospitalSichuan UniversityChengduChina
| | - Yueming Song
- Department of Orthopaedics, Orthopaedic Research Institute, West China HospitalSichuan UniversityChengduChina
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Delcont MR, Ou-Yang DC, Burger EL, Patel VV, Wessell NM, Kleck CJ. Alternative Uses of O-Arm and Stealth Navigation Technology Over 10 Years: The University of Colorado Experience. Orthopedics 2023; 46:e89-e97. [PMID: 35876781 DOI: 10.3928/01477447-20220719-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Intraoperative computed tomography scanning with O-arm and use of Stealth navigation can improve surgical outcomes in a variety of orthopedic subspecialties. In spine surgery, the accuracy, precision, and safety of pedicle screw and interbody implant placement has improved. This technology is now routinely used in percutaneous pedicle screw placement and minimally invasive sacroiliac joint fusion. Other applications include, but are not limited to, isthmic pars defect repair, lumbosacral pseudoarticulation resection in Bertolotti's syndrome, radiofrequency ablation, and en bloc tumor resection. Intraoperative navigation has numerous applications, and use of this technology should continue to evolve as the technology advances. [Orthopedics. 2023;46(2):e89-e97.].
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Jamshidi AM, Soldozy S, Levi AD. Percutaneous Direct Pars Repair in Young Athletes. Neurosurgery 2023; 92:263-270. [PMID: 36637264 DOI: 10.1227/neu.0000000000002210] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Accepted: 08/30/2022] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Lumbar pars defects are common in adolescent athletes and are often due to recurrent axial loading and traumatic stressors. OBJECTIVE To present an updated case series of young athletes who underwent percutaneous direct pars repair after failure of conservative management. METHODS A single-center, nonrandomized, retrospective observation study of athletes who were referred for minimally invasive direct pars repair after failure of at least 6 months of conservative management was performed. Summary demographic information, clinical features of presentation, perioperative and intraoperative radiographic imaging, and visual analog scale back pain scores were collected and analyzed. RESULTS A total of 21 patients were included (mean age [± SD] 17.47 ± 3.02 years, range 14-25 years), 6 of whom were female (29%). All patients presented with bilateral pars fractures, with L5 being the most frequent level involved (n = 13). The average follow-up time was 31.52 ± 9.38 months (range 3-110 months). The visual analog scale score for back pain was significantly reduced from 7.62 ± 1.83 preoperatively to 0.28 ± 0.56 at the final postoperative examination (P < .01). Fusion was noted in 20 of the 21 patients on final follow-up (95%). CONCLUSION Percutaneous direct pars repair is a safe and effective means in treating young adolescents who have failed conservative management. The advantages included minimized muscle and soft tissue dissection, reduced blood loss, and early mobilization and recovery. In young athletes who desire return to high-level physical activity, this surgical technique is of particular benefit and should be considered in this patient population.
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Affiliation(s)
- Aria M Jamshidi
- Department of Neurological Surgery, University of Miami - Miller School of Medicine, Lois Pope Life Center, Miami, Florida, USA
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11
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Surgical Reduction and Direct Repair Using Pedicle Screw-Rod-Hook Fixation in Adult Patients with Low-Grade Isthmic Spondylolisthesis. Pain Res Manag 2022; 2022:8410519. [PMID: 35991588 PMCID: PMC9385336 DOI: 10.1155/2022/8410519] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 06/28/2022] [Indexed: 11/17/2022]
Abstract
Background Although direct pars repair using a pedicle screw-rod-hook system has achieved satisfactory results in patients with spondylolysis, its application in adults with low-grade isthmic spondylolisthesis is rarely reported. Objective To assess the surgical effect of reduction and direct repair surgery with a pedicle screw-rod-hook system combined with autogenous bone grafts in adult patients with low-grade isthmic spondylolisthesis. Methods Sixty-four adult patients with low-grade isthmic spondylolisthesis underwent reduction and direct repair using a pedicle screw-rod-hook system in our department from September 2009 to April 2018. The clinical efficacy was evaluated by clinical and radiological assessments. Results The average follow-up was 52.15 ± 9.96 months. The visual analog scale (VAS) scores (VAS-lumbar and VAS-leg) and Oswestry Disability Index (ODI) at the final follow-up (FFU) were significantly lower than the preoperative levels (P < 0.05). The modified Prolo score was “excellent” for 60 patients (93.75%) and “good” for 4 patients (6.25%). The slip distance and slipping percentage showed significant decreases postoperatively and FFU compared to preoperatively (P < 0.05). There were no significant differences in the disc height, slip angle, and range of motion of the surgical intervertebral space or upper intervertebral space between preoperation and FFU (P < 0.05). Successful bony fusion had a 96.86% success rate. Conclusion Reduction of slip and direct repair using pedicle screw-rod-hook fixation combined with autogenous iliac bone grafting in adult patients with low-grade isthmic spondylolisthesis is a safe and effective technique.
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12
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Li DM, Li YC, Jiang W, Peng BG. Application of a new anatomic hook-rod-pedicle screw system in young patients with lumbar spondylolysis: A pilot study. World J Clin Cases 2022; 10:5680-5689. [PMID: 35979102 PMCID: PMC9258354 DOI: 10.12998/wjcc.v10.i17.5680] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 03/28/2022] [Accepted: 04/20/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The 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. AIM To investigate the clinical effects of a new anatomical hook-rod-pedicle screw system in the treatment of lumbar spondylolysis in young adults. METHODS We 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. RESULTS At 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%. CONCLUSION The 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.
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Affiliation(s)
- Duan-Ming Li
- Department of Orthopaedics, The Third Medical Center of PLA General Hospital, Beijing 100039, China
| | - Yong-Chao Li
- Department of Orthopaedics, The Third Medical Center of PLA General Hospital, Beijing 100039, China
| | - Wei Jiang
- Department of Anesthesiology, The Third Medical Center of PLA General Hospital, Beijing 100039, China
| | - Bao-Gan Peng
- Department of Orthopaedics, The Third Medical Center of PLA General Hospital, Beijing 100039, China
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13
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Linton AA, Hsu WK. A Review of Treatment for Acute and Chronic Pars Fractures in the Lumbar Spine. Curr Rev Musculoskelet Med 2022; 15:259-271. [DOI: 10.1007/s12178-022-09760-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/28/2022] [Indexed: 11/24/2022]
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14
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Li L, Jiang S, Zhao J, Zhao M, Zhou X, Li K, Liu C, Zhang W, Chen J, Yu Q, Zhao Y, Wang J, Si H. Comparison of two internal fixation systems in lumbar spondylolysis by finite element methods. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2022; 218:106713. [PMID: 35272148 DOI: 10.1016/j.cmpb.2022.106713] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 01/27/2022] [Accepted: 02/23/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND AND PURPOSE Internal fixation surgeries are currently the most effective treatments for lumbar spondylolysis, but the optimal fixation method is still on debate. This study was designed to compare the biomechanical characteristics of two fixation methods for lumbar spondylolysis, the pedicle screw-U shape rod (PSUSR) internal fixation system, and the pedicle screw-vertebral plate hook (PSVPH) internal fixation system, through three-dimensional finite element analysis, expecting to provide clinical guidance. METHODS Four finite element models (A, B, C, D) of L4-S1 vertebral body of a female patient were reconstructed by CT image segmentation. (A: intact model. B: spondylolysis model. C: spondylolysis model with PSUSR internal fixation. D: spondylolysis model with PSVPH internal fixation). Six physiological motion states were simulated by applying 500N concentrated force and 10Nm moment load to four models. The biomechanical advantages of the two internal fixation systems were evaluated by comparing the range of motion (ROM), maximum stress, maximum strain, and maximum displacement of the models. RESULTS Compared to model B, the ROM decreased by 35.7%-57.1% in model C and 39.7%-64.8% in model D. The maximum displacements of model C and D both decreased. The maximum stresses in both vertebral and the internal fixation system are greater in model C than those in model D. The maximum stress and strain reduction of L5-S1 intervertebral disc in model D was greater than that in model C. Model D restores the articular cartilage stresses to the normal levels of model A. The maximum stress and maximum displacement of the bone graft in model C are greater than those in model D. CONCLUSIONS The PSVPH internal fixation system has better biomechanical properties than PSUSR internal fixation system in several mechanical comparisons. Experimental results suggest that PSVPH internal fixation system can effectively treat lumbar spondylolysis while preserving segmental mobility, and can be the treatment of choice.
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Affiliation(s)
- Le Li
- Department of Orthopedics, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, People's Republic of China
| | - Shuhao Jiang
- Shandong Provincial Engineering and Technical Center of Light Manipulations & Shandong Provincial Key Laboratory of Optics and Photonic Device, School of Physics and Electronics, Shandong Normal University, Jinan, 250014, People's Republic of China
| | - Junyong Zhao
- College of Computer Science and Technology, Nanjing University of Aeronautics and Astronautics, Nanjing, 211106, People's Republic of China
| | - Mengmeng Zhao
- Shandong Provincial Engineering and Technical Center of Light Manipulations & Shandong Provincial Key Laboratory of Optics and Photonic Device, School of Physics and Electronics, Shandong Normal University, Jinan, 250014, People's Republic of China
| | - Xin Zhou
- Department of Orthopedics, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, People's Republic of China
| | - Kunpeng Li
- Department of Orthopedics, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, People's Republic of China
| | - Chen Liu
- Department of Orthopedics, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, People's Republic of China
| | - Wencan Zhang
- Department of Orthopedics, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, People's Republic of China
| | - Junfei Chen
- Department of Orthopedics, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, People's Republic of China
| | - Qun Yu
- Shandong Provincial Engineering and Technical Center of Light Manipulations & Shandong Provincial Key Laboratory of Optics and Photonic Device, School of Physics and Electronics, Shandong Normal University, Jinan, 250014, People's Republic of China
| | - Yuefeng Zhao
- Shandong Provincial Engineering and Technical Center of Light Manipulations & Shandong Provincial Key Laboratory of Optics and Photonic Device, School of Physics and Electronics, Shandong Normal University, Jinan, 250014, People's Republic of China
| | - Jingjing Wang
- Shandong Provincial Engineering and Technical Center of Light Manipulations & Shandong Provincial Key Laboratory of Optics and Photonic Device, School of Physics and Electronics, Shandong Normal University, Jinan, 250014, People's Republic of China
| | - Haipeng Si
- Department of Orthopedics, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, People's Republic of China.
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Meng H, Gao Y, Lu P, Zhao GM, Zhang ZC, Sun TS, Li F. Risk factor analysis of disc and facet joint degeneration after intersegmental pedicle screw fixation for lumbar spondylolysis. J Orthop Surg Res 2022; 17:247. [PMID: 35459170 PMCID: PMC9034521 DOI: 10.1186/s13018-022-03082-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 03/17/2022] [Indexed: 01/17/2023] Open
Abstract
Background Patients who do not respond to conservative treatment of the isthmus are often treated with surgery. We used direct repair plus intersegment pedicle screw fixation for the treatment of lumbar spondylolysis. The aim of this observational study was to assess the effects of this technique and evaluate various risk factors potentially predicting the probability of disc and facet joint degeneration after instrumentation. Methods The study included 54 male L5 spondylolysis patients who underwent pars repair and intersegment fixation using pedicle screws. Bony union was evaluated using reconstruction images of computed tomography. Radiographic changes, including disc height, vertebral slip, facet joint and disc degeneration in the grade of adjacent and fixed segments, were determined from before to final follow-up. Logistic regression analysis was performed to identify factors associated with the incidence of disc and facet joint degeneration. Results Bony union was achieved in all cases. Logistic regression analysis revealed that instrumentation durations of greater than 15.5 months and 21.0 months were significant risk factors for the incidence of L4/5 and L5S1 facet degeneration, respectively. Conclusions Intersegmental pedicle screw fixation provides good surgical outcomes and good isthmic bony union rates in patients with lumbar spondylolysis. The duration of fixation was confirmed as a risk factor for facet joint degeneration. Once bony union is achieved, instrument removal should be recommended.
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Affiliation(s)
- Hao Meng
- Department of Orthopaedics, The 7th Medical Center of Chinese PLA General Hospital, No. 5 Nanmen Cang, Beijing, 100700, China.
| | - Yuan Gao
- Department of Gynecology and Obstetrics, The 1st Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Peng Lu
- Department of Orthopaedics, The 7th Medical Center of Chinese PLA General Hospital, No. 5 Nanmen Cang, Beijing, 100700, China
| | - Guang-Min Zhao
- Department of Orthopaedics, The 7th Medical Center of Chinese PLA General Hospital, No. 5 Nanmen Cang, Beijing, 100700, China
| | - Zhi-Cheng Zhang
- Department of Orthopaedics, The 7th Medical Center of Chinese PLA General Hospital, No. 5 Nanmen Cang, Beijing, 100700, China
| | - Tian-Sheng Sun
- Department of Orthopaedics, The 7th Medical Center of Chinese PLA General Hospital, No. 5 Nanmen Cang, Beijing, 100700, China
| | - Fang Li
- Department of Orthopaedics, The 7th Medical Center of Chinese PLA General Hospital, No. 5 Nanmen Cang, Beijing, 100700, China.
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16
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Zayan M, Hussien MA, El Zahlawy H. Pars interarticularis repair using pedicle screws and laminar hooks fixation technique in patients with symptomatic lumbar spondylolysis. SICOT J 2022; 8:13. [PMID: 35389337 PMCID: PMC8988864 DOI: 10.1051/sicotj/2022013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 03/22/2022] [Indexed: 11/23/2022] Open
Abstract
STUDY DESIGN Prospective case series. PURPOSE To assess the outcomes of pars repair surgery using pedicle screws and laminar hooks. METHODS This study was conducted on 22 patients with symptomatic lumbar spondylolysis. Curettage of the fibrocartilage in the defect and drilling of the sclerotic bone ends were done, followed by impaction of cancellous bone graft. Pedicle screws were inserted bilaterally in the corresponding pedicles and connected to a laminar hook via rods (screw-rod-hook fixation). The intensity of back pain and the functional outcome were assessed using the visual analog scale (VAS) and the Oswestry disability index (ODI). Plain radiographs were performed immediately postoperatively and after 3 and 6 months. CT scan was done at the final follow-up to assess pars healing. The mean follow-up period was 27 months. RESULTS The mean preoperative VAS and ODI were 7.4 ± 0.8 and 64.8 ± 6.7, which improved to 2.4 ± 0.8 and 20 ± 6 respectively at the final follow-up (P < 0.001). Healing of the defect was found in 19 patients at the final follow-up. Non-fusion with graft resorption was noticed in the remaining 3 cases (13.6%). However, postoperative VAS and ODI values improved even in the radiologically non-fused patients. LEVEL OF EVIDENCE Therapeutic study, Level IV. CONCLUSION Pars repair using pedicle screws and laminar hooks is a relatively simple yet effective procedure.
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Affiliation(s)
- Mohammed Zayan
- Department of Orthopedic surgery, Faculty of Medicine, Ain Shams University 38 Abbassia Square, Next to Al-Nour Mosque Cairo 11865 Egypt
| | - Mohammed Ali Hussien
- Department of Orthopedic surgery, Faculty of Medicine, Ain Shams University 38 Abbassia Square, Next to Al-Nour Mosque Cairo 11865 Egypt
| | - Hany El Zahlawy
- Department of Orthopedic surgery, Faculty of Medicine, Ain Shams University 38 Abbassia Square, Next to Al-Nour Mosque Cairo 11865 Egypt
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Kim SJ, Mobbs RJ, Natarajan P, Fonseka RD, Walsh WR. Historical Note: The Evolution of Cortical Bone Trajectory and Associated Techniques. Spine Surg Relat Res 2022; 6:1-9. [PMID: 35224240 PMCID: PMC8842353 DOI: 10.22603/ssrr.2021-0059] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 04/15/2021] [Indexed: 11/17/2022] Open
Abstract
Cortical bone trajectory (CBT) for posterior fixation with pedicle screws is considered a relatively new alternative trajectory that travels in the medio-lateral direction in the transverse plane and in the caudo-cephalad path in the sagittal plane. Various biomechanical studies have already validated its superior pullout strength and mechanical stability over the traditional trajectory of convergent pedicle screws. Due to the relatively medial starting point of this trajectory, the CBT also poses the clinical advantage of requiring a smaller surgical field of exposure, thus minimizing tissue and muscle injury while reducing operative time and intraoperative blood loss. The evolution of CBT through time has closely been linked to the unwavering philosophy of prioritizing patient outcomes, advancements in neuronavigational technology, and the mounting biomechanical, morphometric, and clinical evidence. In this historical review, we provide a unique perspective on how CBT surgical technique has developed through time, highlighting key milestones and attempting to explain its explosive rise in popularity.
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Affiliation(s)
- Sihyong J. Kim
- Surgical Orthopaedics Research Laboratory, Prince of Wales Hospital
| | | | | | | | - William R. Walsh
- Surgical Orthopaedics Research Laboratory, Prince of Wales Hospital
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18
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Yagi K, Kishima K, Tezuka F, Morimoto M, Yamashita K, Takata Y, Sakai T, Maeda T, Fujitani J, Sairyo K. A Technical Pitfall of Decompression with Direct Repair of a Ragged Edge Using the Smiley-Face Rod Method : A Case Report. THE JOURNAL OF MEDICAL INVESTIGATION 2022; 69:308-311. [PMID: 36244786 DOI: 10.2152/jmi.69.308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
The smiley-face rod method has been reported to be a successful technique for reducing slippage and repairing pars defects in lumbar spondylolisthesis. However, we encountered a patient who developed right L5 radiculopathy with muscle weakness after use of the smiley-face rod method. The patient was a 19-year-old female judo player who had undergone direct repair surgery using the smiley-face rod method for terminal-stage lumbar spondylolysis. Postoperatively, she developed paresthesia on the lateral side of the right thigh with weakness of the right tibialis anterior and extensor hallucis longus. Computed tomography showed right foraminal stenosis at L5 with the floating lamina shifted ventrally and apophyseal ring fracture. In this case, the spondylolysis fracture angle differed between the left and right sides, with the fracture line on the right side running more sagittally. As a result, the floating lamina was shifted ventrally on the right side by compression and the right L5 intervertebral foraminal space was narrowed due to the ventral shift in the floating lamina and the apophyseal ring bone fragment. The shape of the fracture line should be examined carefully before surgery to avoid this technical pitfall. J. Med. Invest. 69 : 308-311, August, 2022.
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Affiliation(s)
- Kiyoshi Yagi
- Department of Orthopedics, Tokushima University, Tokushima, Japan
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Nagoya City University, Nagoya, Japan
| | - Kazuya Kishima
- Department of Orthopedics, Tokushima University, Tokushima, Japan
- Department of Orthopaedic Surgery, Hyogo College of Medicine, Hyogo, Japan
| | - Fumitake Tezuka
- Department of Orthopedics, Tokushima University, Tokushima, Japan
| | | | - Kazuta Yamashita
- Department of Orthopedics, Tokushima University, Tokushima, Japan
| | - Yoichiro Takata
- Department of Orthopedics, Tokushima University, Tokushima, Japan
| | - Toshinori Sakai
- Department of Orthopedics, Tokushima University, Tokushima, Japan
| | - Toru Maeda
- Department of Orthopedics, Anan Medical Center, Tokushima, Japan
| | - Junzo Fujitani
- Department of Orthopedics, Tokushima University, Tokushima, Japan
| | - Koichi Sairyo
- Department of Orthopedics, Tokushima University, Tokushima, Japan
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Debnath UK. Lumbar spondylolysis - Current concepts review. J Clin Orthop Trauma 2021; 21:101535. [PMID: 34405089 PMCID: PMC8358467 DOI: 10.1016/j.jcot.2021.101535] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 06/27/2021] [Accepted: 07/26/2021] [Indexed: 12/27/2022] Open
Abstract
Lumbar pars interarticularis (PI) injury or spondylolysis occurs only in humans. This represents a stress fracture of the PI. Excessive loading in repetitive hyperextension is a significant risk factor and occurs most commonly at L5 followed by L4. It is bilateral in 80% of symptomatic cases but can be unilateral defect as well which runs a more benign course. Symptoms of low back pain relating to this lesion are more common in young athletes involved in trunk twisting sports. Like other stress fractures, the pain may come on abruptly or more insidiously over time and only related to certain activities. The pathologic progression starts with a stress reaction in the pars, progressing to an incomplete stress fracture, and then a complete pars fracture. Diagnosis is dependent on clinical examination and radiological imaging studies (plain radiography, computed tomography (CT) scans and magnetic resonance imaging (MRI) scans). Treatment is dependent on symptoms as well as radiographic stage of the lesion. Conservative management is the mainstay of treating early lesions. A comprehensive rehabilitation program incorporates core spinal stabilization exercises. Athletes should not return to sports until pain free. Professional sporting individuals are at increased risk of failure of resolution of symptoms that may require early surgical repair of the PI defect. Modified Buck's technique & pedicle screw-hook constructs for direct repair has a high success rate in patients who have persistent low back pain. Minimally invasive lumbar pars defect repair has given similar successful outcome with added advantage of minimizing muscle injury, preserving the adjacent joint and reduced hospital stay. Functional outcome is evaluated using the Visual Analogue Scale (VAS) for back pain, Oswestry Disability Index (ODI) and 36-Item Short-Form Health Survey (SF-36). Preoperative ODI and SF-36 physical component scores (PCS) are significant predictor of a good functional outcome.
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Affiliation(s)
- Ujjwal K Debnath
- Professor of Orthopaedics, Jagannath Gupta Institute of Medical Sciences, Kolkata
- Consultant Orthopaedic & Spine, Surgeon, Fortis Hospital, Kolkata
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Comparing Surgical Treatments for Spondylolysis: Review on Current Research. Clin Spine Surg 2021; 34:276-285. [PMID: 33298798 DOI: 10.1097/bsd.0000000000001115] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 11/07/2020] [Indexed: 11/27/2022]
Abstract
STUDY DESIGN Narrative review. OBJECTIVE To compare the various surgical methods of repairing spondylolysis defects in regard to improving pain, restoration of function, radiographic improvement, and complication rate. SUMMARY OF BACKGROUND DATA Spondylolysis is a defect in the pars interarticularis of the vertebral arch, typically in the lumbar vertebra. Treatment can be nonoperative and/or surgical. There are various types of surgical repair including spinal compression, fusion, and direct pars repair. METHODS A comprehensive review of the English literature was performed utilizing Medline, Embase, and Web of Science. Inclusion criteria included papers or abstracts that evaluated the surgical techniques. Exclusion criteria included non-English-language papers or abstracts with inadequate information about outcomes. RESULTS Postoperative pain levels and patient function were consistently improved, regardless of surgical technique chosen. Positive clinical outcomes after surgery were seen more often in patients under age 20 and those who underwent minimally invasive repairs. Positive radiographic improvements were reported broadly, although some reported higher rates of nonunion with spinal compression. Complication rates were low throughout and minimally invasive techniques reported decreased blood loss and shorter hospital stays. CONCLUSIONS Present surgical options appear largely comparable in terms of their ability to provide meaningful treatment for spondylolysis where conservative treatments have failed or otherwise remain unattempted.
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21
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The Management of Acute Lumbar Stress Reactions of the Pedicle and Pars in Professional Athletes Playing Collision Sports. Clin Spine Surg 2021; 34:247-259. [PMID: 32991362 DOI: 10.1097/bsd.0000000000001081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 08/19/2020] [Indexed: 11/26/2022]
Abstract
Acute stress reactions in the lumbar spine most commonly occur in athletes at the pars interarticularis followed by the pedicle. These reactions occur as a result of repetitive microtrauma from supraphysiological loads applied to the lumbar spine. Characteristic motions such as trunk extension and twisting are also thought to play a role and may be sport-specific. Other risk factors include increased lumbar lordosis, hamstring and thoracolumbar fascia tightness, and abdominal weakness. On physical examination, pain is typically reproduced with lumbar hyperextension. Currently, magnetic resonance imaging or nuclear imaging remain the most sensitive imaging modalities for identifying acute lesions. In the elite athlete, management of these conditions can be challenging, particularly in those playing collision sports such as American football, hockey, or rugby. Nonoperative treatment is the treatment of choice with rehabilitation programs focused on pain-free positioning and progressive strengthening. Operative treatment is rare, but may be warranted for patients symptomatic for >12 months. Specialized diagnosis protocols as well as treatment and return to play guidelines from 4 physicians treating elite athletes playing collision sports are presented and reviewed.
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Abstract
Repetitive stress on the lumbosacral spine during sporting activity places the athletic patient at risk of developing symptomatic pars defect. Clinical history, physical examination, and diagnostic imaging are important to distinguish spondylolysis from other causes of lower back pain. Early pars stress reaction can be identified with advanced imaging, before the development of cortical fracture or vertebral slip progression to spondylolisthesis. Conservative management is first-line for low-grade injury with surgical intervention indicated for refractory symptoms, severe spondylolisthesis, or considerable neurologic deficit. Prompt diagnosis and management of spondylolysis leads to good outcomes and return to competition for most athletes.
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Affiliation(s)
- Christopher C Chung
- Department of Orthopaedic Surgery, University of Virginia, PO Box 800159, Charlottesville, VA 22908, USA
| | - Adam L Shimer
- Department of Orthopaedic Surgery, University of Virginia, PO Box 800159, Charlottesville, VA 22908, USA.
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Repair of Pars Interarticularis Defect Utilizing a Pedicle and Laminar Screw Construct: A Technique Discussion and Case Series. Tech Orthop 2021. [DOI: 10.1097/bto.0000000000000382] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Okuwaki S, Tatsumura M, Gamada H, Ogawa T, Mammoto T, Hirano A, Yamazaki M. Direct reduction and repair of spondylolysis with grade 1 slip using the smiley face rod: a case report. J Rural Med 2021; 16:56-61. [PMID: 33442437 PMCID: PMC7788300 DOI: 10.2185/jrm.2020-039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 08/29/2020] [Indexed: 12/14/2022] Open
Abstract
Objective: Lumbar spondylolysis, caused by stress fracture of the pars
interarticularis may lead to a bony defect or spondylolisthesis. In adolescents, its
surgical treatment employs the smiley face rod method for direct reduction of
pseudoarthrotic spondylolysis and spondylolisthesis. Clinical outcomes of this treatment
have been occasionally described; however, implant removal has not been discussed
previously. We present a patient with lumbar spondylolysis with grade 1 slip at the 5th
lumbar vertebra (L5) per the Meyerding classification. Patient: A 14-year-old boy presented with chronic severe lower back pain.
Since conservative therapy did not resolve pain or enable resuming sports activities, the
smiley face rod repair was performed 7 months after the initial treatment. Result: Anterior slippage of the L5 was surgically reduced. The patient wore
a brace for 3 months postoperatively, and partial bone fusion was noted 6 months
postoperatively. He resumed his sports activity 8 months postoperatively, and absolute
bone fusion was confirmed 18 months postoperatively. Implant removal was performed 3 years
postoperatively. Grade 1 slip was corrected with absolute bone fusion, and long-term
follow-up revealed good results in terms of healing and rehabilitation. Conclusion: Smiley face rod method that allows for implant removal after
bone fusion is suitable for adolescents.
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Affiliation(s)
- Shun Okuwaki
- Department of Orthopedic Surgery, Kenpoku Medical Center Takahagi Kyodo Hospital, Japan
| | - Masaki Tatsumura
- Department of Orthopedics Surgery and Sports Medicine, University of Tsukuba Hospital Mito Clinical Education and Training Center Mito Kyodo General Hospital, Japan
| | - Hisanori Gamada
- Department of Orthopedics Surgery, Faculty of Medicine, University of Tsukuba, Japan
| | - Takeshi Ogawa
- Department of Orthopedics Surgery and Sports Medicine, University of Tsukuba Hospital Mito Clinical Education and Training Center Mito Kyodo General Hospital, Japan
| | - Takeo Mammoto
- Department of Orthopedics Surgery and Sports Medicine, University of Tsukuba Hospital Mito Clinical Education and Training Center Mito Kyodo General Hospital, Japan
| | - Atsushi Hirano
- Department of Orthopedics Surgery and Sports Medicine, University of Tsukuba Hospital Mito Clinical Education and Training Center Mito Kyodo General Hospital, Japan
| | - Masashi Yamazaki
- Department of Orthopedics Surgery, Faculty of Medicine, University of Tsukuba, Japan
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Syundyukov АR, Nikolayev NS, Kuzmina VА, Aleksandrov SА, Kornyakov PN, Emelyanov VY. Minimally Invasive Reconstruction of Vertebral Arch in Spondylolisthesis in Children and Adolescents. Sovrem Tekhnologii Med 2021; 13:62-68. [PMID: 35265351 PMCID: PMC8858413 DOI: 10.17691/stm2021.13.5.08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Indexed: 11/22/2022] Open
Abstract
The aim of the study was to assess the effectiveness of the minimally invasive technique used to reconstruct the vertebral arch with a pedicle screw hook system in grade I isthmic spondylolisthesis in comparison with the traditional technique of segment stabilization with interbody fusion.
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Affiliation(s)
- А R Syundyukov
- Head of the Pediatric Traumatological and Orthopedic Unit Federal Center of Traumatology, Orthopedics and Arthroplasty, Ministry of Health of the Russian Federation, 33 Fedor Gladkov St., Cheboksary, Chuvash Republic, 428020, Russia
| | - N S Nikolayev
- Professor, Chief Doctor Federal Center of Traumatology, Orthopedics and Arthroplasty, Ministry of Health of the Russian Federation, 33 Fedor Gladkov St., Cheboksary, Chuvash Republic, 428020, Russia;; Head of the Department of Traumatology, Orthopedics and Extreme Medicine Chuvash State University named after I.N. Ulyanov, 15 Moskovsky Prospect, Cheboksary, Chuvash Republic, 428015, Russia
| | - V А Kuzmina
- Functional Diagnostician Federal Center of Traumatology, Orthopedics and Arthroplasty, Ministry of Health of the Russian Federation, 33 Fedor Gladkov St., Cheboksary, Chuvash Republic, 428020, Russia
| | - S А Aleksandrov
- Traumatologist-Orthopedist Federal Center of Traumatology, Orthopedics and Arthroplasty, Ministry of Health of the Russian Federation, 33 Fedor Gladkov St., Cheboksary, Chuvash Republic, 428020, Russia
| | - P N Kornyakov
- Traumatologist-Orthopedist Federal Center of Traumatology, Orthopedics and Arthroplasty, Ministry of Health of the Russian Federation, 33 Fedor Gladkov St., Cheboksary, Chuvash Republic, 428020, Russia
| | - V Yu Emelyanov
- Researcher Federal Center of Traumatology, Orthopedics and Arthroplasty, Ministry of Health of the Russian Federation, 33 Fedor Gladkov St., Cheboksary, Chuvash Republic, 428020, Russia;; Associate Professor Chuvash State University named after I.N. Ulyanov, 15 Moskovsky Prospect, Cheboksary, Chuvash Republic, 428015, Russia
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A Novel Technique for Spondylolysis Repair With Pedicle Screws, Rod and Polyester Band: Case Report With Technical Note and Systematic Literature Review. Spine (Phila Pa 1976) 2020; 45:E1682-E1691. [PMID: 32947495 DOI: 10.1097/brs.0000000000003697] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Systematic review and case report. OBJECTIVE Our study aims to present a new technique using three components to repair the pars defect: pedicle screws, rod and polyester band. Furthermore, we perform a systematic literature review of the previously described techniques. SUMMARY OF BACKGROUND Spondylolysis is a common condition in children and adolescents. Depending on the severity it may be treated either nonoperatively or surgically. Surgery is required if nonoperative treatment failed to give sustained pain relief. Several surgical techniques have been described. METHODS The literature review investigates the database (MEDLINE-EMBASE-Cochrane-ScienceDirect) up to May 2019 for studies presenting a surgical technique for spondylolysis.The Screw-Rod-Band (SRB) technique combines the use of pedicle screws, a rod and a polyester band to repair the spondylolysis. The horizontal rod connects the pedicle screws. The polyester band linked to the rod passes below the spinous process to apply compressive forces on the pars. RESULTS Twenty-one out of 982 studies described a surgical procedure. Eight main different techniques were identified: Isthmic Screw, Wiring, Butterfly-Plate, Hook-Screw Construct, Shaped-Rod, Laminar-Screw, and two combination technique (Lag Screw and Tension Band Fixation and Cortical Screws and Spinous-Process ModularLink). Our technique showed immediate postoperative clinical improvement. No surgical or perisurgical complication occurred. CONCLUSION The systematic literature review revealed a great number of surgical techniques for the spondylolysis, demonstrating the lack of consensus.SRB technique is an effective and simple treatment for pars fixation. The surgical procedure puts the pars under strong compression. The results are comparable with procedures present in the literature and seems capable to reduce the invasiveness and the risk of neurological injury. LEVEL OF EVIDENCE 2.
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Üçer M. Minimally Invasive Approach Toward Percutaneous Direct Pars Repair: An Observational Study. World Neurosurg 2020; 146:e1301-e1306. [PMID: 33307253 DOI: 10.1016/j.wneu.2020.11.165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 11/27/2020] [Accepted: 11/28/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Spondylolysis refers to a defect of the vertebral pars interarticularis. Percutaneous direct pars repair using a minimally invasive technique was performed in a group of young patients to maintain their spinal segment movement and to restore their normal anatomy. The aim of this study was to present the clinical, functional, and radiologic outcomes of pars defects that were repaired percutaneously via the minimally invasive technique. METHODS This was a single-center, nonrandomized, prospective study of the demographic, clinical, functional, and radiographic outcomes of 18 patients (age range, 18-32 years). The visual analog scale for back pain and the Oswestry Disability Index were used to evaluate the functional outcomes. The Macnab criteria were applied to evaluate patient satisfaction after surgery. RESULTS All patients were admitted with bilateral pars fracture at the level of L4 (n = 4) or L5 (n = 14). The average duration of clinical follow-up was 16.04 months (range, 12-28 months). With reference to the Macnab criteria, 17 patients (94%) showed perfect or good outcomes. Fusion or bridging of bones was observed on computed tomography in 14 patients (77%) at the last radiological examination. CONCLUSIONS Minimally invasive surgery to treat symptomatic spondylolysis is a safe option that minimizes muscle and soft tissue dissection. In this study, good clinical and functional outcomes were achieved in young patients with low complications and high fusion rates using completely percutaneous treatment.
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Affiliation(s)
- Melih Üçer
- Department of Neurosurgery, Kanuni Sultan Süleyman Education and Research Hospital, University of Health Sciences, Istanbul, Turkey.
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Abstract
STUDY DESIGN Bibliographic analysis. OBJECTIVE The aim of this study is to identify the most cited studies on lumbar spondylolisthesis and report their impact in spine field. METHODS Thomson Reuters Web of Science-Science Citation Index Expanded was searched using title-specific search "spondylolisthesis." All studies published in English language between 1900 and 2019 were included with no restrictions. The top 100 cited articles were identified using "Times cited" arranging articles from high to low according to citation count. Further analysis was made to obtain the following items: article title, author's name and specialty, country of origin, institution, journal of publication, year of publication, citations number, study design. RESULTS The citation count of the top 100 articles ranged from 68 to 589. All published between 1932 and 2016. Among 20 journals, Spine had the highest number of articles (49), with citation number of 6155 out of 13 618. Second ranked was Journal of Bone and Joint Surgery with 15 articles and total citations of 3023. With regard to the primary author's specialty, orthopedic surgeons contributed to the majority of top 100 list with 82 articles, and neurosurgery was the second specialty with 11 articles. The United States had produced more than half of the list with 59 articles. England was the second country with 7 articles. Surgical management of degenerative lumbar spondylolisthesis was the most common discussed topic. CONCLUSION This article identifies the top 100 influential articles on lumbar spondylolisthesis and recognizes an important aspect of knowledge evolution served by leading researchers as they guided today's clinical decision making in spondylolisthesis.
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Affiliation(s)
- Khalifah Aldawsari
- College of Medicine, King Saud University, Riyadh, Saudi Arabia,Khalifah Aldawsari, College of Medicine, King Saud
University, Riyadh 11451, Saudi Arabia.
| | | | - Khalid Alsaleh
- College of Medicine, King Saud University, Riyadh, Saudi Arabia,College of Medicine, King Khalid University Hospital, Riyadh, Saudi
Arabia
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Roberts SB, Calligeros K, Tsirikos AI. Evaluation and management of paediatric and adolescent back pain: Epidemiology, presentation, investigation, and clinical management: A narrative review. J Back Musculoskelet Rehabil 2020; 32:955-988. [PMID: 31524137 DOI: 10.3233/bmr-170987] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
This narrative review will summarise a clinical approach to the investigation of back pain in children and adolescent patients, including a discussion of the epidemiology, presentation, investigation and clinical management of back pain in children and adolescents. This will assist the prompt and accurate diagnosis of spinal disorders that require significant medical intervention. Existing evidence suggests a relatively high incidence of non-specific back pain among young people; 27-48% of presentations of back pain in children and adolescents are attributed to non-specific back pain. Low back pain among schoolchildren is often linked to psychosocial factors and only occasionally requires medical attention, as pain is benign and self-limiting. Nonetheless, those young patients who seek medical assistance exhibit a higher incidence of organic conditions underlying the major symptom of spinal pain. A cautious and comprehensive strategy - including a detailed history, examination, radiographic imaging and diagnostic laboratory studies - should be employed, which must be accurate, reliable, consistent and reproducible in identifying spinal pathologies. A specific diagnosis can be reached in 52-73% of the cases. For cases in which a specific diagnosis cannot be made, re-evaluation after a period of observation is recommended. At this later stage, minor symptoms unrelated to underlying pathology will resolve spontaneously, whereas serious pathologies will advance and become easily identified.
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Abstract
STUDY DESIGN Literature review. OBJECTIVE To conduct a literature review of studies reporting the incidence of pars interarticularis defects in athletes of specific sports, in order to allow more targeted prevention and treatment strategies to be implemented for the groups at highest risk. METHODS Electronic searches were performed using PubMed, Ovid Medline, EMBASE, Google Scholar, Cochrane Database of Systematic Reviews, and Cochrane Database of Controlled Trials from their dates of inception to September 2017, with the following keywords: "spondylolysis," "sports," "low back pain," and "pars defects." RESULTS A total of 509 total articles were retrieved, of which 114 were used in the final review. The incidence of pars interarticularis defects was found to be highest in diving (35.38%), cricket (31.97%), baseball/softball (26.91%), rugby (22.22%), weightlifting (19.49%), sailing (17.18%), table tennis (15.63%), and wrestling (14.74%). Only 5 studies reported the management instituted for their participants, and these were all case reports. Of 74 players with spondylolysis in these studies, 70 (94.59%) underwent conservative treatment and 4 (5.41%) underwent surgical treatment. 61 (82.43%) returned to their previous level of play, 6 (8.11%) retired, and the disposition of the final 7 was not reported. CONCLUSION The current medical literature provides good evidence that the incidence of pars interarticularis defects is higher in the athletic population, with the highest incidence in diving. There remains no gold standard protocol for the management of pars interarticularis defects. Further research is required to compare conservative therapy to surgical therapy and to compare the various surgical techniques to each other.
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Affiliation(s)
- Samuel Tawfik
- University of New South Wales, Sydney, New South Wales, Australia,St George Hospital, Sydney, New South Wales, Australia,Samuel Tawfik, St George Hospital, Sydney, New South Wales, Australia 2217.
| | - Kevin Phan
- University of New South Wales, Sydney, New South Wales, Australia,Neurospine Surgery Research Group, Sydney, New South Wales, Australia
| | - Ralph J. Mobbs
- Neurospine Surgery Research Group, Sydney, New South Wales, Australia,Prince of Wales Private Hospital, Sydney, New South Wales, Australia
| | - Prashanth J. Rao
- Neurospine Surgery Research Group, Sydney, New South Wales, Australia,University of Sydney, Sydney, New South Wales, Australia,Westmead Hospital, Sydney, New South Wales, Australia
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Mobbs RJ, Choy WJ, Singh T, Cassar L, Davidoff C, Harris L, Phan K, Fiechter M. Three-Dimensional Planning and Patient-Specific Drill Guides for Repair of Spondylolysis/L5 Pars Defect. World Neurosurg 2019; 132:75-80. [DOI: 10.1016/j.wneu.2019.08.112] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 08/14/2019] [Accepted: 08/16/2019] [Indexed: 12/21/2022]
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Mohammed N, Patra DP, Narayan V, Savardekar AR, Dossani RH, Bollam P, Bir S, Nanda A. A comparison of the techniques of direct pars interarticularis repairs for spondylolysis and low-grade spondylolisthesis: a meta-analysis. Neurosurg Focus 2019; 44:E10. [PMID: 29290131 DOI: 10.3171/2017.11.focus17581] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Spondylosis with or without spondylolisthesis that does not respond to conservative management has an excellent outcome with direct pars interarticularis repair. Direct repair preserves the segmental spinal motion. A number of operative techniques for direct repair are practiced; however, the procedure of choice is not clearly defined. The present study aims to clarify the advantages and disadvantages of the different operative techniques and their outcomes. METHODS A meta-analysis was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The following databases were searched: PubMed, Cochrane Library, Web of Science, and CINAHL ( Cumulative Index to Nursing and Allied Health Literature). Studies of patients with spondylolysis with or without low-grade spondylolisthesis who underwent direct repair were included. The patients were divided into 4 groups based on the operative technique used: the Buck repair group, Scott repair group, Morscher repair group, and pedicle screw-based repair group. The pooled data were analyzed using the DerSimonian and Laird random-effects model. Tests for bias and heterogeneity were performed. The I2 statistic was calculated, and the results were analyzed. Statistical analysis was performed using StatsDirect version 2. RESULTS Forty-six studies consisting of 900 patients were included in the study. The majority of the patients were in their 2nd decade of life. The Buck group included 19 studies with 305 patients; the Scott group had 8 studies with 162 patients. The Morscher method included 5 studies with 193 patients, and the pedicle group included 14 studies with 240 patients. The overall pooled fusion, complication, and outcome rates were calculated. The pooled rates for fusion for the Buck, Scott, Morscher, and pedicle screw groups were 83.53%, 81.57%, 77.72%, and 90.21%, respectively. The pooled complication rates for the Buck, Scott, Morscher, and pedicle screw groups were 13.41%, 22.35%, 27.42%, and 12.8%, respectively, and the pooled positive outcome rates for the Buck, Scott, Morscher, and pedicle screw groups were 84.33%, 82.49%, 80.30%, and 80.1%, respectively. The pedicle group had the best fusion rate and lowest complication rate. CONCLUSIONS The pedicle screw-based direct pars repair for spondylolysis and low-grade spondylolisthesis is the best choice of procedure, with the highest fusion and lowest complication rates, followed by the Buck repair. The Morscher and Scott repairs were associated with a high rate of complication and lower rates of fusion.
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Abstract
Artistic gymnastics is a physically demanding sport that requires flexibility, agility, and extreme upper and lower body strength. The specific biomechanics of the sport leads to a unique injury profile. Gymnastic skills require intense upper body weight-bearing, placing unusual forces across the upper extremity joints and predisposing them to injury. In addition, the required body control during air aerobatics (tumbling, twisting, flipping) necessitates precise landing techniques to avoid spine and lower extremity injury. Common gymnastic injuries include those of the spine and upper extremity such as spondylolysis, shoulder instability, ulnar collateral ligament injuries, capitellar osteochondritis dissecans, and several wrist pathologies. Understanding the injury etiology, prevention, and treatment protocols is important for a successful recovery and return to sport.
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Success and Failure of Percutaneous Minimally Invasive Direct Pars Repair: Analysis of Fracture Morphology. World Neurosurg 2019; 126:181-188. [DOI: 10.1016/j.wneu.2019.03.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 03/02/2019] [Accepted: 03/04/2019] [Indexed: 11/24/2022]
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Raffa SJ, Luther E, Levi AD. Repair of isthmic pars interarticularis fractures: a literature review of conventional and minimally invasive techniques. J Neurosurg Sci 2019; 63:318-329. [DOI: 10.23736/s0390-5616.19.04646-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Linhares D, Cacho Rodrigues P, Ribeiro da Silva M, Matos R, Veludo V, Pinto R, Neves N. Minimum of 10-year follow-up of V-rod technique in lumbar spondylolysis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2018; 28:1743-1749. [DOI: 10.1007/s00586-018-5833-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 11/14/2018] [Indexed: 02/07/2023]
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Gagnet P, Kern K, Andrews K, Elgafy H, Ebraheim N. Spondylolysis and spondylolisthesis: A review of the literature. J Orthop 2018; 15:404-407. [PMID: 29881164 PMCID: PMC5990218 DOI: 10.1016/j.jor.2018.03.008] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 03/16/2018] [Indexed: 02/07/2023] Open
Abstract
Spondylolysis is a common diagnosis with a high prevalence in children and adolescents complaining of low back pain. It may be caused by either a defect or fracture of the pars interarticularis due to mechanical stress. Depending on the severity of the spondylolysis and symptoms associated it may be treated either conservatively or surgically, both of which have shown significant success. Conservative treatments such as bracing and decreased activity have been shown to be most effective with patients who have early diagnosis and treatment. Low-intensity pulsed ultrasound (LIPUS) in addition to conservative treatment appears to be very promising for achieving a higher rate of bony union. LIPUS requires more supporting studies, but may prove to become a standard of care in the future. Surgery may be required if conservative treatment, for at least six months, failed to give sustained pain relief for the activities of daily living. Based on studies performed on each of the major surgical treatments we suggest the use of the pedicle screw hook technique and the pedicle screw rod technique due to low rates of hardware failure, increased maintenance of mobility, and lack of a postoperative bracing requirement.
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Affiliation(s)
- Paul Gagnet
- Department of Orthopaedic Surgery, University of Toledo Medical Center, 3000 Arlington Avenue, Toledo, OH, USA
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38
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Debnath UK, Scammell BE, Freeman BJC, McConnell JR. Predictive Factors for the Outcome of Surgical Treatment of Lumbar Spondylolysis in Young Sporting Individuals. Global Spine J 2018; 8:121-128. [PMID: 29662741 PMCID: PMC5898674 DOI: 10.1177/2192568217713008] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
STUDY DESIGN Retrospective consecutive case series. OBJECTIVES Only few sporting individuals with symptomatic lumbar pars injuries require surgical repair and it is often difficult to predict the outcome following surgery. The factors that predict the outcome after direct repair of lumbar pars defect was evaluated clinically and statistically. The preoperative background variables both subjective and objective as well as radiological evaluation were used in a multiple regression model to find the strong predictors of postoperative outcome as measured by VAS (visual analogue scores), ODI (Oswestry Disability Index) and SF-36 (Short Form). METHODS Fifty-two consecutive young sporting individuals with a mean age of 19 years (range 8-30 years) were treated surgically for lumbar pars defect confirmed on imaging studies (ie, single-photon emission computed tomography, computed tomography, and magnetic resonance imaging). Fifty patients completed the VAS, ODI, and SF-36 questionnaires as a part of their assessment. Preoperative background variables were used in a multiple regression model to find the strongest predictor of postoperative outcome as measured by ODI. Ethical approval was taken by the institutional review board. RESULTS Buck's screw repair of the pars defect was carried out in 44 patients (33 males, 11 female): unilateral in 8 patients (7 males, 1 female) and bilateral in 36 patients (26 males, 10 females). Although age at surgery showed linear colinearity (ρ = 0.32, P < .05), it was not significant in the model. The most consistent association with the preoperative VAS score were the pre- and postoperative ODI scores, that is, ρ = 0.51 (P < .01) and ρ = 0.33 (P < .05), respectively. In the bilateral group, with Buck's repair at a single level, that is, 33 of 36 (93%) patients had returned to sports at a mean time of 7.5 months (range 6-12 months). Overall, 44 of 52 (84%) individuals had returned to their sports with posttreatment ODI score of <10. The stepwise regression modeling suggested 6 independent factors (preoperative ODI, preoperative SF-36 physical component summary (PCS), Buck's repair, multiple operations, professionalism, and pars defect at L3), as the determinants of the outcome (ie, postoperative ODI) in 80.9% patients (R2 = 0.809). CONCLUSIONS The outcome after direct repair of pars defect in those younger than 25 years runs a predictable course. Professionalism in sports has a high impact on the outcome. Preoperative ODI and SF-36 PCS scores are significant predictors of good functional outcome. The regression equation can predict the outcome in 80.9% sporting individuals undergoing Buck's repair.
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Affiliation(s)
| | - B. E. Scammell
- Queens Medical Centre, University of Nottingham, Nottingham, UK
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Ishida K, Aota Y, Mitsugi N, Kuniya T, Morii T, Kawai T, Yamada K, Saito T. Spondylolysis repair using a pedicle screw hook or claw-hook system. -a comparison of bone fusion rates. Spine Surg Relat Res 2018; 2:135-139. [PMID: 31440659 PMCID: PMC6698499 DOI: 10.22603/ssrr.2017-0011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 09/10/2017] [Indexed: 11/05/2022] Open
Abstract
Introduction To assess the bone fusion rates and clinical results of two surgical methods (pedicle screw claw-hook fixation and pedicle screw hook fixation) of lumbar spondylolysis repair. Methods A multicenter database of surgical patients with lumbar spondylolysis was reviewed. All patients < 20 years old with a minimum of 6 months of follow-up and computed tomography images were included. Operation time and blood loss amount were investigated. Visual analogue scale (VAS; 0-10) scores for lower back pain were evaluated to assess clinical results. Results A total of 17 patients met the inclusion criteria. Pedicle screw hook fixation was performed in five patients (the hook group), and pedicle screw claw-hook fixation was performed in 13 patients (the claw-hook group). One patient was included in both groups because each method was performed at different lumbar levels (L4 and L5). The bone fusion rates at 3, 6, and 9 months after surgery were significantly higher in the claw-hook group than those in the hook group. Operation time and blood loss amount were not significantly different between the groups. VAS scores improved in the claw-hook group but not in the hook group because of a small number of patients. Conclusions Pedicle screw claw-hook fixation was more effective than pedicle screw hook fixation in terms of bone fusion rates.
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Affiliation(s)
- Ko Ishida
- Department of Orthopedic Surgery, Yokohama City University Medical Center, Kanagawa, Japan
| | - Yoichi Aota
- Department of Spine Surgery, Yokohama City Brain and Spine Center, Kanagawa, Japan
| | - Naoto Mitsugi
- Department of Orthopedic Surgery, Yokohama City University Medical Center, Kanagawa, Japan
| | - Takashi Kuniya
- Department of Orthopedic Surgery, Yokohama City University Medical Center, Kanagawa, Japan
| | - Takaaki Morii
- Department of Orthopedic Surgery, Yokohama City University Medical Center, Kanagawa, Japan
| | - Takuya Kawai
- Department of Spine Surgery, Yokohama City Brain and Spine Center, Kanagawa, Japan
| | - Katsutaka Yamada
- Department of Orthopedic Surgery, Yokohama City University, Kanagawa, Japan
| | - Tomoyuki Saito
- Department of Orthopedic Surgery, Yokohama City University, Kanagawa, Japan
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Raudenbush BL, Chambers RC, Silverstein MP, Goodwin RC. Indirect pars repair for pediatric isthmic spondylolysis: a case series. JOURNAL OF SPINE SURGERY 2017; 3:387-391. [PMID: 29057347 DOI: 10.21037/jss.2017.08.08] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Isthmic spondylolysis (ISY) is a common cause of back pain in the pediatric population. Historically, non-operative treatments have had a very high success rate. The purpose of this study was to review the mid-term results of an indirect pars repair technique on reducing the visual analog score for pain (VAS), spondylolysis defect healing, complication rates and rates of return to pre-surgery activity level in pediatric patients who failed conservative care for ISY. METHODS A retrospective review of all pediatric patients (<18 years old) treated surgically by one surgeon over a 5-year period was performed. Patients were treated with indirect pars repair utilizing pedicle screws and laminar hooks and local autograft. Preoperative VAS was compared to the final follow-up score, and return to activity was evaluated. Radiographs were reviewed to evaluate healing. RESULTS Nine patients (6 females, 3 males) were treated surgically. Average age at the time of surgery was 15.4 years, (range, 13 to 17 years). Average length of final follow-up was 11.9 months (range, 6 to 24 months). Preoperative VAS averaged 5.6 points (range, 2 to 8 points) compared to final follow-up of 1.2 (range, 0 to 3). Definitive bony healing was noted in 7 of 9 cases (77.8%) with at least 6 months follow-up. Eight of nine patients (88.9%) returned to preoperative competitive sports activity level. No complications were noted during the follow-up period. CONCLUSIONS Pediatric patients treated surgically with indirect pars repair appear to achieve satisfactory mid-term outcomes. This technique appears safe, and has both a high healing rate and return to competitive athletics. Further study is needed to determine durability of this procedure.
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Affiliation(s)
- Brandon L Raudenbush
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Reid C Chambers
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Michael P Silverstein
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Ryan C Goodwin
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA
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Voisin MR, Witiw CD, Deorajh R, Guha D, Oremakinde A, Wang S, Yang V. Multilevel Spondylolysis Repair Using the "Smiley Face" Technique with 3-Dimensional Intraoperative Spinal Navigation. World Neurosurg 2017; 109:e609-e614. [PMID: 29054782 DOI: 10.1016/j.wneu.2017.10.046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 10/06/2017] [Accepted: 10/09/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND/OBJECTIVE Multilevel spondylolysis is a rare cause of progressive lower back pain, and patients who fail conservative management are treated surgically. Direct repair methods can maintain mobility and lead to decreased morbidity compared with spinal fusion in single-level spondylolysis. In this paper, we present a patient with nonadjacent multilevel spondylolysis who underwent the "smiley face" technique of direct multilevel repair without fusion using 3-dimensional intraoperative spinal navigation. METHODS Bilateral spondylolysis at L3 and L5 with associated spondylolisthesis in a 50-year-old male was repaired using the "smiley face" technique. Patient-reported outcomes, including the Oswestry Disability Index (ODI) and visual analog scale scores for back and leg pain, were assessed preoperatively along with 6 weeks and 4 months postoperatively. RESULTS Postoperative computed tomography imaging showed precise screw insertion and rod placement along with stable hardware alignment in follow-up imaging. The patient's ODI and lower back visual analog scale scores decreased from 25 to 8 and 7.5 to 4, respectively, correlating to an excellent outcome on ODI. CONCLUSION Direct repair and avoidance of fusion is possible and can provide good functional outcomes in patients with nonadjacent multilevel spondylolysis and associated spondylolisthesis.
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Affiliation(s)
- Mathew R Voisin
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
| | - Christopher D Witiw
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Ryan Deorajh
- Sunnybrook Research Institute, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada
| | - Daipayan Guha
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Department of Surgery, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Ontario, Canada
| | - Adetunji Oremakinde
- Department of Surgery, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Ontario, Canada
| | - Shelly Wang
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Victor Yang
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Department of Surgery, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Ontario, Canada; Sunnybrook Research Institute, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada
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Percutaneous Direct Repair of a Pars Defect Using Intraoperative Computed Tomography Scan: A Modification of the Buck Technique. Spine (Phila Pa 1976) 2017; 42:E691-E694. [PMID: 27755495 DOI: 10.1097/brs.0000000000001929] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Case report. OBJECTIVE To describe a young adult with a pars defect undergoing percutaneous direct fixation using intraoperative computed tomography (CT) scan. SUMMARY OF BACKGROUND DATA Direct pars repair has been utilized since the 1960s. There are no reports in the literature describing a percutaneous technique. METHODS Using a percutaneous technique under the guide of intraoperative CT scan, a cannulated partially threaded screw was inserted across the pars defect. RESULTS Surgery was completed without complication and the patient returned to preoperative activity level 3 months post-op. Postoperative CT scan showed a well-healed L4 pars defect. CONCLUSION Percutaneous direct pars repair using intraoperative CT scan offers the advantage of minimal soft tissue dissection, thereby reducing blood loss, infection risk, and recovery time. LEVEL OF EVIDENCE 5.
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A minimal soft tissue damage approach of spondylolysis repair in athletes: preliminary report. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2017; 27:1011-1017. [PMID: 28497280 PMCID: PMC5605594 DOI: 10.1007/s00590-017-1974-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 05/02/2017] [Indexed: 01/13/2023]
Abstract
Purpose and hypothesis Both spondylolysis and spondylolisthesis come in second place in the causes of pain among athletes. Treatment options include both conservative management and different operative methods. Athletes and adolescents are groups where the priority is to protect tissues from perioperative damage. Objective We present our modification of the Buck’s, direct pars repair method, which we believe offers maximum protection of tissues. We used the modified surgical method in young, competitive athletes, in whom non-surgical treatment was not effective. Method Eight pars defects in five patients were treated using suggested method. All of them were young males (aged between 13 and 18 years), who practice soccer professionally. We use modified method of direct repair pars through the cannulated screw fixation, first proposed by Buck. Preoperative preparation consists of proper analysis of computer tomography images in multiplanar reconstruction mode: measuring screw length, measurement of inclination angle of the optimal screw trajectory in the frontal and sagittal plane. During the operation, the wire proper direction is performed by usage of the predetermined angles. Starting point for guide wire was also changed to the lower end of the facet. The fusion takes place with a screw of 3 mm diameter. After the operation patient need to use thoracolumbar spinal orthosis as a primary immobilization for 6 weeks and appropriate rehabilitation for another 6 weeks. We used these methods in eight pars fixations. Results All of the patients were painless in first week after surgery. All of them underwent total rehabilitation programme and returned to sport. Conclusions Direct pars repair using Buck’s method with proposed modification, including adequate radiographic preparation, the use of a thin cannulated screw and changing the point of screw entry, allows precise and safe screw placement, regardless of the size of the bone at the defect site.
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Irrigation endoscopic assisted percutaneous pars repair: technical note. Spine J 2016; 16:1276-1281. [PMID: 27345745 DOI: 10.1016/j.spinee.2016.06.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 05/03/2016] [Accepted: 06/21/2016] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Spondylolysis is a common source of low back pain in children and adolescents. Despite the benign natural history of the pathology, however, it should be noted that as part of conservative management many young individuals are forced to discontinue their routine sports activities. In cases resistant to conservative management, direct repair of a pars defect is considered a safe and effective option in young adults with preserved discs. Recently, some reports of minimally invasive pars repair have been described, aiming at preservation of the paraspinal muscles and improvement of the postoperative course. PURPOSE The study aimed to present a new minimally invasive endoscopic technique for pars repair. STUDY DESIGN This is a technical note. PATIENT SAMPLE Seven consecutive patients complaining of back pain due to spondylolysis and resistant to conservative management were included. OUTCOME MEASURES Outcome was assessed using the modified Macnab criteria, and bone union was assessed on postoperative radiographs. METHODS Two portals of 0.5 cm were used on each side, 1 cm lateral to the midline. One portal is used for the endoscope and the second for the surgical instruments. Following endoscopic debridement of the defect, the inferior portal was used for percutaneous placement of the Buck screw. There was no source for external funding for this study and no potential conflict of interest to disclose. RESULTS Outcome was excellent in six cases and good in one case. All patients returned back to their normal level of activities. Complete radiographic union was seen in all patients. The mean period of postoperative hospital stay and follow-up was 8 hours and 21 months, respectively. CONCLUSIONS The irrigation endoscopic technique has previously shown promising results in lumbar discectomy and laminectomy. Similar results were observed in the current study on the ability to achieve minimally invasive pars defect debridement and a smooth postoperative course. This is a pilot study and larger patient series and different surgeons' experience are required for further evaluation of the technique.
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Jia M, Wang J, Zhang Z, Zheng W, Zhou Y. Direct Repair of Lumbar Pars Interarticularis Defects by Utilizing Intraoperative O-Arm-Based Navigation and Microendoscopic Techniques. Spine (Phila Pa 1976) 2016; 41 Suppl 19:B6-B13. [PMID: 27488290 DOI: 10.1097/brs.0000000000001815] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A retrospective analysis of the clinical outcomes of eight patients with the lumbar pars interarticulars defects treated by direct repair with the aid of intraoperative O-arm based navigation and microendoscopic techniques. OBJECTIVE The aim of this study was to investigate the efficacy and safety of direct screw repair by using minimally invasive surgery for the lumbar pars interarticulars defects in a pilot study. SUMMARY OF BACKGROUND DATA Direct repair of pars interarticulars defects has been used to treat young adult patients. Reports concerning direct repair by minimally invasive techniques for pars interarticulars defects are quite rare. METHODS Review of medical records identified eight consecutive patients treated with intraoperative O-arm based navigation and microendoscopic techniques. Debridement and autograft of pars interarticularis defects was performed under microendoscopic procedure. Then, percutaneous bilateral intralaminar screws were inserted by utilizing intraoperative navigation. The clinical and radiological data were collected and analyzed retrospectively. RESULTS Eight patients had a mean age of 28.4 years, and five were 30 years or younger at the time of treatment. Symptoms included axial back pain in 100% of patients without concomitant radiculopathy. Autograft was used in all cases. The average follow-up duration was 27.4 months with a range of 20 to 33 months. Symptoms resolved completely or partially in all patients. Low back pain visual analog scores decrease from preoperative 6.8 to postoperative 1.4 of eight cases. Of 16 pars defects, healing was observed in 13 (81.3%) at last radiological follow-up. One patient with bilateral fusion failure refused revision surgery because of mild complaint. No complications such as dural tear, nerve root injury, and infection occurred. CONCLUSION Minimally invasive direct repair of the pars interarticularis defects with intralaminar screws by using microendoscopic system and navigation procedure can provide safe and effective treatment of spondylolysis with satisfactory clinical and radiological outcomes, which need some special tools with steep learning curve. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- Min Jia
- Department of Orthopaedic Surgery, Affiliated Xinqiao Hospital, The Third Military Medical University, Chongqing, People's Republic of China
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Panteliadis P, Nagra NS, Edwards KL, Behrbalk E, Boszczyk B. Athletic Population with Spondylolysis: Review of Outcomes following Surgical Repair or Conservative Management. Global Spine J 2016; 6:615-25. [PMID: 27556003 PMCID: PMC4993622 DOI: 10.1055/s-0036-1586743] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2016] [Accepted: 06/27/2016] [Indexed: 01/13/2023] Open
Abstract
STUDY DESIGN Narrative review. OBJECTIVE The study aims to critically review the outcomes associated with the surgical repair or conservative management of spondylolysis in athletes. METHODS The English literature listed in MEDLINE/PubMed was reviewed to identify related articles using the term "spondylolysis AND athlete." The criteria for studies to be included were management of spondylolysis in athletes, English text, and no year, follow-up, or study design restrictions. The references of the retrieved articles were also evaluated. The primary outcome was time to return to sport. This search yielded 180 citations, and 25 publications were included in the review. RESULTS Treatment methods were dichotomized as operative and nonoperative. In the nonoperative group, 390 athletes were included. A combination of bracing with physical therapy and restriction of activities was used. Conservative measures allowed athletes to return to sport in 3.7 months (weighted mean). One hundred seventy-four patients were treated surgically. The most common technique was Buck's, using a compression screw (91/174). All authors reported satisfactory outcomes. Time to return to play was 7.9 months (weighted mean). There were insufficient studies with suitably homogenous subgroups to conduct a meta-analysis. CONCLUSION There is no gold standard approach for the management of spondylolysis in the athletic population. The existing literature suggests initial therapy should be a course of conservative management with thoracolumbosacral orthosis brace, physiotherapy, and activity modification. If conservative management fails, surgical intervention should be considered. Two-sided clinical studies are needed to determine an optimal pathway for the management of athletes with spondylolysis.
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Affiliation(s)
- Pavlos Panteliadis
- Spinal Department, Oxford University Hospitals, Headley Way, Oxford, United Kingdom,Address for correspondence Pavlos Panteliadis, MD Spinal Department, Oxford University HospitalsHeadley Way, Oxford OX3 9DUUnited Kingdom
| | - Navraj S. Nagra
- Orthopaedic Department, Stoke Mandeville Hospital, Aylesbury, Buckinghamshire, United Kingdom,Division of Medical Sciences, Oxford University Clinical Academic Graduate School, Headley Way, Oxford, United Kingdom
| | | | - Eyal Behrbalk
- The Centre for Spinal Studies and Surgery, Queen's Medical Centre, Nottingham University Hospitals, Nottingham, United Kingdom
| | - Bronek Boszczyk
- The Centre for Spinal Studies and Surgery, Queen's Medical Centre, Nottingham University Hospitals, Nottingham, United Kingdom
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Comparison of Direct Pars Repair Techniques of Spondylolysis in Pediatric and Adolescent Patients: Pars Compression Screw Versus Pedicle Screw-Rod-Hook. Clin Spine Surg 2016; 29:272-80. [PMID: 23075858 DOI: 10.1097/bsd.0b013e318277cb7d] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
STUDY DESIGN Retrospective clinical cohort study. OBJECTIVE To compare the clinical and radiographic outcomes of patients who were treated with intrasegmental pars fixation by either laminar compression screw (LS) or a pedicle screw, rod, and laminar hook (PSRH) construct. SUMMARY OF BACKGROUND DATA Spondylolysis is a nonunion defect of the pars interarticularis. In symptomatic spondylolysis, direct repair of the pars interarticularis defect can preserve motion and prevent abnormal stresses at the adjacent levels. METHODS Sixteen patients who failed nonoperative treatment and underwent direct pars repair by using LS (n=9) or PSRH (n=7) constructs were included in the study. Clinical outcome was assessed by using the MacNab criteria. Radiologic fusion and complications were evaluated using plain radiographs or computed tomography images and patient charts. RESULTS The healing rate was 100% after 6 months. The healing time was similar in both the groups: LS, 6.5 months; PSRH, 6.2 months. Patients with PSRH (5.9 mo) were more likely to return to sports earlier relative to patients with LS (7.7 mo). There were no complications in the LS group; in the PSRH group, 1 patient had mild sensory deficit and 2 had superficial wound infections. The MacNab criteria for pain assessment showed an excellent or good outcome in 8 of 9 patients in LS group and 6 of 7 patients in PSRH group. Relative to LS patients, there was a significant increase in surgical time and estimated blood loss among PSRH patients. CONCLUSIONS Either of the mentioned 2 techniques appears to produce acceptable results. Biplanar fluoroscopy and navigation systems could minimize the risk of screw misplacement with LS construct. Familiarity with the various fixation techniques will allow the surgeon to select the most appropriate surgical technique.
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Abstract
CONTEXT Pediatric patients who undergo spinal surgery are frequently involved in sporting activities. Return to play is often an important postoperative concern for the patient and family. EVIDENCE ACQUISITION A PubMed search was conducted for articles in the English language on return to play after treatment of pediatric acute disc herniation, degenerative disc disease, spondylolysis, spondylolisthesis, and scoliosis from 1980 to 2015. Reference lists were reviewed for additional pertinent articles. We included articles that focused on return to sports after surgical treatment of these conditions in this review. STUDY DESIGN Clinical review. LEVEL OF EVIDENCE Level 4. RESULTS There are no published guidelines, and most of the literature in this area has focused on return to play after spinal injury rather than after spinal surgery. Most children and adolescents have excellent outcomes with minimal pain at 1 year after lumbar discectomy. The majority of surgeons allow return to full activity once pain-free range of motion and strength are regained, typically at 8 to 12 weeks postoperatively. Pediatric patients with spondylolysis have good outcomes after direct pars repair. Satisfactory outcomes have been demonstrated after fusion for low- and high-grade spondylolisthesis. Most surgeons allow return to noncontact sports by 6 months after surgical treatment of spondylolysis and spondylolisthesis. Return to contact and collision sports is controversial. After posterior spinal fusion for scoliosis, most surgeons allow return to noncontact sports by 3 months and return to contact sports between 6 months and 1 year. Return to collision sports is controversial. CONCLUSION There is little evidence to guide practitioners on return to sports after pediatric spinal surgery. Ultimately, the decision to allow any young athlete to resume sports participation after spinal injury or surgery must be individualized.
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Affiliation(s)
- Tyler Christman
- C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, Michigan
| | - Ying Li
- C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, Michigan
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Gillis CC, Eichholz K, Thoman WJ, Fessler RG. A minimally invasive approach to defects of the pars interarticularis: Restoring function in competitive athletes. Clin Neurol Neurosurg 2015; 139:29-34. [DOI: 10.1016/j.clineuro.2015.08.024] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Revised: 08/10/2015] [Accepted: 08/17/2015] [Indexed: 12/22/2022]
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Current Evidence Regarding the Surgical and Nonsurgical Treatment of Pediatric Lumbar Spondylolysis: A Report from the Scoliosis Research Society Evidence-Based Medicine Committee. Spine Deform 2015; 3:30-44. [PMID: 27927449 DOI: 10.1016/j.jspd.2014.06.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Revised: 05/29/2014] [Accepted: 06/03/2014] [Indexed: 10/24/2022]
Abstract
STUDY DESIGN Structured literature review. OBJECTIVES The Scoliosis Research Society requested an assessment of the current state of peer-reviewed evidence regarding pediatric spondylolysis with the goal of identifying both what is really known and what research remains essential to further understanding. SUMMARY OF BACKGROUND DATA Spondylolysis is common among children and adolescents and no formal synthesis of the published literature regarding treatment has been previously performed. METHODS A comprehensive literature search was performed. The researchers reviewed abstracts and analyzed by committee data from included studies. From 947 initial citations with abstract, 383 articles underwent full text review. The best available evidence for clinical questions regarding surgical and nonsurgical treatment was provided by 58 included studies. None of the studies were graded as level I or level II evidence. Two of the studies were graded as level III evidence. Fifty-six of the studies were graded as level IV evidence. No level V (expert opinion) studies were included in the final list. RESULTS Although natural history studies suggest a benign, relatively asymptomatic course for spondylolysis in most patients, both nonsurgical and surgical treatment series suggest that a substantial number of patients present with pain and activity limitations attributed to spondylolysis. Pain resolution and return to activity are common with both nonsurgical and surgical treatment (80% to 85%, respectively). Although it is implied that most surgically treated patients have failed nonsurgical treatment, the specific treatment modalities and duration required before failure is declared are not well defined. There is insufficient evidence to know which patients will benefit from specific treatment modalities (both nonsurgical and surgical). CONCLUSIONS Because of the preponderance of uncontrolled case series and the lack of comparative studies, only low-quality evidence is available to guide the treatment of pediatric spondylolysis.
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