Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
권호 표지
DOI QR코드

DOI QR Code

Direct Pars Repair Surgery Using Two Different Surgical Methods : Pedicle Screw with Universal Hook System and Direct Pars Screw Fixation in Symptomatic Lumbar Spondylosis Patients

  • Shin, Myung-Hoon (Department of Neurosurgery, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine) ;
  • Ryu, Kyeong-Sik (Department of Neurosurgery, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine) ;
  • Rathi, Nitesh Kumar (Department of Neurosurgery, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine) ;
  • Park, Chun-Kun (Department of Neurosurgery, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine)
  • Received : 2011.09.23
  • Accepted : 2012.01.25
  • Published : 2012.01.28
Download PDF
⟨ Previous Next ⟩

Abstract

Objective : The authors performed a retrospective study to assess the clinical and radiological outcome in symptomatic lumbar spondylolysis patients who underwent a direct pars repair surgery using two different surgical methods; pedicle screw with universal hook system (PSUH) and direct pars screw fixation (DPSF), and compared the results between two different treated groups. Methods : Forty-seven consecutive patients (PSUH; 23, DPSF; 15) with symptomatic lumbar spondylolysis who underwent a direct pars repair surgery were included. The average follow-up period was 37 months in the PSUH group, and 28 months in the DPSF group. The clinical outcome was measured using visual analogue pain scale (VAS) and Oswestry disability index (ODI). The length of operation time, the amount of blood loss, the duration of hospital stay, surgical complications, and fusion status were also assessed. Results : When compared to the DPSF group, the average preoperative VAS and ODI score of the PSUH group were less decreased at the last follow-up; (the PSUH group; back VAS : 4.9 vs. 3.0, leg VAS : 6.8 vs. 2.2, ODI : 50.6% vs. 24.6%, the DPSF group; back VAS : 5.7 vs. 1.1, leg VAS : 6.1 vs. 1.2, ODI : 57.4% vs. 18.2%). The average operation time was 174.9 minutes in the PSUH group, and 141.7 minutes in the DPSF group. The average blood loss during operation was 468.8 cc in the PSUH group, and 298.8 cc in the DPSF group. The average hospital stay after operation was 8.9 days in the PSUH group, and 7 days in the DPSF group. In the PSUH group, there was one case of a screw misplacement requiring revision surgery. In the DPSF group, one patient suffered from transient leg pain. The successful bone fusion rate was 78.3% in the PSUH group, and 93.3% in the DPSF group. Conclusion : The present study suggests that the technique using direct pars screw would be more effective than the method using pedicle screw with lamina hook system, in terms of decreased operation time, amount of blood loss, hospital stay, and increased fusion success rate, as well as better clinical outcome.

Keywords

References

  1. Askar Z, Wardlaw D, Koti M : Scott wiring for direct repair of lumbar spondylolysis. Spine (Phila Pa 1976) 28 : 354-357, 2003
  2. Beutler WJ, Fredrickson BE, Murtland A, Sweeney CA, Grant WD, Baker D : The natural history of spondylolysis and spondylolisthesis : 45-year follow-up evaluation. Spine (Phila Pa 1976) 28 : 1027-1035; discussion 1035, 2003
  3. Buck JE : Direct repair of the defect in spondylolisthesis. Preliminary report. J Bone Joint Surg Br 52 : 432-437, 1970
  4. Buck JE : Spondylolisthesis (two cases). Proc R Soc Med 64 : 713-714, 1971
  5. Cheh G, Bridwell KH, Lenke LG, Buchowski JM, Daubs MD, Kim Y, et al. : Adjacent segment disease followinglumbar/thoracolumbar fusion with pedicle screw instrumentation : a minimum 5-year follow-up. Spine (Phila Pa 1976) 32 : 2253-2257, 2007 https://doi.org/10.1097/BRS.0b013e31814b2d8e
  6. Chung CH, Chiu HM, Wang SJ, Hsu SY, Wei YS : Direct repair of multiple levels lumbar spondylolysis by pedicle screw laminar hook and bone grafting : clinical, CT, and MRI-assessed study. J Spinal Disord Tech 20 : 399-402, 2007 https://doi.org/10.1097/01.bsd.0000211253.67576.90
  7. Dai LY, Jia LS, Yuan W, Ni B, Zhu HB : Direct repair of defect in lumbar spondylolysis and mild isthmic spondylolisthesis by bone grafting, with or without facet joint fusion. Eur Spine J 10 : 78-83, 2001 https://doi.org/10.1007/s005860000205
  8. Debusscher F, Troussel S : Direct repair of defects in lumbar spondylolysis with a new pedicle screw hook fixation : clinical, functional and Ct-assessed study. Eur Spine J 16 : 1650-1658, 2007 https://doi.org/10.1007/s00586-007-0392-0
  9. Fan J, Yu GR, Liu F, Zhao J, Zhao WD : Direct repair of spondylolysis by TSRH's hook plus screw fixation and bone grafting : biomechanical study and clinical report. Arch Orthop Trauma Surg 130 : 209-215, 2010 https://doi.org/10.1007/s00402-009-0897-6
  10. Fredrickson BE, Baker D, McHolick WJ, Yuan HA, Lubicky JP : The natural history of spondylolysis and spondylolisthesis. J Bone Joint Surg Am 66 : 699-707, 1984 https://doi.org/10.2106/00004623-198466050-00008
  11. Gillet P, Petit M : Direct repair of spondylolysis without spondylolisthesis, using a rod-screw construct and bone grafting of the pars defect. Spine (Phila Pa 1976) 24 : 1252-1256, 1999 https://doi.org/10.1097/00007632-199906150-00014
  12. Harrop JS, Youssef JA, Maltenfort M, Vorwald P, Jabbour P, Bono CM, et al. : Lumbar adjacent segment degeneration and disease after arthrodesis and total disc arthroplasty. Spine (Phila Pa 1976) 33 : 1701-1707, 2008 https://doi.org/10.1097/BRS.0b013e31817bb956
  13. Hefti F : [Direct screw repair of spondylolysis with the hooked screw.] Orthopade 26 : 769-773, 1997
  14. Ivanic GM, Pink TP, Achatz W, Ward JC, Homann NC, May M : Direct stabilization of lumbar spondylolysis with a hook screw : mean 11-year follow-up period for 113 patients. Spine (Phila Pa 1976) 28 : 255-259, 2003
  15. Jeanneret B : Direct repair of spondylolysis. Acta Orthop Scand Suppl 251 : 111-115, 1993
  16. Kakiuchi M : Repair of the defect in spondylolysis. Durable fixation with pedicle screws and laminar hooks. J Bone Joint Surg Am 79 : 818-825, 1997 https://doi.org/10.2106/00004623-199706000-00003
  17. Kawaguchi Y, Ishihara H, Kanamori M, Yasuda T, Abe Y, Nogami S, et al. : Adjacent segment disease following expansive lumbar laminoplasty. Spine J 7 : 273-279, 2007 https://doi.org/10.1016/j.spinee.2006.04.003
  18. Kimura M : [My method of filing the lesion with spongy bone in spondylolysis and spondylolistesis]. Seikei Geka 19 : 285-296, 1968
  19. Kimura M : [Radiological follow-up of spondylolysis--in 4 cases from the view point of postnatal development]. Seikei Geka 22 : 31-38, 1971
  20. Klopfenstein JD, Kim LJ, Feiz-Erfan I, Dickman CA : Retroperitoneal approach for lumbar interbody fusion with anterolateral instrumentation for treatment of spondylolisthesis and degenerative foraminal stenosis. Surg Neurol 65 : 111-116; discussion 116, 2006 https://doi.org/10.1016/j.surneu.2005.08.021
  21. Lee CS, Hwang CJ, Lee SW, Ahn YJ, Kim YT, Lee DH, et al. : Risk factors for adjacent segment disease after lumbar fusion. Eur Spine J 18 : 1637-1643, 2009 https://doi.org/10.1007/s00586-009-1060-3
  22. Levin DA, Hale JJ, Bendo JA : Adjacent segment degeneration following spinal fusion for degenerative disc disease. Bull NYU Hosp Jt Dis 65 : 29-36, 2007
  23. Mihara H, Onari K, Cheng BC, David SM, Zdeblick TA : The biomechanical effects of spondylolysis and its treatment. Spine (Phila Pa 1976) 28 : 235-238, 2003
  24. Morscher E, Gerber B, Fasel J : Surgical treatment of spondylolisthesis by bone grafting and direct stabilization of spondylolysis by means of a hook screw. Arch Orthop Trauma Surg 103 : 175-178, 1984 https://doi.org/10.1007/BF00435550
  25. Nicol RO, Scott JH : Lytic spondylolysis. Repair by wiring. Spine (Phila Pa 1976) 11 : 1027-1030, 1986 https://doi.org/10.1097/00007632-198612000-00011
  26. Noggle JC, Sciubba DM, Samdani AF, Anderson DG, Betz RR, Asghar J : Minimally invasive direct repair of lumbar spondylolysis with a pedicle screw and hook construct. Neurosurg Focus 25 : E15, 2008
  27. Park P, Garton HJ, Gala VC, Hoff JT, McGillicuddy JE : Adjacent segment disease after lumbar or lumbosacral fusion : review of the literature. Spine (Phila Pa 1976) 29 : 1938-1944, 2004 https://doi.org/10.1097/01.brs.0000137069.88904.03
  28. Pavlovcic V : Surgical treatment of spondylolysis and spondylolisthesis with a hook screw. Int Orthop 18 : 6-9, 1994 https://doi.org/10.1007/BF00180169
  29. Qian Z, Tang T, Yang H : [The direct repair of the defect and grafting with single segment reduction fixation system in the treatment of lumbar spondylolysis and spondylolisthesis]. Zhonghua Wai Ke Za Zhi 33 : 711-714, 1995
  30. Salib RM, Pettine KA : Modified repair of a defect in spondylolysis or minimal spondylolisthesis by pedicle screw, segmental wire fixation, and bone grafting. Spine (Phila Pa 1976) 18 : 440-443, 1993 https://doi.org/10.1097/00007632-199303010-00006
  31. Schlenzka D, Remes V, Helenius I, Lamberg T, Tervahartiala P, YrjÖnen T, et al. : Direct repair for treatment of symptomatic spondylolysis and low-grade isthmic spondylolisthesis in young patients : no benefit in comparison to segmental fusion after a mean follow-up of 14.8 years. Eur Spine J 15 : 1437-1447, 2006 https://doi.org/10.1007/s00586-006-0072-5
  32. Schlenzka D, Seitsalo S, Poussa M, Osterman K : Operative treatment of symptomatic lumbar spondylolysis and mild isthmic spondylolisthesis in young patients : direct repair of the defect or segmental spinal fusion? Eur Spine J 2 : 104-112, 1993 https://doi.org/10.1007/BF00302712
  33. Shim JH, Kim WS, Kim JH, Kim DH, Hwang JH, Park CK : Comparison of instrumented posterolateral fusion versus percutaneous pedicle screw fixation combined with anterior lumbar interbody fusion in elderly patients with L5-S1 isthmic spondylolisthesis and foraminal stenosis. J Neurosurg Spine 15 : 311-319, 2011 https://doi.org/10.3171/2011.4.SPINE10653
  34. Sys J, Michielsen J, Bracke P, Martens M, Verstreken J : Nonoperative treatment of active spondylolysis in elite athletes with normal X-ray findings : literature review and results of conservative treatment. Eur Spine J 10 : 498-504, 2001 https://doi.org/10.1007/s005860100326
  35. Ulibarri JA, Anderson PA, Escarcega T, Mann D, Noonan KJ : Biomechanical and clinical evaluation of a novel technique for surgical repair of spondylolysis in adolescents. Spine (Phila Pa 1976) 31 : 2067-2072, 2006 https://doi.org/10.1097/01.brs.0000231777.24270.2b
  36. Winter RB : The natural history of spondylolysis and spondylolisthesis. J Bone Joint Surg Am 67 : 823, 1985
  37. Zhao J, Liu F, Shi HG, Fan J, Zhao WD, Wang YH, et al. : Biomechanical and clinical study on screw hook fixation after direct repair of lumbar spondylolysis. Chin J Traumatol 9 : 288-292, 2006

Cited by

  1. Spondylolysis outcomes in adolescents after direct screw repair of the pars interarticularis : Clinical article vol.21, pp.3, 2012, https://doi.org/10.3171/2014.5.spine13772
  2. Direct Repair Surgery With Screw Fixation for Young Patients With Lumbar Spondylolysis: Patient-Reported Outcomes and Fusion Rate in a Prospective Interventional Study vol.40, pp.4, 2015, https://doi.org/10.1097/brs.0000000000000714
  3. Posterior Dynamic Stabilization With Direct Pars Repair via Wiltse Approach for the Treatment of Lumbar Spondylolysis: The Application of a Novel Surgery vol.41, pp.8, 2012, https://doi.org/10.1097/brs.0000000000001295
  4. Comparison of Direct Pars Repair Techniques of Spondylolysis in Pediatric and Adolescent Patients : Pars Compression Screw Versus Pedicle Screw-Rod-Hook vol.29, pp.7, 2016, https://doi.org/10.1097/bsd.0b013e318277cb7d
  5. Percutaneous Direct Repair of a Pars Defect Using Intraoperative Computed Tomography Scan: A Modification of the Buck Technique vol.42, pp.11, 2012, https://doi.org/10.1097/brs.0000000000001929
  6. A comparison of the techniques of direct pars interarticularis repairs for spondylolysis and low-grade spondylolisthesis: a meta-analysis vol.44, pp.1, 2012, https://doi.org/10.3171/2017.11.focus17581
  7. A comparison of the techniques of direct pars interarticularis repairs for spondylolysis and low-grade spondylolisthesis: a meta-analysis vol.44, pp.1, 2012, https://doi.org/10.3171/2017.11.focus17581
  8. Three-Dimensional Planning and Patient-Specific Drill Guides for Repair of Spondylolysis/L5 Pars Defect vol.132, pp.None, 2019, https://doi.org/10.1016/j.wneu.2019.08.112