Chen J F, Lee S T
Department of Neurosurgery, Chang Gung Memorial Hospital, Taipei, Taiwan, R.O.C.
Chang Gung Med J. 2000 Feb;23(2):92-8.
Anterior or posterolateral spondylodesis has been reported as a widely used surgical treatment for lumbar spondylolysis and spondylolisthesis. However, the expenditure of energy for both the physician and the patient is relatively great. The risk of complications is significant and the loss of one motion segment must be accepted. The latter is problematical, especially in young adult patients who only have symptomatic isthmic lumbar spondylolysis.
For these patients, direct repair of the defect is recommended. We used a spondylolysis hook screw and bone grafting for direct repair of the pars defect. The results were analyzed according to the clinical results and functional x-ray exams.
The clinical results were good or excellent. The roentgenologic examinations at 6 months showed the presence of bone trabeculation across the pars defect in all cases. The physiological motion of the lumbar spine was preserved without limitation, and all of the patients had resumed daily activities or work without discomfort.
There were no complications among our cases. Particularly, according to our anatomical investigations, normal structures were safe from injury as long as the proper technique was followed. A spondylolysis hook screw with bone grafting can preserve the physiological motion of the offending levels. This method is a much more physiologically appropriate surgical method for non-complicated and symptomatic lumbar spondylolysis in the young adult.
前路或后外侧脊柱融合术已被报道为腰椎峡部裂和腰椎滑脱广泛采用的手术治疗方法。然而，医生和患者所消耗的精力都相对较大。并发症风险显著，且必须接受一个运动节段的丧失。后者存在问题，尤其是在仅有症状性峡部型腰椎峡部裂的年轻成年患者中。
对于这些患者，建议直接修复缺损。我们使用峡部裂钩螺钉和植骨术直接修复椎弓根缺损。根据临床结果和功能性X线检查分析结果。
临床结果良好或优异。6个月时的X线检查显示所有病例椎弓根缺损处均有骨小梁形成。腰椎的生理活动得以保留且无受限，所有患者均已恢复日常活动或工作，无不适。
我们的病例中无并发症发生。特别是，根据我们的解剖学研究，只要遵循适当的技术，正常结构不会受到损伤。带植骨术的峡部裂钩螺钉可保留病变节段的生理活动。该方法对于年轻成年患者非复杂性且有症状的腰椎峡部裂而言，是一种在生理上更为合适的手术方法。
