Noggle Joseph C, Sciubba Daniel M, Samdani Amer F, Anderson D Greg, Betz Randal R, Asghar Jahangir
Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland 21287, USA.
Neurosurg Focus. 2008;25(2):E15. doi: 10.3171/FOC/2008/25/8/E15.
Object Lumbar spondylolysis occurs in approximately 6% of the population and presents with localized mechanical back pain, often in young athletes. Surgical treatment may involve decompression, lumbar intersegmental fusion, or direct repair of pars defects. Although such open procedures may effectively resolve symptoms, minimal-access approaches may additionally decrease collateral damage to soft tissues, allowing young, active patients to resume athletic activities sooner. In this study, the authors review their experience repairing bilateral lumbar spondylolyses with screw and hook constructs placed via a minimal-access approach. Methods Five consecutive pediatric patients with bilateral L-5 spondylolysis were treated. Bilateral incisions (2.5 cm) were made over L-5. Exposure was maintained with bilateral expandable tubular retractor systems. Pedicle screws were placed in the L-5 pedicles and attached to hooks under the L-5 laminae. A direct repair was performed at the pars defect. Clinical characteristics, operative variables, and postoperative outcomes were collected. Results All 5 patients underwent surgery; 4 were male (80%) and 1 was female (20%), and the mean age was 15.8 years (range 15-17 years). The mean estimated blood loss and duration of surgery were 37 ml (range 15-75 ml) and 1.94 hours (range 1-3 hours), respectively. Postoperative hospital stays ranged from 1 to 3 days (mean 1.8 days). The only complication occurred in 1 patient who experienced minor superficial wound breakdown. All patients have experienced resolution of symptoms at this preliminary stage, which has continued over an 8-month follow-up period. Conclusions Lumbar spondylolysis can be adequately and safely treated via minimal-access surgical repair of the pars interarticularis by using pedicle screws and rod-hook constructs. This approach may decrease the collateral soft tissue damage common to open dissections, and may be ideal for young, active surgical candidates.
腰椎峡部裂在大约6%的人群中出现，常表现为局限性机械性背痛，多见于年轻运动员。手术治疗可能包括减压、腰椎节段间融合或直接修复峡部缺损。尽管此类开放手术可能有效缓解症状，但微创入路方法可能还能减少对软组织的附带损伤，使年轻、活跃的患者能更快恢复体育活动。在本研究中，作者回顾了他们通过微创入路放置螺钉和钩状结构修复双侧腰椎峡部裂的经验。
连续治疗5例双侧L5峡部裂的儿科患者。在L5上方做双侧切口（2.5厘米）。使用双侧可扩张管状牵开器系统维持暴露。将椎弓根螺钉置入L5椎弓根，并连接至L5椎板下方的钩。在峡部缺损处进行直接修复。收集临床特征、手术变量和术后结果。
所有5例患者均接受了手术；4例为男性（80%），1例为女性（20%），平均年龄为15.8岁（范围15 - 17岁）。平均估计失血量和手术时长分别为37毫升（范围15 - 75毫升）和1.94小时（范围1 - 3小时）。术后住院时间为1至3天（平均1.8天）。唯一的并发症发生在1例患者身上，出现了轻微的浅表伤口裂开。在这个初步阶段，所有患者的症状均已缓解，并且在8个月的随访期内持续改善。
通过使用椎弓根螺钉和棒 - 钩结构对关节突间部进行微创外科修复，可以充分且安全地治疗腰椎峡部裂。这种方法可能减少开放手术常见的附带软组织损伤，对于年轻、活跃的手术候选者可能是理想的选择。
