Raudenbush Brandon L, Chambers Reid C, Silverstein Michael P, Goodwin Ryan C
Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
J Spine Surg. 2017 Sep;3(3):387-391. doi: 10.21037/jss.2017.08.08.
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.
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.
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.
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.
峡部裂性脊椎滑脱（ISY）是儿童背痛的常见原因。从历史上看，非手术治疗成功率非常高。本研究的目的是回顾一种间接峡部修复技术在降低疼痛视觉模拟评分（VAS）、峡部裂缺损愈合、并发症发生率以及在因ISY保守治疗失败的儿科患者中恢复术前活动水平方面的中期结果。
对一位外科医生在5年期间手术治疗的所有儿科患者（<18岁）进行回顾性研究。患者采用椎弓根螺钉、椎板钩和局部自体骨移植进行间接峡部修复治疗。将术前VAS与最终随访评分进行比较，并评估恢复活动情况。复查X线片以评估愈合情况。
9例患者（6例女性，3例男性）接受了手术治疗。手术时的平均年龄为15.4岁（范围13至17岁）。最终随访的平均时长为11.9个月（范围6至24个月）。术前VAS平均为5.6分（范围2至8分），而最终随访时为1.2分（范围0至3分）。9例患者中有7例（77.8%）在至少6个月的随访后实现了明确的骨愈合。9例患者中有8例（88.9%）恢复到了术前的竞技体育活动水平。随访期间未发现并发症。
接受间接峡部修复手术治疗的儿科患者似乎取得了令人满意的中期结果。该技术似乎是安全的，并且具有高愈合率和恢复竞技运动的能力。需要进一步研究以确定该手术的持久性。
