Kolcun John Paul G, Chieng Lee Onn, Madhavan Karthik, Wang Michael Y
Department of Neurological Surgery and The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, FL, USA.
Asian Spine J. 2017 Oct;11(5):832-842. doi: 10.4184/asj.2017.11.5.832. Epub 2017 Oct 11.
Spondylolysis from pars fracture is a common injury among young athletes, which can limit activity and cause chronic back pain. While current literature has examined the relative benefits of surgical and conservative management of these injuries, no study has yet compared outcomes between conventional direct repair of pars defects and modern minimally invasive procedures. The goals of surgery are pain resolution, return to play at previous levels of activity, and a shorter course of recovery. In this review, the authors have attempted to quantify any differences in outcome between patients treated with conventional or minimally invasive techniques. A literature search was performed of the PubMed database for relevant articles, excluding articles describing conservative management, traumatic injury, or high-grade spondylolisthesis. Articles included for review involved young athletes treated for symptomatic spondylolysis with either conventional or minimally invasive surgery. Two independent reviewers conducted the literature search and judged articles for inclusion. All studies were classified according to the North American Spine Society standards. Of the 116 results of our initial search, 16 articles were included with a total of 150 patients. Due to a paucity of operative details in older studies and inconsistencies in both clinical methods and reporting among most articles, little quantitative analysis was possible. However, patients in the minimally invasive group did have significantly higher rates of pain resolution (<0.001). Short recovery times were also noted in this group. Both groups experienced low complication rates, and the majority of patients returned to previous levels of activity. Surgical repair of spondylolysis in young athletes is a safe and practical therapy. Current literature suggests that while conventional repair remains effective, minimally invasive procedures better clinical outcomes. We await further data to conduct a more thorough quantitative analysis of these techniques.
峡部裂引起的脊椎峡部裂是年轻运动员中常见的损伤，会限制活动并导致慢性背痛。虽然目前的文献已经研究了这些损伤的手术治疗和保守治疗的相对益处，但尚无研究比较传统的峡部缺损直接修复与现代微创手术的疗效。手术的目标是缓解疼痛、恢复到以前的活动水平以及缩短恢复过程。在这篇综述中，作者试图量化采用传统技术或微创技术治疗的患者在疗效上的差异。对PubMed数据库进行了文献检索以查找相关文章，排除描述保守治疗、创伤性损伤或重度腰椎滑脱的文章。纳入综述的文章涉及接受传统手术或微创手术治疗有症状脊椎峡部裂的年轻运动员。两名独立评审员进行了文献检索并判断文章是否纳入。所有研究均根据北美脊柱协会标准进行分类。在我们初步检索的116个结果中，纳入了16篇文章，共150例患者。由于早期研究中手术细节不足，且大多数文章的临床方法和报告存在不一致性，因此几乎无法进行定量分析。然而，微创组患者的疼痛缓解率显著更高（<0.001）。该组还观察到恢复时间较短。两组的并发症发生率都很低，大多数患者恢复到了以前的活动水平。年轻运动员脊椎峡部裂的手术修复是一种安全实用的治疗方法。目前的文献表明，虽然传统修复仍然有效，但微创手术的临床效果更好。我们期待进一步的数据来对这些技术进行更全面的定量分析。
