Neurosurg Focus. 2018 Jan;44(1):E10. doi: 10.3171/2017.11.FOCUS17581.
OBJECTIVE Spondylosis with or without spondylolisthesis that does not respond to conservative management has an excellent outcome with direct pars interarticularis repair. Direct repair preserves the segmental spinal motion. A number of operative techniques for direct repair are practiced; however, the procedure of choice is not clearly defined. The present study aims to clarify the advantages and disadvantages of the different operative techniques and their outcomes. METHODS A meta-analysis was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The following databases were searched: PubMed, Cochrane Library, Web of Science, and CINAHL ( Cumulative Index to Nursing and Allied Health Literature). Studies of patients with spondylolysis with or without low-grade spondylolisthesis who underwent direct repair were included. The patients were divided into 4 groups based on the operative technique used: the Buck repair group, Scott repair group, Morscher repair group, and pedicle screw-based repair group. The pooled data were analyzed using the DerSimonian and Laird random-effects model. Tests for bias and heterogeneity were performed. The I statistic was calculated, and the results were analyzed. Statistical analysis was performed using StatsDirect version 2. RESULTS Forty-six studies consisting of 900 patients were included in the study. The majority of the patients were in their 2nd decade of life. The Buck group included 19 studies with 305 patients; the Scott group had 8 studies with 162 patients. The Morscher method included 5 studies with 193 patients, and the pedicle group included 14 studies with 240 patients. The overall pooled fusion, complication, and outcome rates were calculated. The pooled rates for fusion for the Buck, Scott, Morscher, and pedicle screw groups were 83.53%, 81.57%, 77.72%, and 90.21%, respectively. The pooled complication rates for the Buck, Scott, Morscher, and pedicle screw groups were 13.41%, 22.35%, 27.42%, and 12.8%, respectively, and the pooled positive outcome rates for the Buck, Scott, Morscher, and pedicle screw groups were 84.33%, 82.49%, 80.30%, and 80.1%, respectively. The pedicle group had the best fusion rate and lowest complication rate. CONCLUSIONS The pedicle screw-based direct pars repair for spondylolysis and low-grade spondylolisthesis is the best choice of procedure, with the highest fusion and lowest complication rates, followed by the Buck repair. The Morscher and Scott repairs were associated with a high rate of complication and lower rates of fusion.
对于保守治疗无效的伴或不伴脊椎滑脱的脊椎病，直接关节突间修复术可取得极佳的效果。直接修复可保留节段性脊柱运动。目前已经有许多种直接修复的手术技术，但选择哪种手术方法并不明确。本研究旨在阐明不同手术技术的优缺点及其结果。
按照 PRISMA（系统评价和荟萃分析的首选报告项目）指南进行荟萃分析。检索了以下数据库：PubMed、Cochrane 图书馆、Web of Science 和 CINAHL（护理与联合健康文献累积索引）。纳入了接受直接修复治疗的伴或不伴低度脊椎滑脱的脊椎裂患者的研究。根据所使用的手术技术，将患者分为 4 组：Buck 修复组、Scott 修复组、Morscher 修复组和椎弓根螺钉修复组。使用 DerSimonian 和 Laird 随机效应模型分析汇总数据。进行偏倚和异质性检验。计算 I 统计量并进行分析。统计分析使用 StatsDirect 版本 2 进行。
本研究共纳入了 46 项研究，包括 900 名患者。大多数患者处于 20 多岁。Buck 组包括 19 项研究，共 305 名患者；Scott 组有 8 项研究，共 162 名患者。Morscher 法包括 5 项研究，共 193 名患者，椎弓根组包括 14 项研究，共 240 名患者。计算了总体融合、并发症和结果的汇总率。Buck、Scott、Morscher 和椎弓根螺钉组的总体融合率分别为 83.53%、81.57%、77.72%和 90.21%。Buck、Scott、Morscher 和椎弓根螺钉组的总体并发症发生率分别为 13.41%、22.35%、27.42%和 12.8%，Buck、Scott、Morscher 和椎弓根螺钉组的总体阳性结果发生率分别为 84.33%、82.49%、80.30%和 80.1%。椎弓根螺钉组的融合率最高，并发症发生率最低。
对于伴或不伴低度脊椎滑脱的脊椎裂，基于椎弓根螺钉的直接关节突间修复是最佳的手术选择，融合率最高，并发症发生率最低，其次是 Buck 修复。Morscher 和 Scott 修复的并发症发生率高，融合率低。
