Department of Neurosurgery, MedStar Georgetown University Hospital, Washington, DC, USA.
Department of Neurosurgery, MedStar Georgetown University Hospital, Washington, DC, USA.
World Neurosurg. 2019 Jun;126:181-188. doi: 10.1016/j.wneu.2019.03.026. Epub 2019 Mar 12.
Spondylolysis is a defect in the pars interarticularis that typically presents with axial back pain. Recently, minimally invasive spine techniques have increased in popularity and have been applied to the Buck technique of direct pars repair.
In our series, 2 patients underwent minimally invasive direct pars repair by the percutaneous insertion of a cannulated lag screw across the pars defect with compression against the lamina. The defect was then decorticated and packed with bone grafting material through a tubular retractor. The clinical records, including preoperative imaging characteristics and intraoperative variables, were collected. The first patient was a 22-year-old woman with bilateral pars defects, and the second was a 21-year-old woman with a left-sided pars defect. They underwent minimally invasive direct pars repair without complications and were discharged home within 24-48 hours. In the first patient, the fusion was successful; however, the second experienced screw back out and required subsequent revision. The follow-up period was 25 months for patient 1 and 21 months for patient 2. The fracture morphology differed. The successfully repaired fractures were linear with smooth cortical edges and oriented perpendicular to the screw trajectory. The failed repair involved a unilateral, curved defect with comminuted cortical edges.
Minimally invasive direct pars repair can be performed safely and effectively with shortened hospital stays and reduced morbidity. Fracture morphology and orientation could be important predictors of the success of surgery.
脊椎裂是椎弓峡部的缺损，通常表现为轴向背痛。最近，微创脊柱技术越来越受欢迎，并已应用于直接椎弓根修复的 Buck 技术。
在我们的系列中，2 名患者通过经皮插入穿过椎弓根缺陷的带螺纹的拉力螺钉，对椎板施加压缩力，从而进行微创直接椎弓根修复。然后通过管状牵开器对缺陷进行去皮质和用骨移植材料填充。收集了临床记录，包括术前影像学特征和术中变量。第一个患者是一名 22 岁的女性，双侧椎弓根缺陷，第二个是一名 21 岁的女性，左侧椎弓根缺陷。他们接受了微创直接椎弓根修复，没有并发症，在 24-48 小时内出院回家。第一个患者的融合是成功的；然而，第二个患者的螺钉重新脱出，需要后续修正。第一个患者的随访期为 25 个月，第二个患者为 21 个月。骨折形态不同。成功修复的骨折呈线性，皮质边缘光滑，与螺钉轨迹垂直。失败的修复涉及单侧、弯曲的缺陷，皮质边缘粉碎。
微创直接椎弓根修复可以安全有效地进行，住院时间缩短，发病率降低。骨折形态和方向可能是手术成功的重要预测因素。
