University of New South Wales, Sydney, New South Wales, Australia; NeuroSpine Surgery Research Group, Sydney, New South Wales, Australia; Prince of Wales Private Hospital, Randwick, New South Wales, Australia; NeuroSpine Clinic, Prince of Wales Private Hospital, Randwick, New South Wales, Australia.
University of New South Wales, Sydney, New South Wales, Australia; NeuroSpine Surgery Research Group, Sydney, New South Wales, Australia; NeuroSpine Clinic, Prince of Wales Private Hospital, Randwick, New South Wales, Australia.
World Neurosurg. 2019 Dec;132:75-80. doi: 10.1016/j.wneu.2019.08.112. Epub 2019 Aug 27.
Incomplete ossification of the pars interarticularis will result in a pars defect, a common cause of low back pain in youth and strongly associated with participation in high-impact sports. If left untreated, it can result in spondylolisthesis, causing dynamic canal stenosis, low back pain, and radiculopathy. The treatment of pars defect was first described by Bucks in 1970, who used screws in the lamina placed through an upward and outward direction. However, because of the multiple inclusion and exclusion criteria and narrow margin of error, the Bucks pars repair technique is not commonly performed.
A 28-year-old woman had with low back pain that she had been experiencing since mid-adolescence. Computed tomography revealed a bilateral L5 pars defect without spondylolisthesis. Her L5 vertebra was reconstructed virtually. The screw trajectories, a 3-dimensional (3D) model of the vertebra, and a patient-specific drill guide (PSDG) were designed and printed using positioning guide software (MySpine MC Guides [Medacta International SA, Castel San Petro, Switzerland]). A modified Bucks procedure using cannulated compression screws and the PSDG was performed.
Follow-up computed tomography revealed accurate placement of the compression screws, mirroring the planned trajectory. The patient was pain free at 3 months postoperatively, and early union across the defect was visualized on the 5-month radiographic imaging study.
Using 3D planning software, complex surgical procedures can be planned using the patient's anatomy and computed tomography. With the aid of 3D-printed PSDGs, screw placement in narrow corridors, such as was shown in our case, is safe, efficient, and achievable.
椎弓峡部裂会导致椎弓根裂，这是年轻人腰痛的常见原因，与高强度运动有很强的相关性。如果不治疗，它会导致脊椎滑脱，导致动态椎管狭窄、腰痛和神经根病。1970 年，Bucks 首次描述了椎弓根裂的治疗方法，他使用穿过向上和向外方向的椎板上的螺钉。然而，由于 Bucks 椎弓根修复技术的多项纳入和排除标准以及误差范围较窄，该技术并不常用。
一名 28 岁女性，自青春期中期开始出现腰痛。计算机断层扫描显示双侧 L5 椎弓根裂，但无脊椎滑脱。对她的 L5 椎体进行了虚拟重建。使用定位导向软件（MySpine MC Guides [Medacta International SA，Castel San Petro，Switzerland]）设计和打印了螺钉轨迹、椎体的三维（3D）模型和患者特异性钻导（PSDG）。采用改良的 Bucks 术式，使用空心加压螺钉和 PSDG。
术后随访 CT 显示加压螺钉准确放置，与计划轨迹一致。术后 3 个月患者疼痛消失，5 个月的影像学研究显示缺损处有早期愈合。
使用 3D 规划软件，可以根据患者的解剖结构和计算机断层扫描来规划复杂的手术程序。借助 3D 打印的 PSDG，即使在狭窄的通道（如我们的病例所示）中，螺钉放置也是安全、高效和可行的。
