Kibici Kenan, Erok Berrin
Altinbas University School of Medicine, Bahcelievler Medical Park Hospital, Department of Neurosurgery, Istanbul, Turkey.
Turk Neurosurg. 2020;30(6):923-931. doi: 10.5137/1019-5149.JTN.30167-20.2.
To evaluate the satisfactory clinical and radiological outcomes of posterior dynamic stabilization for the direct repair of bilateral L5 pars interarticularis defects and pars fusion.
This is a retrospective evaluation of postoperative follow-up results of 13 patients with bilateral L5 pars interarticularis defects without spondylolisthesis. The patients underwent dynamic transpedicular stabilization between 2013 and 2018. Our surgical criteria included unilateral or bilateral L5 spondylolysis; excessive low back pain; low back pain accompanied by leg pain without neurological findings; symptoms lasting at least six months despite conservative treatments, age < 50 years; and lack of significant adjacent disc degeneration.
There were seven female and six male patients with a mean age of 38.9 years. All patients achieved satisfactory postoperative results during a mean follow-up period of 22 months. Preoperative visual analog scale score and Oswestry Disability Index value were 8.85 ± 0.69 and 54.46 ± 7.62, respectively, which decreased to 1.31 ± 0.48 and 9.85 ± 3.51, respectively, at the postoperative 24th month. In all patients, the bony fusion of the pars interarticularis at the stabilized segment was confirmed on the computed tomography scan at an average of 22 months postoperatively.
The posterior dynamic system ensures that the spine moves within physiological limits and carries the load by sharing it with the spine. The advantages of direct pars repair using our technique are the restoration of the posterior structures? normal anatomy, protection of the functional mobility segment, and early functional recovery without degeneration in the adjacent segment. Therefore, when there is no significant instability, patients with spondylolysis can be treated with posterior dynamic stabilization techniques with satisfactory clinical and radiological results.
评估后路动力稳定术直接修复双侧L5关节突间部缺损及关节突融合的临床和影像学满意效果。
这是一项对13例无椎体滑脱的双侧L5关节突间部缺损患者术后随访结果的回顾性评估。患者于2013年至2018年接受了动力性经椎弓根稳定术。我们的手术标准包括单侧或双侧L5峡部裂；严重的下腰痛；伴有腿痛但无神经学表现的下腰痛；尽管进行了保守治疗但症状持续至少6个月，年龄<50岁；以及无明显的相邻椎间盘退变。
有7名女性和6名男性患者，平均年龄为38.9岁。所有患者在平均22个月的随访期内均取得了满意的术后效果。术前视觉模拟评分和Oswestry功能障碍指数值分别为8.85±0.69和54.46±7.62，术后第24个月分别降至1.31±0.48和9.85±3.51。在所有患者中，术后平均22个月时，通过计算机断层扫描证实了稳定节段关节突间部的骨融合。
后路动力系统可确保脊柱在生理限度内移动，并通过与脊柱分担负荷来承载重量。采用我们的技术直接修复关节突的优点是恢复了后部结构的正常解剖，保护了功能活动节段，并实现了早期功能恢复且相邻节段无退变。因此，当不存在明显不稳定时，峡部裂患者可采用后路动力稳定技术进行治疗，临床和影像学效果满意。
