Okuwaki Shun, Tatsumura Masaki, Gamada Hisanori, Ogawa Takeshi, Mammoto Takeo, Hirano Atsushi, Yamazaki Masashi
Department of Orthopedic Surgery, Kenpoku Medical Center Takahagi Kyodo Hospital, Japan.
Department of Orthopedics Surgery and Sports Medicine, University of Tsukuba Hospital Mito Clinical Education and Training Center Mito Kyodo General Hospital, Japan.
J Rural Med. 2021 Jan;16(1):56-61. doi: 10.2185/jrm.2020-039. Epub 2021 Jan 5.
Lumbar spondylolysis, caused by stress fracture of the pars interarticularis may lead to a bony defect or spondylolisthesis. In adolescents, its surgical treatment employs the smiley face rod method for direct reduction of pseudoarthrotic spondylolysis and spondylolisthesis. Clinical outcomes of this treatment have been occasionally described; however, implant removal has not been discussed previously. We present a patient with lumbar spondylolysis with grade 1 slip at the 5th lumbar vertebra (L5) per the Meyerding classification. A 14-year-old boy presented with chronic severe lower back pain. Since conservative therapy did not resolve pain or enable resuming sports activities, the smiley face rod repair was performed 7 months after the initial treatment. Anterior slippage of the L5 was surgically reduced. The patient wore a brace for 3 months postoperatively, and partial bone fusion was noted 6 months postoperatively. He resumed his sports activity 8 months postoperatively, and absolute bone fusion was confirmed 18 months postoperatively. Implant removal was performed 3 years postoperatively. Grade 1 slip was corrected with absolute bone fusion, and long-term follow-up revealed good results in terms of healing and rehabilitation. Smiley face rod method that allows for implant removal after bone fusion is suitable for adolescents.
腰椎峡部裂是由关节突间部应力性骨折引起的，可能导致骨缺损或椎体滑脱。在青少年中，其手术治疗采用笑脸棒法直接复位假关节性腰椎峡部裂和椎体滑脱。这种治疗的临床结果偶尔有描述；然而，此前尚未讨论过植入物取出问题。我们报告一名按照迈耶丁分类法在第5腰椎（L5）有I度滑脱的腰椎峡部裂患者。一名14岁男孩出现慢性严重下背痛。由于保守治疗未能缓解疼痛或使他恢复体育活动，在初始治疗7个月后进行了笑脸棒修复。L5的前滑脱通过手术复位。患者术后佩戴支具3个月，术后6个月观察到部分骨融合。他在术后8个月恢复体育活动，术后18个月确认完全骨融合。术后3年进行了植入物取出。I度滑脱通过完全骨融合得到矫正，长期随访显示在愈合和康复方面效果良好。允许在骨融合后取出植入物的笑脸棒法适用于青少年。
