Department of Orthopaedic Surgery, National University Health System, Singapore.
Department of Orthopaedic Surgery, National University Health System, Singapore.
Spine J. 2021 Aug;21(8):1268-1285. doi: 10.1016/j.spinee.2021.03.011. Epub 2021 Mar 21.
Pars repair is less explored in adults due to associated disc degeneration with advancing age. The aim of our systematic review was to define optimal characteristics of adults with spondylolysis/grade-I spondylolisthesis suitable for pars repair and evaluate the feasibility, effectiveness, and safety of standard repair techniques in these adults.
This systematic review is reported in line with PRISMA-P and protocol is registered with PROSPERO (CRD42020189208). Electronic searches were conducted in PubMed, Embase, Scopus, and Web of Science in June 2020 using systematic search strategy. Studies involving adults aged ≥18-years with spondylolysis/grade-1 isthmic spondylolisthesis treated with standard pars repair techniques were considered eligible. A two-staged (titles/abstracts and full-text) screening was conducted independently by three authors followed by quality assessment using the Joanna Briggs Institute critical appraisal checklist for selection of final articles for narrative synthesis.
A total of 5,813-articles were retrieved using systematic search strategy. First screening followed by removal of duplicates resulted in 111-articles. Second (full-text) screening resulted in exclusion of 64-articles. A final 47-articles were considered for data extraction after quality assessment. A total of 590-adults were enrolled across 47-studies; 93% were 'young adults' (18-35 years); 82% were males. Persistent low back pain was the common presenting complaint. Lysis defect was primarily bilateral (96.4%) and L5 was the most involved level (68.5%). Majority had no disc degeneration (83.5%) and had spondylolysis as the primary diagnosis (86%); only 14% had grade-I spondylolisthesis. Pars infiltration test was conducted in 22-studies and discography in 8-studies. Duration of prior conservative therapy was 3 to 72-months. Buck's repair was the commonest technique (27-studies, 372-adults). Successful repair was reported in 86% of patients treated with Buck's and ≥90% treated with Scott's, Morscher's and pedicle-screw-based techniques. Improvement in pain/functional outcomes, union rate and rate-of-return to sports/activity was high and comparable across all techniques. Intraoperative blood loss was low with minimally invasive versus traditional repair. The overall complication rate was 11.9%, with implant failure being the major complication.
Our systematic review establishes a definite place for lysis repair in carefully selected adults with spondylolysis/grade-I spondylolisthesis. We propose a treatment algorithm for optimizing patient selection and outcomes. We conclude that adults with age 18 to 45 years, no/mild disc or facet degenerative changes, positive diagnostic infiltration test, and normal preoperative discography will have successful outcomes with pars repair, regardless of the technique.
由于年龄增长导致的椎间盘退变，成人脊柱峡部裂的椎板修复术研究较少。本系统评价的目的是确定适合椎板修复的伴有峡部裂/Ⅰ度滑脱的成人的最佳特征，并评估这些成人标准修复技术的可行性、有效性和安全性。
本系统评价按照 PRISMA-P 报告，并在 PROSPERO（CRD42020189208）进行了方案注册。2020 年 6 月，我们在 PubMed、Embase、Scopus 和 Web of Science 中使用系统搜索策略进行了电子检索。研究对象为年龄≥18 岁、伴有峡部裂/Ⅰ度峡部裂滑脱的成年人，采用标准椎板修复技术进行治疗。三位作者独立进行了两阶段（标题/摘要和全文）筛选，然后使用 Joanna Briggs 研究所的选择最终文章进行叙述性综合的批判性评价清单进行质量评估。
使用系统搜索策略共检索到 5813 篇文章。初次筛选后去除重复项，得到 111 篇文章。第二次（全文）筛选排除了 64 篇文章。经过质量评估，最终有 47 篇文章被认为适合进行数据提取。共有 47 项研究纳入了 590 名成年人；93%为“年轻成年人”（18-35 岁）；82%为男性。持续性腰痛是常见的首发症状。溶骨缺陷主要为双侧（96.4%），L5 为最常受累的节段（68.5%）。大多数患者没有椎间盘退变（83.5%），主要诊断为峡部裂（86%）；只有 14%的患者有Ⅰ度滑脱。22 项研究进行了椎板浸润试验，8 项研究进行了椎间盘造影。先前保守治疗的持续时间为 3 至 72 个月。Buck 修复是最常见的技术（27 项研究，372 名成人）。Buck 治疗的成功率为 86%，Scott、Morscher 和椎弓根螺钉技术的成功率≥90%。所有技术的疼痛/功能结果改善、融合率和重返运动/活动率均较高且相似。微创与传统修复相比，术中出血量较少。总体并发症发生率为 11.9%，主要并发症为植入物失败。
本系统评价明确了在精心挑选的伴有峡部裂/Ⅰ度滑脱的成人中进行溶骨修复的地位。我们提出了优化患者选择和结果的治疗算法。我们得出结论，年龄在 18 至 45 岁之间、无/轻度椎间盘或小关节退行性改变、阳性诊断性浸润试验和正常术前椎间盘造影的成年人，无论采用何种技术，均可通过椎板修复获得成功的结果。
