Department of Orthopedic Surgery and Traumatology, Faculty of Medicine, Minia University, El-Minia, Egypt; Minia University Spine Unit (MUSU), Faculty of Medicine, Minia University, El-Minia, Egypt.
Department of Orthopedic Surgery and Traumatology, Faculty of Medicine, Minia University, El-Minia, Egypt; Minia University Spine Unit (MUSU), Faculty of Medicine, Minia University, El-Minia, Egypt.
World Neurosurg. 2021 Oct;154:e698-e706. doi: 10.1016/j.wneu.2021.07.124. Epub 2021 Aug 3.
Conservative methods are the traditional options in the management of lumber spondylolysis whereas surgery is indicated for symptomatic patients not responding to medical treatment and cases with a multilevel pars defect. The aim of this prospective study was to evaluate the clinical, functional, and radiologic results of using bone graft and fixation with pedicular screw-rod-laminar hook construct in treatment of lumber spondylolysis.
Between October 2017 and January 2020, 20 patients with symptomatic lumbar spondylolysis not responding to conservative treatment for more than 6 months were treated by defect reconstruction fixation using bone block autografting and pedicular screw laminar hook construct. The mean follow-up time was 12.5 ± 03.5 months. All patients were examined pre- and postoperatively and followed up clinically (pain [visual analog scale]), functionally (Oswestry Disability Index, Modified Prolo Functional Economic Scales, and Macnab criteria), and radiologically (pars defect healing). Perioperative outcomes and complications were documented.
Clinical, radiologic, and functional outcomes were significantly improved. Bony union was evident in all patients (100%). Blood loss, operative time, and hospital stay increased in cases with a multilevel pars defect and cases with associated injuries. Two cases reported complications in this study as misplaced pedicular screw and superficial wound infection.
Reconstruction fixation of pars defect using this construct is an effective, feasible procedure in the treatment of Lumbar spondylolysis regarding the preservation of lumbar motion and avoidance of adjacent-segment problems after fusion.
对于腰椎峡部裂，保守治疗是传统的选择，而手术则适用于对药物治疗无反应且有多节段峡部裂的症状患者。本前瞻性研究旨在评估使用骨移植和经皮椎弓根螺钉-杆-板钩固定治疗腰椎峡部裂的临床、功能和影像学结果。
2017 年 10 月至 2020 年 1 月，对 20 例经 6 个月以上保守治疗无效的症状性腰椎峡部裂患者采用骨块自体移植和经皮椎弓根螺钉-板钩固定进行缺陷重建固定治疗。平均随访时间为 12.5±03.5 个月。所有患者均在术前、术后进行检查，并进行临床随访（疼痛[视觉模拟评分]）、功能（Oswestry 残疾指数、改良 Prolo 功能经济量表和 Macnab 标准）和影像学（峡部愈合）。记录围手术期结果和并发症。
临床、影像学和功能结果均显著改善。所有患者均有骨愈合（100%）。多节段峡部裂和合并损伤的患者术中出血量、手术时间和住院时间增加。本研究中有 2 例报告了并发症，分别为椎弓根螺钉位置不当和浅表伤口感染。
该固定结构的峡部缺陷重建固定是治疗腰椎峡部裂的有效、可行的方法，可保留腰椎活动度，并避免融合后相邻节段的问题。
