University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
World Neurosurg. 2022 Jul;163:e263-e274. doi: 10.1016/j.wneu.2022.03.107. Epub 2022 Mar 30.
Lumbar spondylolysis occurs in 5%-8% of adults. This study aimed to report clinical and radiographic outcomes of direct pars repair in adults with lumbar spondylolysis.
We conducted a retrospective review of all patients treated for lumbar spondylolysis via open fracture reduction and direct pars repair with cannulated screws using a lag technique. Demographics, clinical presentation, perioperative and intraoperative imaging, and postoperative data were collected. We subsequently performed a systematic review to describe radiographic and clinical outcomes following direct pars repair.
Three patients were identified (mean age 40.3 years; range, 21-72 years; 2 male). All patients had bilateral L5 pars fractures treated via open, direct repair with cannulated screws. There were no intraoperative complications. Length of stay was <24 hours for each patient. All patients reported back/radicular symptom relief and returned to full-time manual labor by latest follow-up. Noncontrast lumbar computed tomography performed 14-20 months postoperatively confirmed that all patients had good bilateral screw placement without fracture. Two patients (21 and 28 years old at surgery) had evidence of fusion across fracture sites, while 1 patient exhibited radiolucency around the screws and no progression of spondylolisthesis. Additionally, we reviewed 8210 articles and included 15 in a systematic review of direct pars repair. Fusion rates were 67%-100%, with improved average Oswestry Disability Index and visual analog scale back pain scores by latest follow-up.
Lumbar spondylolysis treatment with open fracture reduction and direct pars repair with cannulated screws in adults is safe and may result in mechanical back/radicular pain relief, even in the absence of radiographic fusion.
腰椎峡部裂在成年人中发生率为 5%-8%。本研究旨在报告成人腰椎峡部裂经开放骨折复位和经皮椎弓根螺钉直接修复的临床和影像学结果。
我们对所有接受经皮椎弓根螺钉（使用拉力螺钉技术）开放复位和直接峡部修复治疗的腰椎峡部裂患者进行回顾性研究。收集患者的人口统计学、临床表现、围手术期和术中影像学以及术后数据。随后我们进行了系统回顾，以描述直接峡部修复后的影像学和临床结果。
共确定了 3 例患者（平均年龄 40.3 岁；范围，21-72 岁；2 例男性）。所有患者均存在双侧 L5 椎弓峡部裂，通过开放手术、经皮椎弓根螺钉直接修复治疗。术中无并发症。每位患者的住院时间均<24 小时。所有患者均报告背部/神经根症状缓解，并在随访时恢复全职体力劳动。术后 14-20 个月行非增强腰椎 CT 检查，证实所有患者双侧螺钉位置良好，无骨折。2 例患者（手术时年龄分别为 21 岁和 28 岁）在骨折部位有融合证据，而 1 例患者显示螺钉周围透亮影，腰椎滑脱无进展。此外，我们回顾了 8210 篇文章，并对 15 篇直接峡部修复的系统评价进行了综述。融合率为 67%-100%，末次随访时平均 Oswestry 功能障碍指数和视觉模拟评分法腰痛评分均有改善。
成人腰椎峡部裂采用开放骨折复位和经皮椎弓根螺钉直接修复治疗是安全的，即使没有影像学融合，也可能缓解机械性腰背/神经根疼痛。
