Department of Orthopaedics, The 7th Medical Center of Chinese PLA General Hospital, No. 5 Nanmen Cang, Beijing, 100700, China.
Department of Gynecology and Obstetrics, The 1st Medical Center of Chinese PLA General Hospital, Beijing, China.
J Orthop Surg Res. 2022 Apr 22;17(1):247. doi: 10.1186/s13018-022-03082-9.
Patients who do not respond to conservative treatment of the isthmus are often treated with surgery. We used direct repair plus intersegment pedicle screw fixation for the treatment of lumbar spondylolysis. The aim of this observational study was to assess the effects of this technique and evaluate various risk factors potentially predicting the probability of disc and facet joint degeneration after instrumentation.
The study included 54 male L5 spondylolysis patients who underwent pars repair and intersegment fixation using pedicle screws. Bony union was evaluated using reconstruction images of computed tomography. Radiographic changes, including disc height, vertebral slip, facet joint and disc degeneration in the grade of adjacent and fixed segments, were determined from before to final follow-up. Logistic regression analysis was performed to identify factors associated with the incidence of disc and facet joint degeneration.
Bony union was achieved in all cases. Logistic regression analysis revealed that instrumentation durations of greater than 15.5 months and 21.0 months were significant risk factors for the incidence of L4/5 and L5S1 facet degeneration, respectively.
Intersegmental pedicle screw fixation provides good surgical outcomes and good isthmic bony union rates in patients with lumbar spondylolysis. The duration of fixation was confirmed as a risk factor for facet joint degeneration. Once bony union is achieved, instrument removal should be recommended.
对于峡部非手术治疗无效的患者，常需手术治疗。我们采用直接修复加节段间椎弓根螺钉固定治疗腰椎峡部裂。本观察性研究旨在评估该技术的效果，并评估各种潜在的风险因素，这些因素可能预测器械固定后椎间盘和小关节退变的概率。
本研究纳入 54 例男性 L5 峡部裂患者，均采用椎弓根螺钉行峡部修复和节段间固定。通过 CT 重建图像评估骨性融合。从术前到最终随访，评估影像学变化，包括椎间盘高度、椎体滑移、邻近和固定节段小关节和椎间盘退变的分级。采用 logistic 回归分析确定与椎间盘和小关节退变发生率相关的因素。
所有患者均获得骨性融合。Logistic 回归分析显示，固定时间大于 15.5 个月和 21.0 个月是发生 L4/5 和 L5S1 小关节退变的显著危险因素。
节段间椎弓根螺钉固定为腰椎峡部裂患者提供了良好的手术效果和峡部骨性融合率。固定时间被确认为小关节退变的危险因素。一旦获得骨性融合，应建议取出内固定。
