Department of Orthopaedics, The First Affiliated Hospital of Bengbu Medical University, 287 Changhuai Road, Bengbu, 233004, China.
Anhui Province Key Laboratory of Tissue Transplantation, Bengbu Medical University, 2600 Donghai Road, Bengbu, 233030, China.
J Orthop Surg Res. 2024 Jun 8;19(1):340. doi: 10.1186/s13018-024-04823-8.
Lumbar spondylolysis is a bone defect in the pars interarticularis of the lumbar vertebral, which is a common cause of low back pain in youth. Although non-surgical treatment is a mainstream option, surgery is necessary for patients with persistent symptoms. Buck technique is widely used as a classical direct repair technique, but it cannot achieve reduction of low-grade spondylolisthesis and reconstruction of lumbosacral sagittal balance. We have described a novel surgical procedure based on Buck technique with temporary intersegmental pedicle screw fixation, and report a series of clinical outcomes in 5 patients to provide a reference for the clinical treatment of young lumbar spondylolysis.
Five young patients with symptomatic lumbar spondylolysis with a mean age of 19.20 ± 5.41 years underwent surgical treatment after an average of 7.60 ± 1.52 months of failure to respond to conservative treatment, using a new surgical procedure based on Buck technique combined with temporary intersegmental pedicle screw fixation.
Five patients were successfully operated without serious complications such as nerve and vascular injury. The average operation time was 109.00 ± 7.42 min, the interpretative average blood loss was 148.00 ± 31.14 ml, and the average fusion time was 11.20 ± 1.64 months. All patients were followed up for 2 years after surgery, and the visual analogue score (VAS) of low back pain and Oswestry disability index (ODI) scores were significantly improved compared with those before surgery, and the Henderson's evaluation were rated excellent or good. After the removal of the internal fixation, it was observed that temporary intersegmental fixation could repair the isthmus, reduce lumbar spondylolisthesis, and reconstruct the sagittal balance of the lumbosacral vertebrae while preserving lumbar motion and preventing intervertebral disc degeneration. Postoperative MRI indicated the Pfirrmann classification of the affected discs: 1 case from grade III to grade II, 3 cases from grade II to grade I, and 1 case remained grade II.
Buck technique supplemented by temporary intersegmental pedicle screw fixation is a highly applicable and effective method for the treatment of adolescent lumbar spondylolysis. The isthmic fusion is accurate, and temporary intersegmental fixation can effectively prevent disc degeneration and reconstruct the sagittal balance of lumbosacral vertebra.
腰椎峡部裂是腰椎椎弓峡部的骨质缺损，是青少年腰痛的常见原因。尽管非手术治疗是主流选择，但对于持续存在症状的患者，手术是必要的。Buck 技术作为一种经典的直接修复技术被广泛应用，但它无法实现低度脊柱滑脱的复位和腰骶部矢状平衡的重建。我们基于 Buck 技术描述了一种新的手术方法，并采用临时节段性椎弓根螺钉固定，对 5 例青年腰椎峡部裂患者的一系列临床结果进行了报道，为青年腰椎峡部裂的临床治疗提供参考。
5 例有症状的青年腰椎峡部裂患者，平均年龄 19.20±5.41 岁，平均保守治疗失败时间为 7.60±1.52 个月，采用基于 Buck 技术结合临时节段性椎弓根螺钉固定的新手术方法进行手术治疗。
5 例患者均顺利完成手术，无神经、血管损伤等严重并发症。手术时间平均 109.00±7.42 分钟，术中出血量平均 148.00±31.14ml，融合时间平均 11.20±1.64 个月。所有患者术后均随访 2 年，术后腰痛视觉模拟评分（VAS）和 Oswestry 功能障碍指数（ODI）评分均较术前显著改善，Henderson 评价优良率为 100%。内固定取出后，观察到临时节段固定可修复峡部裂，降低腰椎滑脱程度，重建腰骶部椎体矢状平衡，同时保留腰椎运动功能，防止椎间盘退变。术后 MRI 显示受累椎间盘 Pfirrmann 分级：1 例由 3 级变为 2 级，3 例由 2 级变为 1 级，1 例仍为 2 级。
Buck 技术辅以临时节段性椎弓根螺钉固定是治疗青少年腰椎峡部裂的一种高度适用且有效的方法。峡部融合准确，临时节段固定可有效防止椎间盘退变，重建腰骶部椎体矢状平衡。
