Mansour Moustafa A, Mostafa Hamdi Nabawi
Department of Neurosurgery, Nasser Institute for Research and Treatment, Cairo, Egypt.
Department of Neurosurgery, Misr University for Science and Technology, Giza, Egypt.
Brain Spine. 2025 Aug 8;5:104390. doi: 10.1016/j.bas.2025.104390. eCollection 2025.
Symptomatic spondylolysis is a debilitating cause of low back pain in young adults, often necessitating surgical intervention when conservative treatments fail. While spinal fusion has been the traditional approach, direct pars screw fixation-pioneered by Buck in 1970-offers a motion-preserving alternative that may reduce long-term complications.
This study evaluated the efficacy of Buck's technique in 14 patients (mean age: 26.5 years) with grade 0 spondylolisthesis and normal disc morphology, all of whom had failed six months of non-operative management. Surgical outcomes, including fusion rates, operative time, blood loss, and clinical results, were assessed.
The procedure achieved a 78.5 % fusion rate, with mean operative times of 40 min and blood loss under 100 mL, demonstrating technical efficiency. Clinically, 71.4 % of patients reported excellent or good outcomes at 18-month follow-up, with no neurological complications. Three nonunion cases were attributed to the learning curve and the use of lamina-derived grafts instead of iliac crest bone. The single poor outcome occurred in a patient with undetected disc degeneration, highlighting the importance of strict patient selection.
Pars screw fixation is a safe, rapid, and cost-effective solution for symptomatic spondylolysis, particularly in resource-limited settings where operative time and implant costs are critical. Its ability to preserve spinal mobility while addressing the pain generator makes it especially suitable for young, active patients.
症状性椎弓崩裂是导致年轻成人腰痛的一个使人衰弱的原因，当保守治疗失败时常常需要手术干预。虽然脊柱融合一直是传统方法，但1970年由巴克开创的直接椎弓根螺钉固定提供了一种保留运动功能的替代方法，可能会减少长期并发症。
本研究评估了巴克技术对14例（平均年龄：26.5岁）0级椎体滑脱且椎间盘形态正常的患者的疗效，所有这些患者均在6个月的非手术治疗后失败。评估了手术结果，包括融合率、手术时间、失血量和临床结果。
该手术的融合率达到78.5%，平均手术时间为40分钟，失血量不到100毫升，显示出技术效率。临床上，71.4%的患者在18个月随访时报告了优秀或良好的结果，且无神经并发症。3例不愈合病例归因于学习曲线以及使用椎板来源的移植物而非髂嵴骨。唯一的不良结果发生在一名未被发现椎间盘退变的患者身上，凸显了严格选择患者的重要性。
椎弓根螺钉固定对于症状性椎弓崩裂是一种安全、快速且具有成本效益的解决方案，特别是在手术时间和植入物成本至关重要的资源有限的环境中。它在解决疼痛根源的同时保留脊柱活动度的能力使其特别适合年轻、活跃的患者。
