Egyptian Spine Journal (Jun 2019)

Pars Repair in Isthmic Spondylolysis in the Young Adults

  • Amr M Madkour, MD.,
  • Tamer E Metwally, MD.,
  • Mohamed M Agamy, MD.

DOI
https://doi.org/10.21608/esj.2019.12979.1102
Journal volume & issue
Vol. 31, no. 1
pp. 27 – 35

Abstract

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Background Data: Spondylolysis remains the commonest identifiable cause of low back pain in children and adolescents. Isthmic spondylolysis occurs most commonly at L5. Both repetitive trauma and inherent genetic weakness can make an individual more susceptible to spondylolysis. There are varieties of surgical treatments to spondylolysis whether surgical fusion or pars repair in patients with no evident slippage or disc degeneration. Purpose: To evaluate the efficacy of pars repair in patients with spondylolysis in regard to pain improvement and fusion. Study Design: Prospective case series study. Patients and Methods: Ten cases with isthmic spondylolysis were reported in this study. Between January 2016 and December 2018, three males and seven females were recruited. Inclusion criteria were as follows: age <30 years; weight <80 kg; back pain not responding to conservative treatment; slippage <2 mm; healthy disc space; no previous operation; and preserved lumbar lordosis. All patients underwent direct pars repair surgery using smiley face-shaped rod technique (V-shaped rod technique) with iliac crest bone graft. All patients were examined clinically and radiologically at 6 and 12 months after surgery to assess back pain using Roland-Morris Disability Questionnaire (RMQ) and fusion by plain radiographs and MS-CT of lumbosacral spine. Results: Good outcome was achieved in seven cases (70% of patients) with significant improvement in back pain, RMQ; radiologically, sound pars fusion was shown. Two cases (20% of patients) had fair outcome and sound pars fusion with occasional back pain occurring with sports and strenuous activities with sound pars fusion. One case (10% of patients) had poor outcome as there was no fusion radiologically with poor improvement in RMQ and underwent traditional surgery with 4 screws, 2 rods, and cage placement. Conclusion: Direct pars repair with V-shaped rod technique provides good functional outcomes in young adult patients with isthmic spondylolysis and can be an alternative method for traditional fusion. (2019ESJ180)

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