Biomechanical Comparison of Spondylolysis Fixation Techniques

Deguchi, Masashi; Rapoff, Andrew J.; Zdeblick, Thomas A.

doi:10.1097/00007632-199902150-00004

Cited by 81 publications

(60 citation statements)

References 25 publications

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“…2,4,8 However, data on the usage and outcomes of these different surgical techniques are limited, especially in the adolescent population with spondylolysis. 6 As athletics becomes increasing competitive and important to adolescent patients vying for college scholarships, it behooves the spine surgeon to evaluate spondylolysis fixation techniques.…”

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confidence: 99%

Spondylolysis outcomes in adolescents after direct screw repair of the pars interarticularis

Snyder

Shufflebarger

O’Brien

et al. 2014

SPI

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Object Isthmic spondylolysis can significantly decrease functional abilities, especially in adolescent athletes. Although treatment can range from observation to surgery, direct screw placement through the fractured pars, or Buck's procedure, may be a more minimally invasive procedure than the more common pedicle screw-hook construct. Methods Review of surgical databases identified 16 consecutive patients treated with Buck's procedure from 2004 to 2010. Twelve patients were treated at Miami Children's Hospital and 4 at Barrow Neurological Institute. Demographics and clinical and radiographic outcomes were recorded and analyzed retrospectively. Results The 16 patients had a median age of 16 years, and 14 were 20 years or younger at the time of treatment. Symptoms included axial back pain in 100% of patients with concomitant radiculopathy in 38%. Pars defects were bilateral in 81% and unilateral in 19% for a total of 29 pars defects treated using Buck's procedure. Autograft or allograft augmented with recombinant human bone morphogenetic protein as well as postoperative bracing was used in all cases. Postoperatively, symptoms resolved completely or partially in 15 patients (94%). Of 29 pars defects, healing was observed in 26 (89.6%) prior to 1 revision surgery, and an overall fusion rate of 97% was observed at last radiological follow-up. There were no implant failures. All 8 athletes in this group had returned to play at last follow-up. Conclusions Direct screw repair of the pars interarticularis defect as described in this series may provide a more minimally invasive treatment of adolescent patients with satisfactory clinical and radiological outcomes, including return to play of adolescent athletes.

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confidence: 99%

Spondylolysis outcomes in adolescents after direct screw repair of the pars interarticularis

Snyder

Shufflebarger

O’Brien

et al. 2014

SPI

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“…The screw-rod-hook construct again was noted to have the greatest stiffness and the least motion across the pars defect. 10 Interestingly, this finding goes against earlier biomechanial work by Crawford and colleagues, 7 who found that greater stiffness and yield strength were achieved with Buck's technique than with the Morscher hook-screw construct and wiring technique. In the present series, we used a fully threaded lag screw, fluoroscopic guidance, and placement of rhBMP-2 across the fracture site.…”

Section: Discussionmentioning

confidence: 80%

“…Reported complications include nerve injury, screw protrusion/ backout, screw malpositioning, screw loosening, pseudarthrosis, and iliac crest graft donor-site pain. 10,57,61 Overall, complication rates have been reported to be as high as 40% with the Buck technique, 14% with Scott's wiring, and 44% with Morscher's technique. 4,5,11,27,43,44,60 The authors report no intraoperative complications in the present series.…”

Section: Complicationsmentioning

confidence: 99%

Minimally invasive direct pars repair with cannulated screws and recombinant human bone morphogenetic protein: case series and review of the literature

Ghobrial

Crandall

Lau

et al. 2017

Neurosurgical Focus

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OBJECTIVEThe objective of this study was to describe the use of a minimally invasive surgical treatment of lumbar spondylolysis in athletes by a fluoroscopically guided direct pars screw placement with recombinant human bone morphogenetic protein–2 (rhBMP-2) and to report on clinical and radiographic outcomes.METHODSA retrospective review was conducted of all patients treated surgically for lumbar spondylolysis via a minimally invasive direct pars repair with cannulated screws. Demographic information, clinical features of presentation, perioperative and intraoperative radiographic imaging, and postoperative data were collected. A 1-cm midline incision was performed for the placement of bilateral pars screws utilizing biplanar fluoroscopy, followed by placement of a fully threaded 4.0-mm-diameter titanium cannulated screw. A tubular table-mounted retractor was utilized for direct pars fracture visualization and debridement through a separate incision. The now-visualized pars fracture could then be decorticated, with care taken not to damage the titanium screw when using a high-speed drill. Local bone obtained from the curettage was then placed in the defect with 1.05 mg rhBMP-2 divided equally between the bilateral pars defects.RESULTSNine patients were identified (mean age 17.7 ± 3.42 years, range 14–25 years; 6 male and 3 female). All patients had bilateral pars fractures of L-4 (n = 4) or L-5 (n = 5). The mean duration of preoperative symptoms was 17.22 ± 13.2 months (range 9–48 months). The mean operative duration was 189 ± 29 minutes (range 151–228 minutes). The mean intraoperative blood loss was 17.5 ± 10 ml (range 10–30 ml). Radiographic follow-up was available in all cases; the mean length of time from surgery to the most recent imaging study was 30.8 ± 23.3 months (range 3–59 months). The mean hospital length of stay was 1.13 ± 0.35 days (range 1–2 days). There were no intraoperative complications.CONCLUSIONSLumbar spondylolysis treatment with a minimally invasive direct pars repair is a safe and technically feasible option that minimizes muscle and soft-tissue dissection, which may particularly benefit adolescent patients with a desire to return to a high level of physical activity.

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“…The constructs have to overcome the high stresses on the pars with extension and torsion. They should also not interfere with the surface area for bone grafting [14,19].…”

Section: Discussionmentioning

confidence: 99%

“…Some of those have been technically difficult to perform or biomechanically inadequate to handle the forces across the pars interarticularis resulting in high failure rates [14]. In this study, we present a modified technique for direct pars repair using screws across the pedicles and sublaminar cables, together with the results of the procedure clinically and radiologically.…”

Section: Introductionmentioning

confidence: 99%

The Use of Cable-Screw Construct as an Effective Method for Direct Pars Repair

Arafa¹,

Zahlawy²,

Abdelrady³

2018

MOJOR

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Background: The aim of this study is to assess the use of cable-wire construct together with bone grafting for direct repair of pars defects in spondylolysis. Patient and methods:Thirty patients with bilateral pars defect in complaining of low back pain were included in this prospective study. A cable-screw construct was used for pars repair after failure of conservative measures. Patients were assessed radiologically for union and clinically by Oswestry disability index (ODI) and VAS for back pain. Demographic data and any complications were noted. Results:The mean follow up period was 22 months. The mean preoperative ODI and VAS were 67.77 and 8.2 respectively. This improved to 11.07 and 1.33 at final follow up. The improvements were statistically significant. At the final follow up, radiological healing could be achieved bilaterally in all patients (86.6%) but four. Three of them had initial defects >3mm and 1 from 2-3mm. For the healed cases, the mean time to union was 4.7 months. Conclusion:The cable-screw construct appears to be a rigid, low profile construct with high success rates in treating pars defects both radiologically and clinically.Citation: Arafa AM, Zahlawy HE, Abdelrady AM (2017) The Use of Cable-Screw Construct as an Effective Method for Direct Pars Repair. MOJ Orthop Rheumatol 9(5): 00372.

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Biomechanical Comparison of Spondylolysis Fixation Techniques

Abstract: All four fixation techniques restored the intervertebral rotational displacements under flexion and torsional loading to the intact condition. The screw-rod-hook fixation allowed the least amount of motion across the defect during flexion.

Cited by 81 publications

References 25 publications

Spondylolysis outcomes in adolescents after direct screw repair of the pars interarticularis

Spondylolysis outcomes in adolescents after direct screw repair of the pars interarticularis

Minimally invasive direct pars repair with cannulated screws and recombinant human bone morphogenetic protein: case series and review of the literature

The Use of Cable-Screw Construct as an Effective Method for Direct Pars Repair

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