Direct repair of lumbar spondylolysis by Buck’s technique

Abstract

Background:The lesion in spondylolysis is a nonunion that follows a fatigue fracture of pars interarticularis. Direct repair of the pars defect is a logical alternative to fusion as it helps to preserve the motion segment and prevents abnormal stresses at the adjacent levels. The purpose of the study is to analyze the clinical and radiological results of direct screw osteosynthesis of the pars defect by the Buck’s method in patients with symptomatic spondylolysis with or without grade 1 spondylolisthesis.Materials and Methods:Nine patients (six males, three females, mean age 24 years) with symptomatic spondylolysis with or without grade 1 spondylolisthesis and a normal disc in magnetic resonance imaging (MRI), who failed conservative treatment, underwent surgery between January 2000 and April 2009. Of them five patients had bilateral lysis at one level, one had bilateral lysis at three levels and two levels each and two had unilateral lysis at one level. Direct pars repair by the Buck’s method with internal fixation of the defect using 4.5 mm cortical screws and cancellous bone grafting was done. The mean follow-up period was 45 months. MacNab criteria were used to evaluate the postoperative functional outcome. Healing of the pars defect was assessed by plain radiographs and computed tomography (CT) scan.Results:Spondylolysis was bilateral in seven and unilateral in two patients. Two patients had associated grade 1 spondylolisthesis. The mean operative time was 58 minutes (range 45 – 75 minutes) and blood loss was 98 ml (50 – 140 ml). Although radiological fusion was observed in all patients at a mean follow-up of 45 months (range 9 to 108 months), the functional outcome was excellent in two patients and good in five, with one fair and one poor result. The overall result of the procedure was satisfactory in 78% (7/9) of the patients. The two patients with associated grade 1 spondylolisthesis had fair and poor results. No complications were encountered in the perioperative or postoperative period.Conclusions:In carefully selected patients, direct repair of the pars defect by the Buck’s technique of internal fixation and bone grafting was a safe and effective alternative to fusion in younger patients with symptomatic spondylolysis, without associated spondylolisthesis, who failed conservative management.

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

“…Direct pars repair was first described in 1968 by Kimura, who grafted 16 (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30) the defect alone. 11 Buck was the first to describe stabilization of the defect by a direct pars screw in 1970.…”

“…3,16 These patients may be better served by pedicle screw fixation and fusion with interbody graft. However, spine surgeons should be aware that direct pars repair by Buck's technique can provide good outcomes in the adolescent patient population with isthmic spondylolysis alone and significant back pain, and the procedure should be considered a good option after failure of conservative techniques.…”

Estimation of ground and excited states dipole moments of α-hydroxy phenyl hydrazone derivatives: Experimental and quantum chemical methods

“…One significant group of hydrazone, phenylhydrazone has attracted attention for researchers due to their successful application in biochemistry, medicine [11][12][13][14][15][16] and optical materials [17,18]. Phenylhydrazone also can be used as fluorescence reagents because of their selectivity for metal ions [19] so, they are good ion detector when they react with ions [20,21].…”

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

“…The technique was surgically demanding while the screws interfered with the potential area for bone graft incorporation. Rajasekaran et al [16] performed this procedure in 9 patients. He reported excellent functional outcome in 5 and good outcome in 2.…”