Minimally Invasive Direct Repair of Bilateral Lumbar Spine Pars Defects in Athletes

Widi, Gabriel; Williams, Seth K.; Levi, Allan D.

doi:10.1155/2013/659078

Cited by 38 publications

(24 citation statements)

References 22 publications

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“…However, it is less suitable for correction of deformity and ability to correct angular or translational deformities is compromised. The technical challenges are greater and therefore risk of improper interbody device placement or screw placement higher [72,73].…”

Section: Surgical Treatment (Table 2)mentioning

confidence: 99%

Management of spondylolysis and low-grade spondylolisthesis in fine athletes. A comprehensive review

Bouras

Korovessis

2014

Eur J Orthop Surg Traumatol

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Conservative treatment including physiotherapy and bracing is the mainstay in the treatment of symptomatic spondylolysis and low-grade isthmic spondylolisthesis in fine athletes. If consequent treatment fails, the operative treatment (pars repair and short fusion) is decided. Return to play following surgery varies from 6 to 12 months with prohibition in collision sports. Return to play is mostly depended on specific sport activity.

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Section: Surgical Treatment (Table 2)mentioning

confidence: 99%

Management of spondylolysis and low-grade spondylolisthesis in fine athletes. A comprehensive review

Bouras

Korovessis

2014

Eur J Orthop Surg Traumatol

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“…Recently, minimally invasive surgery pars screw fixation techniques have been described by several groups of investigators. 6,30,31 In their case series of 8 athletes, Gillis and colleagues 13 demonstrated robust improvement of symptoms, which allowed a return to sport at their previous level in 6 of 8 patients. Not until 4 years later was lumbar fusion indicated in 1 patient.…”

Section: 27mentioning

confidence: 98%

Transforaminal endoscopic discectomy to relieve sciatica and delay fusion in a 31-year-old man with pars defects and low-grade spondylolisthesis

Madhavan

Chieng

Hofstetter

et al. 2016

FOC

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Isthmic spondylolisthesis due to pars defects resulting from trauma or spondylolysis is not uncommon. Symptomatic patients with such pars defects are traditionally treated with a variety of fusion surgeries. The authors present a unique case in which such a patient was successfully treated with endoscopic discectomy without iatrogenic destabilization. A 31-year-old man presented with a history of left radicular leg pain along the distribution of the sciatic nerve. He had a disc herniation at L5/S1 and bilateral pars defects with a Grade I spondylolisthesis. Dynamic radiographic studies did not show significant movement of L-5 over S-1. The patient did not desire to have a fusion. After induction of local anesthesia, the patient underwent an awake transforaminal endoscopic discectomy via the extraforaminal approach, with decompression of the L-5 and S-1 nerve roots. His preoperative pain resolved immediately, and he was discharged home the same day. His preoperative Oswestry Disability Index score was 74, and postoperatively it was noted to be 8. At 2-year follow-up he continued to be symptom free, and no radiographic progression of the listhesis was noted. In this case preservation of stabilizing structures, including the supraspinous and interspinous ligaments and the facet capsule, may have reduced the likelihood of iatrogenic instability while at the same time achieving symptom control. This may be a reasonable option for select patient symptoms confined to lumbosacral radiculopathy.

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“…63 The patient was positioned prone and secured to a radiolucent Jackson surgical table (OSI). Neurophysiological monitoring was carried out with somatosensory and motor evoked potentials as well as continuous electromyography.…”

Section: Operative Techniquementioning

confidence: 99%

“…2,30,41,49,54 Previously, we reported on successful direct pars repair in 3 patients. 63 The authors present a clinical case series of the further use of percutaneous direct pars screw repair for lumbar spondylolysis with the use of a minimally invasive tubular approach for curettage and bone grafting of the fracture defect.…”

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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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Minimally Invasive Direct Repair of Bilateral Lumbar Spine Pars Defects in Athletes

Cited by 38 publications

References 22 publications

Management of spondylolysis and low-grade spondylolisthesis in fine athletes. A comprehensive review

Management of spondylolysis and low-grade spondylolisthesis in fine athletes. A comprehensive review

Transforaminal endoscopic discectomy to relieve sciatica and delay fusion in a 31-year-old man with pars defects and low-grade spondylolisthesis

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

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