Minimally Invasive Screw Fixation of Non-Pseudoarthorotic Lumbar Spondylolysis for Early Return to Sports

Abstract

Lumbar spondylolysis is a fatigue fracture that occurs most frequently in middle and high school athletes. Conservative treatment is the first choice when the fracture is fresh. Surgical treatment of lumbar spondylolysis is often reported for pseudarthrosis cases, but surgery for cases of fresh fractures is rare. We report a case of a 16-year-old male, high jump athlete, with recurrent non-pseudoarthorotic lumbar spondylolysis.He presented to our hospital with a chief complaint of back pain, and was diagnosed as right L5, pre-lysisstage lumbar spondylolysis. After 3 months of conservative treatment, bone union was achieved with no obvious worsening of the fracture. His back pain also disappeared and he was able to return to exercise. At 6 months after the first examination, the lesion recurred and he could no longer continue playing sports, so surgical treatment was indicated.Minimally invasive screw fixation was performed by combining Buck's method and the cortical bone trajectory. After the surgery, he started jogging at 5 weeks, resumed jumping practice at 7 weeks, and returned to competition at 2 months. He set a new personal best in a competition 3 months post-surgery. Bone union was achieved at 4 months. This technique is minimally invasive and does not involve debridement or bone grafting, which provides early pain relief and return to sports.

Return to Sports Following Spondylolysis Surgery in Children and Adolescents: A Systematic Review

“…Of those 20 studies, full-text reviews were conducted and 9 studies met the final inclusion criteria (Table 1). Examples of studies excluded were those that did not mention surgical intervention [16] and those with inadequate sample sizes [7,10,14,22,27,30,32]. The final review included 6 retrospective case series [2,11,[24][25][26]28], 2 retrospective cohort studies [5,15], and 1 prospective cohort study [19] (Table 2).…”

Main and contralateral side stages of lesion affected bone union in the conservative treatment of adolescent lumbar spondylolysis: a multivariable analysis of 217 patients and 298 lesions in a retrospective cohort study

“…In lesions that are expected to have a particularly low rate of bone union as they have many negative factors for bone union, if conservative treatment failed to achieve bone union, pain control with oral painkillers or interventional pain injections, early surgery due to pain, or repair surgery for lesions that became pseudoarthrosis may be effective depending on age and sports level [ 6 – 8 , 22 – 25 ]. To further develop the treatment of lumbar spondylolysis, prospective studies on the ability to predict the rate of bone union at the time of the initial visit are a future prospect and challenge.…”

“…This results in successful bone union in 77–100% of patients [ 1 , 3 – 5 ]. However, while this bone union rate is high, surgery may be required in cases where bone union is not achieved, leading to pseudoarthrosis [ 6 – 8 ]. With conservative treatment, the factor most likely to affect bone union is the lesion stage.…”

Effects of Spina Bifida Occulta on Bone Union in Fifth Lumbar Spondylolysis

“…However, if the rate of bone union is <50% after 3 months of sports interruption, it is not a satisfactory outcome for fracture treatment. In the case of L5 spondylolysis with SBOs at both S1 and S2 at the time of initial examination, the use of low-intensity pulsed ultrasound to improve bone union rates or surgical interventions, such as screw fixation, to achieve bony union should be considered 14,15 .…”