Search

PurposeFor patients who suffered from L5 spondylolysis and fail to improve using conservative treatment, the best surgical strategy remains controversial. This study compares the efficacy of the treatment of L5 spondylolysis using the smiley face rod (SFR) method versus intervertebral fusion (IF).MethodsWe analyzed 38 patients with L5 spondylolysis who underwent surgery in our department between January 2017 and June 2019. Of these, 32 patients were included in our study: 14 patients in the SFR group and 18 patients in the IF group. The operation time, intraoperative blood loss, postoperative drainage time, length of stay and postoperative complications were compared. The pain visual analog scale (VAS) and Oswestry dysfunction index (ODI) were evaluated before operation and at 3 months, 6 months, and 1 year postoperatively. The changes in range of motion (ROM) in L4/5 and L5/S1 in these two groups before and after surgery were measured through imaging examinations and the bone graft fusion rate was assessed according to the Brown standard.ResultsThe operation time of the SFR group was much shorter than that of the IF group (98.8 ± 8.3 vs. 113.8 ± 8.6 min, P < 0.05), and the blood loss of the SFR group was significantly lower than that of the IF group (90.0 ± 43.9 vs. 175.0 ± 81.2 ml, P < 0.05). Length of stay in the SFR group was less than that of the IF group (9.5 ± 2.5 vs. 12.6 ± 3.2 d, P < 0.05). No difference was found in the VAS and ODI scores between the two groups at 3 months, 6 months, and 1 year after surgery. In the IF group, the ROM in L4/5 showed an obvious increase after surgery compared to that before surgery, and it was much bigger than that of the SFR group (P < 0.05). A notable reduction of ROM was seen in L5/S1 in the IF group compared to the SFR group (P < 0.05). The fusion rate of the isthmus in the SFR group was 79% at 3 months and 86% at 6 months after surgery. In the IF group, one patient suffered from adjacent segment degeneration (ASD), which caused compression symptoms in the lower extremity, and one patient suffered from an internal fixation fracture; these complications were not seen in the SFR group.ConclusionThe SFR and IF both improve the clinical symptoms and quality of life of patients with L5 spondylolysis. However, the SFR technique had the advantages of a shorter operation time and less blood loss than IF; it could also preserve the ROM of the surgical segment and had little influence on adjacent segments in short-term follow-ups.

Study Design: Systematic review and case report.Objective: Our study aims to present a new technique using three components to repair the pars defect: pedicle screws, rod and polyester band. Furthermore, we perform a systematic literature review of the previously described techniques.Summary Of Background: Spondylolysis is a common condition in children and adolescents. Depending on the severity it may be treated either nonoperatively or surgically. Surgery is required if nonoperative treatment failed to give sustained pain relief. Several surgical techniques have been described.Methods: The literature review investigates the database (MEDLINE-EMBASE-Cochrane-ScienceDirect) up to May 2019 for studies presenting a surgical technique for spondylolysis.The Screw-Rod-Band (SRB) technique combines the use of pedicle screws, a rod and a polyester band to repair the spondylolysis. The horizontal rod connects the pedicle screws. The polyester band linked to the rod passes below the spinous process to apply compressive forces on the pars.Results: Twenty-one out of 982 studies described a surgical procedure. Eight main different techniques were identified: Isthmic Screw, Wiring, Butterfly-Plate, Hook-Screw Construct, Shaped-Rod, Laminar-Screw, and two combination technique (Lag Screw and Tension Band Fixation and Cortical Screws and Spinous-Process ModularLink). Our technique showed immediate postoperative clinical improvement. No surgical or perisurgical complication occurred.Conclusion: The systematic literature review revealed a great number of surgical techniques for the spondylolysis, demonstrating the lack of consensus.SRB technique is an effective and simple treatment for pars fixation. The surgical procedure puts the pars under strong compression. The results are comparable with procedures present in the literature and seems capable to reduce the invasiveness and the risk of neurological injury.Level Of Evidence: 2. [ABSTRACT FROM AUTHOR]

Background: Four-level lumbar spondylolysis is extremely rare. So far, only 1 case has been reported in the literature., Case Summary: A 19-year-old man presented with severe back pain irresponsive to conservative therapies for 2 years. Lumbar radiographs and two-dimensional computed tomography scan showed four segment lumbar spondylolysis on both sides of L2-L5. Lumbar magnetic resonance imaging showed normal signal in all lumbar discs. Because daily activities were severely limited, surgery was recommended for the case. The patient underwent four-level bilateral isthmic repair at L2-L5. During surgery, L2-L5 isthmi were curetted bilaterally, freshened, and then grafted with autologous iliac bone that was bridged and compressed with a pedicular screw connected to a sub-laminar hook by a short rod. The symptoms of back pain almost disappeared. He has been followed-up for 96 mo, and his symptoms have never recurred. Fusion was found in all repaired isthmi 14 mo after surgery according to evaluation of lumbar radiography and computed tomography scan., Conclusion: We report here 1 case of four-level lumbar spondylolysis that was treated successfully with direct isthmic repair., Competing Interests: Conflict-of-interest statement: The authors declare that they have no current financial arrangement or affiliation with any organization that may have a direct influence on their work., (©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.)