J Korean Neurosurg Soc.  2012 Jan;51(1):14-19. 10.3340/jkns.2012.51.1.14.

Direct Pars Repair Surgery Using Two Different Surgical Methods : Pedicle Screw with Universal Hook System and Direct Pars Screw Fixation in Symptomatic Lumbar Spondylosis Patients

Affiliations
  • 1Department of Neurosurgery, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea. nsdoc35@catholic.ac.kr

Abstract


OBJECTIVE
The authors performed a retrospective study to assess the clinical and radiological outcome in symptomatic lumbar spondylolysis patients who underwent a direct pars repair surgery using two different surgical methods; pedicle screw with universal hook system (PSUH) and direct pars screw fixation (DPSF), and compared the results between two different treated groups.
METHODS
Forty-seven consecutive patients (PSUH; 23, DPSF; 15) with symptomatic lumbar spondylolysis who underwent a direct pars repair surgery were included. The average follow-up period was 37 months in the PSUH group, and 28 months in the DPSF group. The clinical outcome was measured using visual analogue pain scale (VAS) and Oswestry disability index (ODI). The length of operation time, the amount of blood loss, the duration of hospital stay, surgical complications, and fusion status were also assessed.
RESULTS
When compared to the DPSF group, the average preoperative VAS and ODI score of the PSUH group were less decreased at the last follow-up; (the PSUH group; back VAS : 4.9 vs. 3.0, leg VAS : 6.8 vs. 2.2, ODI : 50.6% vs. 24.6%, the DPSF group; back VAS : 5.7 vs. 1.1, leg VAS : 6.1 vs. 1.2, ODI : 57.4% vs. 18.2%). The average operation time was 174.9 minutes in the PSUH group, and 141.7 minutes in the DPSF group. The average blood loss during operation was 468.8 cc in the PSUH group, and 298.8 cc in the DPSF group. The average hospital stay after operation was 8.9 days in the PSUH group, and 7 days in the DPSF group. In the PSUH group, there was one case of a screw misplacement requiring revision surgery. In the DPSF group, one patient suffered from transient leg pain. The successful bone fusion rate was 78.3% in the PSUH group, and 93.3% in the DPSF group.
CONCLUSION
The present study suggests that the technique using direct pars screw would be more effective than the method using pedicle screw with lamina hook system, in terms of decreased operation time, amount of blood loss, hospital stay, and increased fusion success rate, as well as better clinical outcome.

Keyword

Lumbar spine; Spondylolysis; Direct pars repair; Pars interarticularis

MeSH Terms

Collodion
Follow-Up Studies
Humans
Leg
Length of Stay
Pain Measurement
Retrospective Studies
Spondylolysis
Spondylosis
Collodion

Figure

  • Fig. 1 The photographs showing system of pedicle screw and universal hook. A : AESCULAP® universal hook. B : AESCULAP® standard screw.

  • Fig. 2 Bar graphs demonstrating the clinical outcomes based on VAS and ODIs cores. Mean VAS and ODI scores were significantly lower at final follow-up visits in both groups. However, the PSUH group shows less degree of clinical improvements than the DPSF group. VAS : visual analogue pain scale, ODI : oswestry disability index, PSUH : pedicle screw with universal hook system, DPSF : direct pars screw fixation.

  • Fig. 3 Bar graphs showing the clinical outcomes of each subgroup in relation to fusion success in the PSUH group. Fusion failure group showed less clinical improvement compared to fusion success group. VAS : visual analogue pain scale, ODI : oswestry disability index, PSUH : pedicle screw with universal hook system, DPSF : direct pars screw fixation.

  • Fig. 4 Direct repair using pedicle screw and lamina hook system performed in 5th lumbar vertebra of a 36-year-old man with symptomatic spondylolysis. A : Postoperative AP plain X-rays shows the lamina hook issecured to the pedicle screw with fixing nut. B : Postoperative lateral plain X-ray shows the incomplete approximation of pars defect (black arrow). C and D : Sagittal and axial CT scans indicate nonunion of pars defect at 38 months after the operation (black arrows).

  • Fig. 5 Direct repair using the direct pars screws performed in 5thlumbar vertebra of a 29-year-old man with symptomatic spondylolysis. A : Postoperative AP plain X-rays shows the pars screws are placed through the pars defect. B : Postoperative lateral plain X-ray shows the approximation of pars defect (black arrow). C and D : Sagittal and axial CT scans indicate well fused pars defect at 26 months after the operation (black arrows).


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