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  • Spondilolysis: A MISS approach and small case series

    Final Number:
    1049

    Authors:
    Raul Baggen Santos MD; Hugo Nunes Romão MD; Tiago Lima MD; Antonio Marques Baptista MD

    Study Design:
    Other

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2018 Annual Meeting

    Introduction: Spondilolysis is defined as a defect in the pars interarticularis. The overall incidence is 5% and young active males are most affected. It is most common at the L5 level (87%). An instability in the antero-posterior plane predisposes these individuals to spondilolisthesis and degeneration of the intervertebral disc. Classic treatment option is fusion of the affected level, which decreases mobility and increases loading of the adjacent segments. Surgical reconstruction of the defect restores normal anatomy and function and is an attractive alternative to fusion.

    Methods: A series of 3 patients with spondilolysis and low back pain worstened by straining were submitted to bilateral surgical reconstruction of the pars interarticularis using a modified Buck technique. Osteosynthesis screws were percutaneously passed through the defect, which was then grafted with locally harvested bone using a MISS approach. Pain was evaluated using a Visual Analogue Scale (VAS) and disability was measured using the Owestry Disability Index (ODI). Pre-operative and 1, 3 and 6 months post-operative moments were measured. Pre and post-operative lumbar CT scans were made of all patients.

    Results: Average age: 21,6 yo; Average Follow-up period: 21 months. Average pre-operative and 6 month post-operative VAS scores: 8 and 3,7. ODI scores: 61% and 17%. Post-operative CT scans showed correct ostheosynthesis material positioning but a lack of defect consolidation.

    Conclusions: By restoring normal anatomy and stability, this technique can avoid facet joint and intervertebral disc degeneration, delaying or even avoiding the need for fusion. It is feasible to assume that the surgical reconstruction of the pars interacticularis of assymptomatic individuals with bilateral spondilolysis could prevent them from needing more aggressive treatment alternatives in the future. Patients improved clinically without radiologic evidence of defect consolidation. The absence of consolidation makes these patients more prone to stress fractures of the osteosynthesis screws. Surgical reconstruction of the pars interarticularis is a valid treatment option of spondilolysis.

    Patient Care: If shown to be better than fusion, surgical pars reconstruction could allow for a less invasive treatment of spondilolysis. Knowing this condition affects mostly young individuals, the need to find alternatives to fusion and adjacent segment loading is even greater.

    Learning Objectives: To determine if pars interarticularis reconstruction is a valid alternative to fusion in the treatment of spondilolysis.

    References:

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