Abstract
Purpose
A conventional midline posterior approach is used for most of the described surgical techniques. We describe a technique of percutaneous fixation of the pars interarticularis, augmented where necessary by grafting the defect, which minimises muscle injury.
Method
A 4.5 mm partially threaded dynamic compression screw is placed over a wire inserted percutaneously across the pars interarticularis defect. Compression is achieved across the pars interarticularis defect on placement of the screw. The screw is locked in a compressed state.
Results
The patient is mobilised the same day with a corset for comfort and discharged the following day. Aerobic fitness is maintained for 3 months; then, focused rehabilitation performed until a CT scan confirms healing at 5–6 months, at which stage full (sports) activity is resumed.
Conclusions
The minimal tissue injury and small incision used allow for the minimising of complications and for a rapid recovery and discharge from hospital. With adolescents, we have the opportunity to treat symptomatic pars interarticularis defects with minimal disruption to their academic and physical development.
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References
Fredrickson BE, Baker D, McHolick WJ et al (1984) The natural history of spondylolysis and spondylolisthesis. J Bone Joint Surg Am 66:699–707
Debnath UK, Freeman BJC, Gregory P et al (2003) Clinical outcome and return to sport after surgical treatment of spondylolysis in young athletes. J Bone Joint Surg Br 85:244–249
Rossi F, Dragoni S (1990) Lumbar spondylolysis: occurrence in competitive athletes. Updated achievements in a series of 390 cases. J Sports Med Phys Fitness 30:450–452
Bonnici AV, Koka SR, Richards DJ (1991) Results of Buck screw fusion in grade I spondylolisthesis. J R Soc Med 84:270–273
Buck JE (1970) Direct repair of the defect in spondylolisthesis. Preliminary report. J Bone Joint Surg Br 52:432–437
Buck JE (1970) Further thoughts on direct repair of the defect in spondylolysis. J Bone Joint Surg Br 61:123
Nicol RO, Scott JH (1986) Lytic spondylolysis. Repair by wiring. Spine 11:1027–1030
Kakiuchi M (1997) Repair of the defect in spondylolysis: durable fixation with pedicle screws and laminar hooks. J Bone Joint Surg Am 79:818–825
Tokuhashi Y, Matsuzaki H (1996) Repair of defects in spondylolysis by segmental pedicular screw hook fixation. A preliminary report. Spine 21:2041–2045
Kawaguchi Y, Matsui H, Tsuji H (1994) Back muscle injury after posterior lumbar spine surgery: part 1. Histologic and histochemical analyses in rats. Spine 19:2590–2597
Kawaguchi Y, Matsui H, Tsuji H (1994) Back muscle injury after posterior lumbar spine surgery: part 2. Histologic ad histochemical analyses in humans. Spine 19:2598–2602
Styf JR, Willen J (1998) The effects of external compression by three different retractors on pressure in the erector spine muscles during and after posterior lumbar spine surgery in humans. Spine 23:354–358
Sihvonen T, Herno A, Paljarvi L et al (1993) Local denervation atrophy of paraspinal muscles in postoperative failed back syndrome. Spine 18:575–581
Fan S, Hu Z, Zhao F et al (2010) Multifidus muscle changes and clinical effects of one-level posterior lumbar interbody fusion: minimally invasive procedure versus conventional open approach. Eur Spine J 19(2):316–324
Stevens KJ, Spenciner DB, Griffiths KL et al (2006) Comparison of minimally invasive and conventional open posterolateral lumbar fusion using magnetic resonance imaging and retraction pressure studies. J Spinal Disord Tech 19:77–86
Tsutsumimoto T, Shimogata M, Ohta H, Misawa H (2009) Mini-open versus conventional open posterior lumbar interbody fusion for the treatment of lumbar degenerative spondylolisthesis: comparison of paraspinal muscle damage and slip reduction. Spine 34:1923–1928
Kim KT, Lee SH, Suk KS, Bae SC (2006) The quantitative analysis of tissue injury markers after mini-open lumbar fusion. Spine 31:712–716
Menga EN, Kebaish KM, Jain A et al (2013) Clinical results and functional outcomes after direct intralaminar screw repair of spondylolysis. Spine 39(1):104–110
Higashino K, Sairyo K, Katoh S et al (2007) Minimally invasive technique for direct repair of the pars defects in young adults using a spinal endoscope: a technical note. Minim Invasive Neurosurg 50(3):186–190
Brennan RP, Smucker PY, Horn EM (2008) Minimally invasive image-guided direct repair of bilateral L-5 pars interarticularis defects. Neurosurg Focus 25(2):E13
Widi GA, Williams SK, Levi AD (2013) Minimally invasive direct repair of bilateral lumbar spine pars defects in athletes. Case Rep Med. doi:10.1155/2013/659078
Kip PC, Esses SI, Doherty BI, Alexander JW, Crawford MJ (1994) Biomechanical testing of pars defect repairs. Spine 19:2692–2697
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Wilson, L., Altaf, F. & Tyler, P. Percutaneous pars interarticularis screw fixation: a technical note. Eur Spine J 25, 1651–1654 (2016). https://doi.org/10.1007/s00586-015-4152-2
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DOI: https://doi.org/10.1007/s00586-015-4152-2