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Surgical Techniques: Spondylolysis Repair

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Spondylolisthesis

Abstract

Lumbar spondylolysis is a bony defect in the pars interarticularis. The most common presentation is bilateral defects in the pars. The clinical symptom is activity-related back pain in young, athletic patients. The diagnosis is confirmed on radiographs or CT scan. MRI is indicated for atypical presentations, neurological symptoms, or pre-operative grading of the lumbar discs involved. While non-operative management is the mainstay of treatment, surgical intervention is indicated for patients who are not responsive despite adequate period of conservative management such as activity modification (stopping sports), physical therapy, and occasionally bracing. The selection of surgical candidates for pars interarticularis includes age, duration of the pain, and responsiveness to a pars block (pain relief after guided injection into the pars with local analgesia and steroid), segmental instability, discal health below the spondylolytic segments and laterality of the defect. The surgical technique has evolved over time. Segmental fusion is not advocated in the young population. The techniques of pars interarticularis repair using direct laminar/pars compression screw fixation or a pedicle screw, rod, and laminar hook construct are described. Overall successful outcome is reported in 90 % of patients. Potential complications include nerve root injury, implant breakage or dislodgement, non-union, infection, and conversion to segmental fusion.

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Authors and Affiliations

  1. University Orthopaedics, Hand and Reconstructive Microsurgery Cluster, National University Health System, 5 Lower Kent Ridge Road, Singapore, 119074, Singapore

    Leok-Lim Lau M.B.Ch.B., F.R.C.S. (Orth.)

  2. Department of Orthopaedics, Nemours/Alfred I. duPont Hospital for Children, 1600 Rockland Road, Wilmington, DE, 19803, USA

    Suken A. Shah M.D.

Authors
  1. Leok-Lim Lau M.B.Ch.B., F.R.C.S. (Orth.)
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  2. Suken A. Shah M.D.
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Correspondence to Suken A. Shah M.D. .

Editor information

Editors and Affiliations

  1. Assistant Professor of Orthopedic Surgery, Albert Einstein College of Medicine, New York, New York, USA

    Adam L. Wollowick

  2. Associate Professor of Orthopedic Surgery, Albert Einstein College of Medicine, Department of Orthopedic Surgery, Montefiore Medical Center, Bronx, New York, USA

    Vishal Sarwahi

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Lau, LL., Shah, S.A. (2015). Surgical Techniques: Spondylolysis Repair. In: Wollowick, A., Sarwahi, V. (eds) Spondylolisthesis. Springer, Boston, MA. https://doi.org/10.1007/978-1-4899-7575-1_11

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  • DOI: https://doi.org/10.1007/978-1-4899-7575-1_11

  • Publisher Name: Springer, Boston, MA

  • Print ISBN: 978-1-4899-7574-4

  • Online ISBN: 978-1-4899-7575-1

  • eBook Packages: MedicineMedicine (R0)

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