Transcript Document

DIRECT REPAIR OF LUMBAR SPONDYLOLYSIS
BY SEGMENTAL PEDICLE SCREWINFRALAMINAR HOOK CONSTRUCT
Cagatay OZTURK, MD
Ahmet ALANAY, MD
Meric ENERCAN, MD
Selhan KARADERELER, MD
Omer KARATOPRAK, MD
Azmi HAMZAOGLU, MD
Istanbul Spine Center
Florence Nightingale Hospital
Istanbul-TURKEY
PURPOSE
 To analyse the safety and efficacy of direct pars repair
by using segmental pedicle screw-infralaminar hook
construct.
PATIENT SAMPLE
 Twenty patients (16 female and 4 male) who had treated
by direct pars repair with segmental pedicular screwhook fixation and with minimum 2 years follow-up were
included in this study.
METHODS
 All patients had spondylolysis with isthmic defect at
 L5 (n=18)
 L4 (n=2)
 Six (30%) of them had grade 1 spondylolysis.
 6 patients (30%) had mild scoliosis
 3 (15%) had Schuermann kyphosis.
 One patient had both scoliosis and Scheuerman
kyphosis.
 All had low back pain unresponsive to conservative
measures for at least 6 months.
 None had radiculopathy signs.
METHODS
 All patients had a preoperative CT scan and magnetic
resonance imaging and all had Phirman class I healthy
discs at the involved level.
 All patients had CT scans at the postoperative 1 year
follow-up to evaluate healing.
 Two-year follow-up x-rays were analysed in terms of
disc degeneration and collapse at the operated level and
progression of existing deformities.
Hook-pedicle screw fixation (Tokuhashi technique) (1996)
Exposure of pars defect
Onlay autograft
harvested from
posterior superior iliac
spine
Removal of fibrous tissue
Autograft placement
on to the defect
Placement of pedicle screws
Placement of
infralaminar hooks
Rod fixation and
compression
RK, 14y, F
RK, 14y, F
Right
Left
RESULTS
 The mean follow-up period was 34.8 (range; 24 to 72)
months.
 Mean age was 16.8 (range; 14 to 18) years.
 CT scan revealed succesfull healing in all patients.
 None of the patients had degenerative findings at the
disc level below the pars defect.
CONCLUSION
 Surgical treatment of adolescent patients with
spondylolysis by using pedicle screw-infralaminar
hook technique resulted with satisfactory clinical
and radiological outcome.
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