A Novel Technique for Spondylolysis Repair With Pedicle Screws, Rod and Polyester Band

Case Report With Technical Note and Systematic Literature Review

Pedro Berjano, MD, PhD; Gabriele Ristori, MD; Maryem-Fama Ismael Aguirre, MD; Francesco Langella, MD; Marco Damilano, MD; Riccardo Cecchinato, MD; Alvin Pun, MD; Claudio Lamartina, MD

Disclosures

Spine. 2020;45(24):E1682-E1691. 

In This Article

Abstract and Introduction

Abstract

Study Design: Systematic review and case report.

Objective: Our study aims to present a new technique using three components to repair the pars defect: pedicle screws, rod and polyester band. Furthermore, we perform a systematic literature review of the previously described techniques.

Summary of Background: Spondylolysis is a common condition in children and adolescents. Depending on the severity it may be treated either nonoperatively or surgically. Surgery is required if nonoperative treatment failed to give sustained pain relief. Several surgical techniques have been described.

Methods: The literature review investigates the database (MEDLINE-EMBASE-Cochrane-ScienceDirect) up to May 2019 for studies presenting a surgical technique for spondylolysis.

The Screw-Rod-Band (SRB) technique combines the use of pedicle screws, a rod and a polyester band to repair the spondylolysis. The horizontal rod connects the pedicle screws. The polyester band linked to the rod passes below the spinous process to apply compressive forces on the pars.

Results: Twenty-one out of 982 studies described a surgical procedure. Eight main different techniques were identified: Isthmic Screw, Wiring, Butterfly-Plate, Hook-Screw Construct, Shaped-Rod, Laminar-Screw, and two combination technique (Lag Screw and Tension Band Fixation and Cortical Screws and Spinous-Process ModularLink). Our technique showed immediate postoperative clinical improvement. No surgical or perisurgical complication occurred.

Conclusion: The systematic literature review revealed a great number of surgical techniques for the spondylolysis, demonstrating the lack of consensus.

SRB technique is an effective and simple treatment for pars fixation. The surgical procedure puts the pars under strong compression. The results are comparable with procedures present in the literature and seems capable to reduce the invasiveness and the risk of neurological injury.

Level of Evidence: 2

Introduction

Spondylolysis is defined as a defect or fracture of the pars interarticularis, or isthmus, located in the transition area between the superior and inferior articular processes of the vertebral arch. Described in the mid-1800s by Kilian, Neugebauer, and Lambl,[1–4] its incidence varies considerably depending on ethnicity, sex, age, level of the sporting activity, occupation, and certain disease.[5]

Fredrickson et al[6] reported in a prospective study that the incidence of spondylolysis at the age of 6 years was 4.4% and increased to 6% in adults, and to 15% in adolescents who practice sports involving repeated hyperextension and rotation of the lumbar spine.[7,8]

The etiology of spondylolysis remains unknown, but current opinion is that there is an element of weakness that is genetically determined, or a degree of dysplasia at the pars interarticularis that renders it susceptible to injury even under the stresses of regular activity, resulting in a stress fracture.[9] High pelvic incidence has been shown to be a risk factor for spondylolysis and spondylolisthesis.[10,11] Patients with spondylolysis can be asymptomatic[12,13] or develop initial symptoms during late childhood, at a period of increased athletic activity.

The treatment of spondylolysis varies from nonoperative (rest, analgesia, physiotherapy, brace, or local injections), to surgical when pain is resistant to nonoperative treatment after at least 6 months.[14] If a painful spondylolysis occurs in a young patient with a still intact disc,[15] without a relevant spondylolisthesis,[16] a direct repair of the spondylolysis without fusing the segment may be the treatment of choice. The goals are to obtain the isthmus reduction and fusion, to restore the spinal stability, and to preserve the mobility of the segment concerned. Many surgical techniques are reported, varying from fixation with screws or hooks, wiring or a combination of the above. Results are generally acceptable, but a percentage of implant failure is reported and can lead to the non-union of the isthmus.

Our study aims to review the techniques previously described and present a case treated with a new surgical procedure. This new technique, a modification of Scott wiring method,[17] combines the use of pedicle screws, a rod and a polyester band to repair the spondylolysis.

Comments

3090D553-9492-4563-8681-AD288FA52ACE

processing....