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Spondylolysis repair with impaction grafting and rigid fixation: prospective outcome study

Spondylolysis repair with impaction grafting and rigid fixation: prospective outcome study. Matthew D Hepler, MD* Matthew T Walker, MD Eugene Lautenschlager, PhD *Vero Orthopaedics and Vero Neurology Departments of Orthopaedic Surgery and Neuroradiology Northwestern Memorial Hospital

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Spondylolysis repair with impaction grafting and rigid fixation: prospective outcome study

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  1. Spondylolysis repair with impaction grafting and rigid fixation: prospective outcome study Matthew D Hepler, MD* Matthew T Walker, MD Eugene Lautenschlager, PhD *Vero Orthopaedics and Vero Neurology Departments of Orthopaedic Surgery and Neuroradiology Northwestern Memorial Hospital Chicago, IL mdhepler@hotmail.com

  2. Introduction • Spondylolysis is common diagnosis (6%) • Chronic lesions • alter lumbar biomechanics • progress to spondylolysthesis or DDD • cause back pain and disability • Surgical treatment • Pars repair high failure rate • fusion sacrifices motion • no consensus

  3. Treatment Controversy M Schaefer L2 Spondylolysis: Surgical vs non surgical treatment Spine Universe 6/12/2008

  4. Purpose • Prospective evaluation of clinical and radiologic outcomes of spondylolysis treated with fracture debridement, impaction grafting, and rigid fixation.

  5. Inclusion • Lysis on MRI/CT • Failed non-operative Tx • Dx inj. if other pathology • Surgery • Fx debridement • ICBG • Pedicle screw/hook • F/U (3, 6, 12, 24 mo) • SF-36, ODI, RM, VAS • Xray (incl. flex/ext) • +/-CT Methods

  6. Demographics • 18 consecutive patients • First 11 (12 lesions) • L5 (8), L4 (2), L3 (2) • 2 females, 9 males • Av age: 28 (range 17-50) • Extension based BP (11) • Leg pain (4) • Neurologix Sx (2)

  7. Concomitant Dx • Adjacent spondylolysis(2) 1 healed non operatively • Spondylolisthesis (3) • DDD (5) • HNP (3) • Schmorl nodes (2) DDD L4 Pars defect

  8. Pars defect debridement Pannus before debridement Defect after debridement

  9. Pars repair:ICBG Bone graft

  10. Rigid Fixation:Pedicle-laminar claw

  11. Postoperative Treatment • Discharge 1.5 days (0-3) • TLSO 2-3 months • PT @ 2-3 months • Sport specific rehabilitation @ 3-4 months

  12. Clinical Follow-up • No infections • No revision surgery • All patients returned to unrestricted activities @ 6 months • 1 fusion for DDD @ 3 yr f/u

  13. Outcome Measures Statistical analysis by repeated measures ANOVA Values in parentheses are standard deviations

  14. Radiographic Results • Xray (fl/ext @ 6 mo. n=11) • No defects • No loosening • No motion • CT @ 6-18 mo (n=6) • 4/6 residual unilateral defect • osseous integration on repeat CT

  15. Conclusion • Pars repair with impaction grafting and rigid fixation has excellent clinical and radiologic outcome • Rapid return to full activities including contact sports • Provides motion preservation • Restores normal biomechanics • Can be treated in presence of other pathology (spondylolisthesis, HNP, DDD)

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