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Spondylolysis Repair with Impaction Grafting: Prospective Outcome Study

This study evaluates the outcomes of spondylolysis treatment using fracture debridement, impaction grafting, and rigid fixation. Results show excellent clinical and radiologic outcomes, rapid return to full activities, and motion preservation.

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Spondylolysis Repair with Impaction Grafting: 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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