Surgical treatment of four segment lumbar spondylolysis:A case report

Four-level lumbar spondylolysis is extremely rare.So far,only 1 case has been reported in the literature.CASE SUMMARY A 19-year-old man presented with severe back pain irresponsive to conservative therapies for 2 years.Lumbar radiographs and two-dimensional computed tomography scan showed four segment lumbar spondylolysis on both sides of L2-L5.Lumbar magnetic resonance imaging showed normal signal in all lumbar discs.Because daily activities were severely limited,surgery was recommended for the case.The patient underwent four-level bilateral isthmic repair at L2-L5.During surgery,L2-L5 isthmi were curetted bilaterally,freshened,and then grafted with autologous iliac bone that was bridged and compressed with a pedicular screw connected to a sub-laminar hook by a short rod.The symptoms of back pain almost disappeared.He has been followed-up for 96 mo,and his symptoms have never recurred.Fusion was found in all repaired isthmi 14 mo after surgery according to evaluation of lumbar radiography and computed tomography scan.CONCLUSION We report here 1 case of four-level lumbar spondylolysis that was treated successfully with direct isthmic repair.

Application of a new anatomic hook-rod-pedicle screw system in young patients with lumbar spondylolysis:A pilot study

BACKGROUND The pedicle screw-laminar hook system has strong fixation and is conducive to bone graft fusion for lumbar spondylolysis.However,the current pedicle screwlaminar hook fixation system is not specifically designed for lumbar spondylolysis.AIM To investigate the clinical effects of a new anatomical hook-rod-pedicle screw system in the treatment of lumbar spondylolysis in young adults.METHODS We designed a new anatomic hook-rod-pedicle screw system for young patients with lumbar spondylolysis.The isthmus and the corresponding pedicle screw entry point were exposed through the intermuscular approach.Autogenous iliac bone graft was obtained to bridge the isthmus defect,and then the anatomic hook-rod-pedicle screw system was used to fix the isthmus in 15 young patients.RESULTS At 24 mo follow-up,the visual analogue scale score of low back pain decreased from 6.73±0.88 to 0.73±0.59,and the Oswestry disability index score decreased from 58.20±8.99 to 7.87±4.97.Computed tomography showed bilateral isthmic bone healing in 14 cases and unilateral isthmic bone healing in 1 case.Magnetic resonance imaging showed that the lumbar disc signal of diseased segment and adjacent segments had no change compared with that before surgery.The pain visual analogue scale score of the donor site was 0.20±0.41 at the last follow-up.According to the Modified Macnab score,the excellent and good rate was 100%.CONCLUSION The application of this new anatomical hook-rod-pedicle screw system to treat young patients with lumbar spondylolysis has the advantages of less trauma,a simple operation and satisfactory clinical effects.

Differences of Sagittal Lumbosacral Parameters between Patients with Lumbar Spondylolysis and Normal Adults

Background： Recent studies have suggested an association between elevated pelvic incidence （PI） and the development of lumbar spondylolysis. However, there is still lack of investigation for Hart Chinese people concerning the normal range ofspinopelvic parameters and relationship between abnormal sagittal parameters and lumbar diseases. The objective of the study was to investigate sagittal lumbosacral parameters of adult lumbar spondylolysis patients in Han Chinese population. Methods： A total of 52 adult patients with symptomatic lumbar spondylolysis treated in the General Hospital of Armed Police Force （Beijing, China） were identified as the spondylolysis group. All the 52 patients were divided into two subgroups, Subgroup A： 36 patients with simple lumbar spondylolysis, and Subgroup B： 16 patients with lumbar spondylolysis accompanying with mild lumbar spondylolisthesis （slip percentage 〈30%）. Altogether 207 healthy adults were chosen as the control group. All patients and the control group took lumbosacral lateral radiographs. Seven sagittal lumbosacral parameters, including PI, pelvic tilt （PT）, sacral slope （SS）, lumbar lordosis （LL）, L5 incidence, L5 slope, and sacral table angle （STA）, were measured in the lateral radiographs. All the parameters aforementioned were compared between the two subgroups and between the spondylolysis group and the control group with independent-sample t-test. Results： There were no statistically significant differences of all seven sagittal lumbosacral parameters between Subgroup A and Subgroup B. PI, PT, SS, and LL were higher （P 〈 0.05） in the spondylolysis group than those in the control group, but STA was lower （P 〈 0.001 ） in the spondylolysis group. Conclusions： Current study results suggest that increased PI and decreased STA may play important roles in the pathology of lumbar spondylolysis in Han Chinese population.

Study on clinical effects of pedicle screw combined with immobilized implantation bone by wirerope and hallow compression screw immobilization in treating spondylolysis of lumbar vertebra of multiple segments of adults

Objective:To observe clinical effects of pedicle screw fixation combined with cable wires and bone graft and cannulated compression screws on adult multi-segment lumbar spondylolysis.Methods:70 cases of patients with multi-segment lumbar spondylolysis were selected in our hospital.According to different surgical schemes,these patients were divided into the observation group(35 cases)and the control group(35 cases).The observation group received pedicle screw fixation combined with cable wires and bone graft and the control group received cannulated compression screw fixation.Macnab criteria were adopted to implement a therapeutic evaluation of two groups of patients to make an observation and comparison of the excellent and good rate of surgery and a series of indicators including perioperative clinical effects,intraoperative blood loss,duration of surgery,hospital length of stay(HLOS),visual analogue scale(VAS),Oswestry disability index and Japanese Orthopaedic Association(JOA)score.Results:The excellent and good rate of the observation group was 97.14%,and that of the control group was 82.86%,the difference between two groups was statistically significant(χ^(2)=6.248,p=0.012).The differences in intraoperative blood loss,duration of surgery and HLOS between two groups were statistically significant(t=-4.55,t=-4.55,t=-4.55;p<0.05).Oswestry index,VAS score and JOA score of the observation group were(2.4±0.9),(28.5±6.4)and(27.1±3.1)respectively,and these of the control group were(3.5±1.2),(37.1±7.8)and(21.3±2.7)respectively,the differences between two groups were statistically significant(t=4.338,t=5.043,t=8.347,p<0.05).Conclusions:Pedicle screw combined with immobilized implantation bone by wirerope has an excellent clinical effect on the treatment of adult multi-segment lumbar spondylolysis,and it has a series of advantages such as fast postoperative recovery,small surgical trauma and so on.In addition,this technique can also restore the stability of spinal segments and relieve pains to a greater degree.