MINIMALLY INVASIVE SURGERY FOR DIRECT REPAIR OF LUMBAR SPONDYLOLYSIS BY UTILIZING INTRAOPERATIVE NAVIGATION AND MICROENDOSCOPIC TECHNIQUES_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHUXiaolong ,  WANGJian , ZHOUYue , ZHANGZhengfeng , LIChangqing , ZHENGWenjie

Department of Orthopaedics, Xinqiao Hospital, Third Military Medical University, Chongqing, 400037, P. R. China;

Corresponding author：

WANGJian, Email: tonywjxq@aliyun.com

Keywords：

Lumbar spondylolysis; Navigation; Microendoscopy; Minimally invasive surgery; Repair

DOI：

10.7507/1002-1892.20150270

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Objective To analyze the effectiveness of direct screw repair for lumbar spondylolysis by using intraoperative O-arm based navigation and microendoscopic techniques. Methods Between February 2012 and May 2014, 11 consecutive patients with lumbar spondylolysis were treated with Buck's procedure by the aid of intraoperative O-arm based navigation and minimally invasive approach. The debridement and autograft of pars interarticularis defects was performed under microendoscopy. There were 7 males and 4 females, with an average age of 28.4 years (range, 19-47 years) and an average disease duration of 10.5 months (range, 8-23 months); no nerve symptoms or signs of lower limb was observed. The radiological examinations showed single level bilateral lumbar spondylolysis without obvious disc degeneration, lumbar instability, or spondylolisthesis. Isthmic injury located at L₄ in 2 cases and at L₅ in 9 cases. Of 11 patients, 7 were rated as grade 2 disc degeneration, and 4 as grade 3 disc degeneration according to the modified Pfirrmann classification system. The operation time, intraoperative blood loss, and complications were recorded. The fluoroscopic examinations were performed to assess defect repair and screw position. Visual analogue scale (VAS) score was used to evaluate the improvement of low back pain. Results The average operation time was 147.6 minutes (range, 126-183 minutes). The average blood loss was 54.9 mL (range, 40-85 mL). Primary healing of incision was obtained. There was no complication of nerve root injury, dural tear, or infection. Three patients had pain at donor site postoperatively, and pain disappeared within 3 weeks. The average follow-up duration was 15.7 months (range, 10-23 months). VAS score of low back pain was significantly decreased from preoperative 7.1±2.3 to 1.8±0.4 at last follow-up (t=13.42, P=0.01). Of 22 isthmic bone grafting, bilateral isthmic bony fusion was achieved in 7 patients and unilateral isthmic bony fusion in 3 patients at 6-10 months (mean, 7.9 months). One patient failed bilateral isthmic bony fusion, and had bony resorption. Conclusion Debridement, autograft, and percutaneous intralaminar screw fixation by microendoscopy and O-arm based navigation may provide safe and effective treatment for spondylolysis. Minimally invasive direct repair can obtain satisfactory effectiveness.

Citation： ZHUXiaolong, WANGJian, ZHOUYue, ZHANGZhengfeng, LIChangqing, ZHENGWenjie. MINIMALLY INVASIVE SURGERY FOR DIRECT REPAIR OF LUMBAR SPONDYLOLYSIS BY UTILIZING INTRAOPERATIVE NAVIGATION AND MICROENDOSCOPIC TECHNIQUES. Chinese Journal of Reparative and Reconstructive Surgery, 2015, 29(10): 1244-1248. doi: 10.7507/1002-1892.20150270 Copy

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2.	Debnath UK, Harshavardhana N, Scammell BE, et al. Lumbar pars injury or spondylolysis-diagnosis and management. Orthopaedics and Trauma, 2009, 23(2):109-116.
3.	Buck JE. Direct repair of the defect in spondylolisthesis. Preliminary report. J Bone Joint Surg (Br), 1970, 52(3):432-437.
4.	Deguchi M, Rapoff AJ, Zdeblick TA. Biomechanical comparison of spondylolysis fixation techniques. Spine (Phila Pa 1976), 1999, 24(4): 328-333.
5.	Mihara H, Onari K, Cheng BC, et al. The biomechanical effects of spondylolysis and its treatment. Spine (Phila Pa 1976), 2003, 28(3): 235-238.
6.	Griffith JF, Wang YX, Antonio GE, et al. Modified Pfirrmann grading system for lumbar intervertebral disc degeneration. Spine (Phila Pa 1976), 2007, 32(24):E708-712.
7.	Kimura M. My method of filling the lesion with spongy bone in spondylolysis and spondylolisthesis. Seikei Geka, 1968, 19(4):285-295.
8.	Higashino K, Sairyo K, Katoh S, et al. Minimally invasive technique for direct repair of the pars defects in young adults using a spinal endoscope:a technical note. Minim Invasive Neurosurg, 2007, 50(3): 182-186.
9.	Widi GA, Williams SK, Levi AD. Minimally invasive direct repair of bilateral lumbar spine pars defects in athletes. Case Rep Med, 2013, 2013:659078.
10.	Amoretti N, Huwart L, Hauger O, et al. Computed tomographyand fluoroscopy-guided percutaneous screw fixation of low-grade isthmic spondylolisthesis in adults:a new technique. Eur Radiol, 2012, 22(12):2841-2847.
11.	Brennan RP, Smucker PY, Horn EM. Minimally invasive imageguided direct repair of bilateral L-5 pars interarticularis defects. Neurosurg Focus, 2008, 25(2):E13.
12.	Kim YT, Lee H, Lee CS, et al. Direct repair of the pars interarticularis defect in spondylolysis. J Spinal Disord Tech, 2012.[Epub ahead of print].
13.	Roca J, Iborra M, Cavanilles-Walker JM, et al. Direct repair of spondylolysis using a new pedicle screw hook fixation:clinical and CT-assessed study:an analysis of 19 patients. J Spinal Disord Tech, 2005, 18 Suppl:S82-89.
14.	Debusscher F, Troussel S. Direct repair of defects in lumbar spondylolysis with a new pedicle screw hook fixation:clinical, functional and CT-assessed study. Eur Spine J, 2007, 16(10):1650-1658.

1. Fredrickson BE, Baker D, McHolick WJ, et al. The natural history of spondylolysis and spondylolisthesis. J Bone Joint Surg (Am), 1984, 66(5):699-707.
2. Debnath UK, Harshavardhana N, Scammell BE, et al. Lumbar pars injury or spondylolysis-diagnosis and management. Orthopaedics and Trauma, 2009, 23(2):109-116.
3. Buck JE. Direct repair of the defect in spondylolisthesis. Preliminary report. J Bone Joint Surg (Br), 1970, 52(3):432-437.
4. Deguchi M, Rapoff AJ, Zdeblick TA. Biomechanical comparison of spondylolysis fixation techniques. Spine (Phila Pa 1976), 1999, 24(4): 328-333.
5. Mihara H, Onari K, Cheng BC, et al. The biomechanical effects of spondylolysis and its treatment. Spine (Phila Pa 1976), 2003, 28(3): 235-238.
6. Griffith JF, Wang YX, Antonio GE, et al. Modified Pfirrmann grading system for lumbar intervertebral disc degeneration. Spine (Phila Pa 1976), 2007, 32(24):E708-712.
7. Kimura M. My method of filling the lesion with spongy bone in spondylolysis and spondylolisthesis. Seikei Geka, 1968, 19(4):285-295.
8. Higashino K, Sairyo K, Katoh S, et al. Minimally invasive technique for direct repair of the pars defects in young adults using a spinal endoscope:a technical note. Minim Invasive Neurosurg, 2007, 50(3): 182-186.
9. Widi GA, Williams SK, Levi AD. Minimally invasive direct repair of bilateral lumbar spine pars defects in athletes. Case Rep Med, 2013, 2013:659078.
10. Amoretti N, Huwart L, Hauger O, et al. Computed tomographyand fluoroscopy-guided percutaneous screw fixation of low-grade isthmic spondylolisthesis in adults:a new technique. Eur Radiol, 2012, 22(12):2841-2847.
11. Brennan RP, Smucker PY, Horn EM. Minimally invasive imageguided direct repair of bilateral L-5 pars interarticularis defects. Neurosurg Focus, 2008, 25(2):E13.
12. Kim YT, Lee H, Lee CS, et al. Direct repair of the pars interarticularis defect in spondylolysis. J Spinal Disord Tech, 2012.[Epub ahead of print].
13. Roca J, Iborra M, Cavanilles-Walker JM, et al. Direct repair of spondylolysis using a new pedicle screw hook fixation:clinical and CT-assessed study:an analysis of 19 patients. J Spinal Disord Tech, 2005, 18 Suppl:S82-89.
14. Debusscher F, Troussel S. Direct repair of defects in lumbar spondylolysis with a new pedicle screw hook fixation:clinical, functional and CT-assessed study. Eur Spine J, 2007, 16(10):1650-1658.

Chinese Journal of Reparative and Reconstructive Surgery

MINIMALLY INVASIVE SURGERY FOR DIRECT REPAIR OF LUMBAR SPONDYLOLYSIS BY UTILIZING INTRAOPERATIVE NAVIGATION AND MICROENDOSCOPIC TECHNIQUES

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