Clinical outcome of ISOBAR TTL dynamic stabilization with pars bone grafting for treatment of lumbar spondylolysis_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZENG Junfeng ,  LIU Hao , WANG Beiyu , GONG Quan , YANG Yi , CHEN Hua , LOU Jigang , SONG Yueming

Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China;

Corresponding author：

LIU Hao, Email: liuhao6304@126.com

Keywords：

Lumbar spondylolysis; ISOBAR TTL dynamic stabilization; pars repair

DOI：

10.7507/1002-1892.201609104

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Objective To evaluate the effectiveness of ISOBAR TTL dynamic stabilization with pars bone grafting for the treatment of lumbar spondylolysis. Methods A retrospective analysis was made the clinical data of 26 patients with lumbar spondylolysis who received ISOBAR TTL dynamic stabilization with pars bone grafting between September 2009 and March 2014. There were 14 males and 12 females, with a mean age of 31 years (range, 19-47 years). The disease duration ranged from 9 to 60 months (mean, 16 months). Preoperative lumbar anteroposterior and lateral X-ray films, CT three-dimensional reconstruction, and MRI scans were performed to identify the location of pars defect. The involved levels were L₄ in 9 cases and L₅ in 17 cases. There were 10 cases of pure spondylolysis and 16 cases of spondylolysis accompanied with I degree slipping. The clinical outcome was assessed by visual analogue scale (VAS) and Oswestry disability index (ODI) scores at preoperation and 1 week, 3 months, 6 months after operation, and at last follow-up. The lumbar CT three-dimensional reconstruction was obtained at 6 months after operation to evaluate bone fusion of the pars. The adjacent segment degeneration was assessed by the University of California at Los Angeles (UCLA) grading scale at preoperation and last follow-up. Results All incisions healed by first intention; no infection, cerebrospinal fluid leakage, or pain at iliac crest donor site occurred. Twenty-six patients were followed up 2-5 years (mean, 36.5 months). No secondary spondylolisthesis, internal fixation loosening and breakage were found during follow-up. The postoperative VAS and ODI scores showed significant differences (P<0.05) when compared with preoperative scores, and the scores at 3 months, 6 months, and last follow-up were significantly better than that at 1 week (P<0.05), but no significant difference was shown between the other time points after operation (P>0.05). The CT three-dimensional reconstruction indicated satisfactory union at the pars in 23 cases (88.5%) at 6 months after operation. Of the 3 nonunion patients, good union was obtained in 1 patient at 1 year after operation; nonunion was observed in 2 patients at last follow-up, but low back pain was obviously alleviated. According to the UCLA grading scale, 20 cases were rated as grade I and 6 cases as grade II at last follow-up, which was the same as preoperative grade and indicated no adjacent segment degeneration. Conclusion It is safe and effective to use the ISOBAR TTL dynamic stabilization with pars bone grafting technique to treat lumbar spondylolysis with or without degree I slipping. The fusion rate is satisfactory, and adjacent segment degeneration can be slowed down after lumbar fusion surgery.

Citation： ZENGJunfeng, LIUHao, WANGBeiyu, GONGQuan, YANGYi, CHENHua, LOUJigang, SONGYueming. Clinical outcome of ISOBAR TTL dynamic stabilization with pars bone grafting for treatment of lumbar spondylolysis. Chinese Journal of Reparative and Reconstructive Surgery, 2017, 31(1): 62-65. doi: 10.7507/1002-1892.201609104 Copy

1.	Wiltse LL, Widell EH JR, Jackson DW. Fatigue fracture: the basic lesion is inthmic spondylolisthesis. J Bone Joint Surg (Am), 1975, 57(1): 17-22.
2.	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.
3.	Mora-de Sambricio A, Garrido-Stratenwerth E. Spondylolysis and spondylolisthesis in children and adolescents. Rev Esp Cir Ortop Traumatol, 2014, 58(6): 395-406.
4.	Bouras T, Korovessis P. Management of spondylolysis and low-grade spondylolisthesis in fine athletes. A comprehensive review. Eur J Orthop Surg Traumatol, 2015, 25 Suppl 1: S167-175.
5.	Karakasli A, Cecen B, Erduran M, et al. Rigid fixation of the lumbar spine alters the motion and mechanical stability at the adjacent segment level. Eklem Hastalik Cerrahisi, 2014, 25(1): 42-46.
6.	Sears WR, Sergides IG, Kazemi N, et al. Incidence and prevalence of surgery at segments adjacent to a previous posterior lumbar arthrodesis. Spine J, 2011, 11(1): 11-20.
7.	Lee GW, Lee SM, Suh BG. Direct repair surgery with screw fixation for young patients with lumbar spondylolysis: patient-reported outcomes and fusion rate in a prospective interventional study. Spine (Phila Pa 1976), 2015, 40(4): E234-241.
8.	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].
9.	Meyerding HW. Spondylolisthesis. J Bone Joint Surg, 1931, 13(1): 39-48.
10.	Ekman P, Möller H, Shalabi A, et al. A prospective randomised study on the long-term effect of lumbar fusion on adjacent disc degeneration. Eur Spine J, 2009, 18(8): 1175-1186.
11.	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.
12.	Kimura M. My method of filing the lesion with spongy bone in spondylolysis and spondylolisthesis. Seikei Geka, 1968, 19(4): 285-296.
13.	Buck JE. Direct repair of the defect in spondylolisthesis. Preliminary report. J Bone Joint Surg (Br), 1970, 52(3): 432-437.
14.	Johnson GV, Thompson AG. The Scott wiring technique for direct repair of lumbar spondylolysis. J Bone Joint Surg (Br), 1992, 74(3): 426-430.
15.	Morscher E, Gerber B, Fasel J. Surgical treatment of spondylolisthesis by bone grafting and direct stabilization of spondylolysis by means of a hook screw. Arch Orthop Trauma Surg, 1984, 103(3): 175-178.
16.	Barrey C, Perrin G, Champain S. Pedicle-Screw-Based Dynamic Systems and Degenerative Lumbar Diseases: Biomechanical and Clinical Experiences of Dynamic Fusion with Isobar TTL. ISRN Orthop, 2013, 2013: 183702.
17.	Hrabálek L, Wanek T, Adamus M. Treatment of degenerative spondylolisthesis of the lumbosacral spine by decompression and dynamic transpedicular stabilization. Acta Chir Orthop Traumatol Cech, 2011, 78(5): 431-436.
18.	Li Z, Li F, Yu S, et al. Two-year follow-up results of the Isobar TTL Semi-Rigid Rod System for the treatment of lumbar degenerative disease. J Clin Neurosci, 2013, 20(3): 394-399.

1. Wiltse LL, Widell EH JR, Jackson DW. Fatigue fracture: the basic lesion is inthmic spondylolisthesis. J Bone Joint Surg (Am), 1975, 57(1): 17-22.
2. 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.
3. Mora-de Sambricio A, Garrido-Stratenwerth E. Spondylolysis and spondylolisthesis in children and adolescents. Rev Esp Cir Ortop Traumatol, 2014, 58(6): 395-406.
4. Bouras T, Korovessis P. Management of spondylolysis and low-grade spondylolisthesis in fine athletes. A comprehensive review. Eur J Orthop Surg Traumatol, 2015, 25 Suppl 1: S167-175.
5. Karakasli A, Cecen B, Erduran M, et al. Rigid fixation of the lumbar spine alters the motion and mechanical stability at the adjacent segment level. Eklem Hastalik Cerrahisi, 2014, 25(1): 42-46.
6. Sears WR, Sergides IG, Kazemi N, et al. Incidence and prevalence of surgery at segments adjacent to a previous posterior lumbar arthrodesis. Spine J, 2011, 11(1): 11-20.
7. Lee GW, Lee SM, Suh BG. Direct repair surgery with screw fixation for young patients with lumbar spondylolysis: patient-reported outcomes and fusion rate in a prospective interventional study. Spine (Phila Pa 1976), 2015, 40(4): E234-241.
8. 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].
9. Meyerding HW. Spondylolisthesis. J Bone Joint Surg, 1931, 13(1): 39-48.
10. Ekman P, Möller H, Shalabi A, et al. A prospective randomised study on the long-term effect of lumbar fusion on adjacent disc degeneration. Eur Spine J, 2009, 18(8): 1175-1186.
11. 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.
12. Kimura M. My method of filing the lesion with spongy bone in spondylolysis and spondylolisthesis. Seikei Geka, 1968, 19(4): 285-296.
13. Buck JE. Direct repair of the defect in spondylolisthesis. Preliminary report. J Bone Joint Surg (Br), 1970, 52(3): 432-437.
14. Johnson GV, Thompson AG. The Scott wiring technique for direct repair of lumbar spondylolysis. J Bone Joint Surg (Br), 1992, 74(3): 426-430.
15. Morscher E, Gerber B, Fasel J. Surgical treatment of spondylolisthesis by bone grafting and direct stabilization of spondylolysis by means of a hook screw. Arch Orthop Trauma Surg, 1984, 103(3): 175-178.
16. Barrey C, Perrin G, Champain S. Pedicle-Screw-Based Dynamic Systems and Degenerative Lumbar Diseases: Biomechanical and Clinical Experiences of Dynamic Fusion with Isobar TTL. ISRN Orthop, 2013, 2013: 183702.
17. Hrabálek L, Wanek T, Adamus M. Treatment of degenerative spondylolisthesis of the lumbosacral spine by decompression and dynamic transpedicular stabilization. Acta Chir Orthop Traumatol Cech, 2011, 78(5): 431-436.
18. Li Z, Li F, Yu S, et al. Two-year follow-up results of the Isobar TTL Semi-Rigid Rod System for the treatment of lumbar degenerative disease. J Clin Neurosci, 2013, 20(3): 394-399.

Chinese Journal of Reparative and Reconstructive Surgery

Clinical outcome of ISOBAR TTL dynamic stabilization with pars bone grafting for treatment of lumbar spondylolysis

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