Outcomes in Direct Repair of Pars Defects at Multiple LevelsDirect repair of pars defects with wire and bone grafting has been widely used for single level spondylolysis. This study is a retrospective study over 12-51 months post-operatively using the same technique for multiple level pars defects and spondylolysis. One of the authers was the surgeon who performed the direct repair with bone grafting procedure on seven patients. Direct repair vs. posterolateral fusion was chosen because of its advantage in terms of maintaining mobility at the segments and less risk of developing adjacent disc degeneration and transitional syndrome.
The seven subjects ranged in age from 19-37 years. All were limited in activities of daily living. They underwent conservative care for at least six months which included bedrest, analgesics, lumbar bracing, and activity restriction. All had participated in sports and none had any significant medical comorbidities.
Following the direct repair with wire and bone grafting, patients were on bedrest for two days. They were then allowed mobility in a lumbar corset for six months. The lumbar corset was replaced with a lumbar support and then they were allowed to resume sports. Assessment of surgical outcomes focused on activities of daily living (ADL) and pain, and healing of the pars defects. The Japanese Orthopaedic Association (JOA) scores were used to assess pain and ADL. A maximum score is 29. Radiographs or CT was used to evaluate healing of the pars defects. The mean JOA improved from 21.29 before surgery to 27.86 after surgery with a recovery rate of 85.21 percent. Healing of all defects was observed in four cases, three out of four defects in two cases, and no healing of four defects in one case. Overall healing of the pars defects was 81.25 percent. Subjects that did not have complete healing of the pars defects, returned to sports activity too soon, or stopped wearing the corset too soon post-operatively. All of the wires had been broken due to non-healing pars defects. The authors conclude that post-operative treatment with a corset is very important for pars healing without wire breakage.
The authors also concluded that in general, conservative care such as bracing, analgesics, and physical therapy did not allow patients to return to previous level of activity and sports. Surgical intervention using a direct repair with wire fixation and bone grafting of the pars defects, even at multiple levels yeilded preferred outcomes particularly in those who desire to return to sports.
Hiroyasu Ogawa, M.D. et.al. Clinical Outcome After Segmental Wire Fixation and Bone Grafting for Repair of the defects in Multiple Level Lumbar Spondylolysis. Journal of Spinal Disorders and Techniques October 2007. Volume 20. Number 7. Pp.521-523.
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