Direct spondylolysis repair in young adults

Abstract

Introduction Spondylolysis is a common problem affecting all ages, but in adolescent and young adults, especially the athletes, it represents a significant dilemma, as most of them are in their initial phase of their life and need a stable free spine. A minority of old people affected by this disease need medical care, and only a few require surgery, but in athletes and young adults, surgery usually has a main role. Reconstruction of the pars interarticularis is an alternative to segmental fusion; this technique has the advantage of preserving segmental motion. Most authors report good results of spondylolysis repair for young patients without intervertebral disc or facet affection. Patients and methods In this study, the fixation of the isthmus was done with a pedicle screw hook system. This stable and strong device is easy to use, allows anatomic pars interarticularis reconstruction, avoids postoperative bracing, and allows early ambulation. A total of 11 patients were assessed in this study. Their mean age at operation was 24 (range: 16–32 years), and the average follow-up was for 24 months (range: 6–36 months). Nine patients showed no preoperative degenerative disc disease and two patients had grade 1 changes. The visual analogical scale and the Oswestry disability index were used for assessment of pain and clinical outcome before and after surgery. Results The results were from ‘excellent’ to ‘good’ for 10 patients and ‘fair’ for one of them. The fusion rate was observed in all cases. Among the patients, the results were from ‘good,’ to ‘excellent’ in all cases, and consolidation was always observed. All of them showed normal disc height after the surgery. Conclusion Direct spondylolysis repair by pedicle screw hook system is an excellent and reliable method in the management of spondylolysis, especially in intact disc in young adults.