1. Spondylolysis repair with impaction grafting and rigid fixation: prospective outcome study
Matthew D Hepler, MD*
Matthew T Walker, MD
Eugene Lautenschlager, PhD
*Vero Orthopaedics and Vero Neurology
Departments of Orthopaedic Surgery and Neuroradiology
Northwestern Memorial Hospital
Chicago, IL

2. Introduction Spondylolysis is common diagnosis (6%) Chronic lesions
alter lumbar biomechanics
progress to spondylolysthesis or DDD
cause back pain and disability
Surgical treatment
Pars repair high failure rate
fusion sacrifices motion
no consensus
The fusion of the adult spine to the sacrum is fraught with difficulties and complications. Combined anterior and posterior approaches to the lumbosacral junction lessens the Pseudarthrosis rate.

3. Treatment Controversy
M Schaefer L2 Spondylolysis: Surgical vs non surgical treatment
Spine Universe 6/12/2008

4. Purpose
Prospective evaluation of clinical and radiologic outcomes of spondylolysis treated with fracture debridement, impaction grafting, and rigid fixation.

5. Methods Inclusion Surgery F/U (3, 6, 12, 24 mo) Lysis on MRI/CT
Failed non-operative Tx
Dx inj. if other pathology
Surgery
Fx debridement
ICBG
Pedicle screw/hook
F/U (3, 6, 12, 24 mo)
SF-36, ODI, RM, VAS
Xray (incl. flex/ext)
+/-CT
The fusion of the adult spine to the sacrum is fraught with difficulties and complications. Combined anterior and posterior approaches to the lumbosacral junction lessens the Pseudarthrosis rate.

6. Demographics 18 consecutive patients First 11 (12 lesions)
L5 (8), L4 (2), L3 (2)
2 females, 9 males
Av age: 28 (range 17-50)
Extension based BP (11)
Leg pain (4)
Neurologix Sx (2)

7. Concomitant Dx Adjacent spondylolysis(2) 1 healed non operatively
Spondylolisthesis (3)
DDD (5)
HNP (3)
Schmorl nodes (2)
The fusion of the adult spine to the sacrum is fraught with difficulties and complications. Combined anterior and posterior approaches to the lumbosacral junction lessens the Pseudarthrosis rate.
DDD
L4 Pars defect

8. Pars defect debridement
Pannus before
debridement
Defect after
debridement
The fusion of the adult spine to the sacrum is fraught with difficulties and complications. Combined anterior and posterior approaches to the lumbosacral junction lessens the Pseudarthrosis rate.

9. Pars repair: ICBG Bone graft
The fusion of the adult spine to the sacrum is fraught with difficulties and complications. Combined anterior and posterior approaches to the lumbosacral junction lessens the Pseudarthrosis rate.
Bone graft

10. Rigid Fixation: Pedicle-laminar claw
The fusion of the adult spine to the sacrum is fraught with difficulties and complications. Combined anterior and posterior approaches to the lumbosacral junction lessens the Pseudarthrosis rate.

11. Postoperative Treatment
Discharge 1.5 days (0-3)
TLSO 2-3 months
2-3 months
Sport specific 3-4 months
The fusion of the adult spine to the sacrum is fraught with difficulties and complications. Combined anterior and posterior approaches to the lumbosacral junction lessens the Pseudarthrosis rate.

12. Clinical Follow-up No infections No revision surgery
All patients returned to unrestricted 6 months
1 fusion for 3 yr f/u

13. Outcome Measures Preop 3 mo 6 mo 1 yr 2 yr ODI 32.5 17.8 6.7 5.3 RM
Preop
3 mo
6 mo
1 yr
2 yr
ODI
32.5
17.8
6.7
5.3 RM
10.6
2.0
2.4
2.8
VAS
8.3
1.3
0.9
0.7
SF-36(PCS)
34.6
(6.5)
44.7
(7.6)
51.5
(11.5)
53.3
52.5
(9.7)
The fusion of the adult spine to the sacrum is fraught with difficulties and complications. Combined anterior and posterior approaches to the lumbosacral junction lessens the Pseudarthrosis rate.
Statistical analysis by repeated measures ANOVA
Values in parentheses are standard deviations

15. Radiographic Results Xray (fl/ext @ 6 mo. n=11) CT @ 6-18 mo (n=6)
No defects
No loosening
No motion
mo (n=6)
4/6 residual unilateral defect
osseous integration on repeat CT
The fusion of the adult spine to the sacrum is fraught with difficulties and complications. Combined anterior and posterior approaches to the lumbosacral junction lessens the Pseudarthrosis rate.

16. Conclusion
Pars repair with impaction grafting and rigid fixation has excellent clinical and radiologic outcome
Rapid return to full activities including contact sports
Provides motion preservation
Restores normal biomechanics
Can be treated in presence of other pathology (spondylolisthesis, HNP, DDD)
The fusion of the adult spine to the sacrum is fraught with difficulties and complications. Combined anterior and posterior approaches to the lumbosacral junction lessens the Pseudarthrosis rate.