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Success and Failure of Percutaneous Minimally Invasive Direct Pars Repair: Analysis of Fracture Morphology.

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Citation: World Neurosurgery. 126:181-188, 2019 Jun.PMID: 30876997Institution: MedStar Washington Hospital CenterDepartment: NeurosurgeryForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *Lumbar Vertebrae/su [Surgery] | *Minimally Invasive Surgical Procedures | *Spondylolysis/su [Surgery] | Female | Humans | Lumbar Vertebrae/dg [Diagnostic Imaging] | Reoperation | Spondylolysis/dg [Diagnostic Imaging] | Treatment Failure | Treatment Outcome | Young AdultYear: 2019 ISSN:

1878-8750

Name of journal: World neurosurgeryAbstract: BACKGROUND: Spondylolysis is a defect in the pars interarticularis that typically presents with axial back pain. Recently, minimally invasive spine techniques have increased in popularity and have been applied to the Buck technique of direct pars repair.CASE DESCRIPTION: In our series, 2 patients underwent minimally invasive direct pars repair by the percutaneous insertion of a cannulated lag screw across the pars defect with compression against the lamina. The defect was then decorticated and packed with bone grafting material through a tubular retractor. The clinical records, including preoperative imaging characteristics and intraoperative variables, were collected. The first patient was a 22-year-old woman with bilateral pars defects, and the second was a 21-year-old woman with a left-sided pars defect. They underwent minimally invasive direct pars repair without complications and were discharged home within 24-48 hours. In the first patient, the fusion was successful; however, the second experienced screw back out and required subsequent revision. The follow-up period was 25 months for patient 1 and 21 months for patient 2. The fracture morphology differed. The successfully repaired fractures were linear with smooth cortical edges and oriented perpendicular to the screw trajectory. The failed repair involved a unilateral, curved defect with comminuted cortical edges.CONCLUSION: Minimally invasive direct pars repair can be performed safely and effectively with shortened hospital stays and reduced morbidity. Fracture morphology and orientation could be important predictors of the success of surgery. Copyright (c) 2019 Elsevier Inc. All rights reserved.All authors: Conte AG, Fayed I, Voyadzis JMFiscal year: FY2019Digital Object Identifier:

https://dx.doi.org/10.1016/j.wneu.2019.03.026

Date added to catalog: 2020-01-31

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Holdings
Item type	Current library	Collection	Call number	Status	Date due	Barcode
Journal Article	MedStar Authors Catalog	Article	30876997	Available		30876997

BACKGROUND: Spondylolysis is a defect in the pars interarticularis that typically presents with axial back pain. Recently, minimally invasive spine techniques have increased in popularity and have been applied to the Buck technique of direct pars repair.

CASE DESCRIPTION: In our series, 2 patients underwent minimally invasive direct pars repair by the percutaneous insertion of a cannulated lag screw across the pars defect with compression against the lamina. The defect was then decorticated and packed with bone grafting material through a tubular retractor. The clinical records, including preoperative imaging characteristics and intraoperative variables, were collected. The first patient was a 22-year-old woman with bilateral pars defects, and the second was a 21-year-old woman with a left-sided pars defect. They underwent minimally invasive direct pars repair without complications and were discharged home within 24-48 hours. In the first patient, the fusion was successful; however, the second experienced screw back out and required subsequent revision. The follow-up period was 25 months for patient 1 and 21 months for patient 2. The fracture morphology differed. The successfully repaired fractures were linear with smooth cortical edges and oriented perpendicular to the screw trajectory. The failed repair involved a unilateral, curved defect with comminuted cortical edges.

CONCLUSION: Minimally invasive direct pars repair can be performed safely and effectively with shortened hospital stays and reduced morbidity. Fracture morphology and orientation could be important predictors of the success of surgery. Copyright (c) 2019 Elsevier Inc. All rights reserved.

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