The age of the patients ranged from 22 to 37 years with a mean of 29.4 ± 4.6 years. Materials and methodsĪfter Institutional Review Board approval, this study was conducted on 22 patients with symptomatic spondylolysis at either L4 or L5 (L4 in 5 cases and L5 in 17 cases). Our study aims to elaborate on Tokuhashi’s study, primarily clarifying the clinical results and secondarily the radiological outcome, operative time, and blood loss in pars repair via his technique to decide on optimum surgery for symptomatic lumbar spondylolysis. A significant difference can be found in the literature regarding the difficulty of surgical technique and postoperative results according to the method used. Tokuhashi and Matsuzaki proposed a repair technique where pedicle screws and laminar hooks were used (screw-rod-hook fixation). Many techniques for pars repair since then have been introduced as the Scott wiring technique, Buck trans-isthmic screws, Morscher hook and screw construct, pedicle screws with segmental wiring technique, and rod-screw construct. Pars repair via bone grafting, first introduced by Kimura in 1968, aimed to restore the stability of the vertebra by promoting the union of the pars defect while preserving the motion of the spinal segment. However, it has disadvantages such as potential adjacent segment disease. Posterior spine fusion could be performed to treat symptomatic pars interarticularis defect after the failure of conservative treatment. Although usually asymptomatic and accidentally discovered, it could cause low back pain needing either conservative or surgical treatment. Lumbar spondylolysis is considered a common finding in adolescents and adults, with a reported prevalence of up to 6%. This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Conclusion: Pars repair using pedicle screws and laminar hooks is a relatively simple yet effective procedure. Level of evidence: Therapeutic study, Level IV. However, postoperative VAS and ODI values improved even in the radiologically non-fused patients. Non-fusion with graft resorption was noticed in the remaining 3 cases (13.6%). Healing of the defect was found in 19 patients at the final follow-up. Results: The mean preoperative VAS and ODI were 7.4 ± 0.8 and 64.8 ± 6.7, which improved to 2.4 ± 0.8 and 20 ± 6 respectively at the final follow-up ( P < 0.001). CT scan was done at the final follow-up to assess pars healing. Plain radiographs were performed immediately postoperatively and after 3 and 6 months. The intensity of back pain and the functional outcome were assessed using the visual analog scale (VAS) and the Oswestry disability index (ODI). Pedicle screws were inserted bilaterally in the corresponding pedicles and connected to a laminar hook via rods (screw-rod-hook fixation). Curettage of the fibrocartilage in the defect and drilling of the sclerotic bone ends were done, followed by impaction of cancellous bone graft. Methods: This study was conducted on 22 patients with symptomatic lumbar spondylolysis. Purpose: To assess the outcomes of pars repair surgery using pedicle screws and laminar hooks. * Corresponding author: Design: Prospective case series. Mohammed Zayan, Mohammed Ali Hussien * and Hany El Zahlawyĭepartment of Orthopedic surgery, Faculty of Medicine, Ain Shams University, 38 Abbassia Square, Next to Al-Nour Mosque, Cairo 11865, Egypt
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