Therapeutic effect analysis of posterior lumbar isthmus bone grafting and screw-rod system fixation for bilateral lumbar spondylolysis in youths

English Keywords:Bilateral spondylolysis  Long-term training  Screw-rod system  Surgery

English Abstract:

  【Abstract】 Objectives: To investigate the effects of posterior lumbar isthmus screw-rod system fixation and local bone grafting in the treatment of bilateral lumbar spondylolysis in youths. Methods: Data of 17 patients with bilateral lumbar spondylolysis admitted to our hospital from October 2015 to October 2017 were retrospectively analyzed, including 13 males and 4 females, aged 18-39 (25.1±6.1) years, with an average course of 12.7±8.8 months. Among them, 1 case with L3 spondylolysis, and the other 16 cases with L5 spondylolysis, and all were caused by long-term sports or military training. All patients were simple spondylolysis. All patients were treated with iliac bone grafting and pedicle screw fixation. The follow-up period ranged from 12 to 18 months, with an average of 15.4±2.0 months. The fusion status of isthmic was evaluated by lumbar CT scan, and the clinical outcome was evaluated by visual analogue score(VAS) and spinal Oswestry disability index(ODI). During the follow-up period, implant was removed after CT scan confirming the isthmus fusion. Gender, age, disease course, fixed level, cause of injury, combined injuries, incision length, operation time, intra-operative bleeding volume, the CT manifestation of isthmus before operation and at final follow-up, VAS of lumbar spine and ODI of spinal column were collected and analyzed. Results: The average age of 17 patients was 25.1±6.1 years, there were 13 males and 4 females, 16 L5 segments and 1 L3 segments. All patients were followed up for an average of 15.4±2.0 months. The course of disease was 12.7±8.8 months. All of them are simple isthmic fissures. The injuries were caused by long-term sports or military training. The incision was 9.1±2.1cm, the operation time was 168.5±46.4min, intra-operative bleeding volumewas 108.8±61.8ml. No infection was found in the incision of all the patients, and grade A healing was achieved. At final follow-up, lumbar spondylolisthesis recovered and isthmus bone healed in all 17 patients, with implant removed during the follow-up. The preoperative and final follow-up VAS scores were 5.8±1.1 and 1.2±0.7 respectively, and the ODI scores were (35.8±9.1)% and (7.1±2.0)%, respectively(P<0.01). At final follow-up, 2 patients had occasional low back pain during intense activities, which did not influence their normal life. No implant breakage, implant loosening and adjacent segments degeneration were found during the follow-up. Conclusions: Posterior lumbar isthmus bone grafting and screw-rod system fixation is an effective and safe method in the treatment of bilateral lumbar spondylolysis in youths.