Classification and treatmentof lumbar spondylolysisin young soldiers

English Keywords:Lumbar pondylolysis  Direct repair  Young soldier  Classification

English Abstract:

  【Abstract】 Objectives: To classify lumbar spondylolysisin young soldiers according to the clinical features and imaging findings, and evaluate the therapeutic outcome and complications of different surgical methods. Methods: From March 2010 to December 2016, 326 cases of young soldiers with lumbar spondylolysis were admitted into our department. All were male, with an average age of 22.4±5.1 years(18-36 years). All patients were divided into three types according to clinical features and imaging findings as follows: Type A, simplex spondylolysis, no disc herniation or slippage; type B, spondylolysis with mild intervertebral disc herniation or degree Ⅰ slippage, without nerve compression symptoms and signs; type C, spondylolysis with degree Ⅰ or Ⅱ slippage and intervertebral disc herniation and accompanied with nerve compression symptoms and signs. Preoperative lumbar spine AP and lateral radiographs, left and right oblique radiographs, full-length standing AP and lateral radiographs, lumbar CT scan and sagittal reconstruction, and lumbar MRI were performed. The position of spondylolysis were evaluated using lumbar X-ray, and the diagnosis and position of spondylolysis were determined based on lumbar CT. Lumbar disc herniation and nerve compression status were assessed using MRI. Operation method: type A or type B cases were treated with pedicle screw fixation, slip reduction and in situ bone graft fusion. Type C cases were treated with posterior decompression and intervertebral disc excision, intervertebral bone graft fusion with pedicle screw fixation. Patients were followed up at 6 months, 1 year, 18 months and then every year after the operation. VAS was adopted to evaluate back pain. Lumbar disability function was evaluated with ODI. CT and sagittal reconstruction were performed at 6 months, one year, 18 months, and 2 years after the operation. Results: Type A and type B include 305 cases, type C 21 cases. A total of 283 cases were followed up. At an average follow-up of 20.0±7.8 months, the average VAS was decreased from 5.6±1.1 points before surgery to 1.1±0.3 points at the last follow-up, and the average ODI was decreased from 25.2±3.2 points before surgery to 5.3±1.7 points. Six months after operation, we found isthmus union on CT scan in 252 type A and type B cases with the healing rate of 91%(252/278), the average healing time was 12 months, and internal fixation were removed after healing. No removal of internal fixation was required in the cases of intervertebral bone grafting. Conclusions: Type A and type B cases of lumbar spondylolysis in young soldiers can be treated using pedicle screw fixation, and iliac crest autograft in isthmus may achieve satisfying fusion rate. For type C patients, posterior intervertebral bone grafting and pedicle screw fixation were appropriate.