If the nonsurgical treatment discussed over the last 2 posts
fails to adequately relieve the low back pain due to spondylolysis/pars
fractures, then surgery might be indicated.
It is important to note that not all patients have the same
pain intensity, frequency or interference with activities. The radiographs of the spondylolysis/pars
fracture may look identical between to patients, but their pain may be very
different, one having little pain, while the other significant pain.
The goal of surgery is to get the crack in the bone to heal,
which should significantly decrease or eliminate the low back pain. Just like in other areas of the body in which
the bone doesn’t heal, there are specific requirements to successful
spondylolysis/pars fracture surgery
What is needed to heal the spondylolysis/pars defect:
1.
Rigid fixation/stabilization of the unhealed
area
2.
Hold the cracked, bone edges firmly against each
other
3. Remove soft tissue at cracked bone area and takedown
of the unhealed area to healthy, bleeding, cancellous bone
4.
Bone graft
Figure (Pountos)
What is the surgery to “fix” spondylolysis/pars
fractures?
The surgical incision to fix the spondylolysis/pars fracture
is demonstated below (red line)
The intraoperative picture below. The incision is made (between the red
arrows), then the muscles are moved to the left and right sides (yellow arrows).
Dissection is continued down to bone and the
spondylolysis/pars fracture is exposed, cleaned of soft tissue then burred down
to healthy, bleeding bone (between green arrows, below)
Below, a pedicle screw is placed through a percutaneous
incision (black circle/red center)
The pedicle screw (black circle, red center) is connected to
a hook (yellow arrow) by a rod, and then are compressed together to put the
cracked bone surfaces together firmly.
Bone graft is then spread over the bone surfaces to
encourage bone-to-bone healing (outlined in blue)
Below are
radiographs, before and after, spondylolysis/pars fracture repair.
References:
Pountos I, Georgouli T, Pneumaticos S, Giannoudis PV. Fracture non-union: Can biomarkers predict
outcome? Injury 2013;44:1725-1732.
More on Spondylolysis/Pars Fracture surgery in next post……