Published on 21/04/2015 by admin
Filed under Surgery
Last modified 21/04/2015
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Procedure 29 Spondylolysis Repair
Manish K. Kasliwal, Brian Walsh, Ernest Found, Vincent C. Traynelis
• Pars defect must be source of pain
• No instability on imaging
• Minimal disk degeneration present
• Patient 30 years of age or younger
• Nonsmoker
Indications Pearls
• Young healthy patients with normal sagittal alignment, no significant instability, and a positive bone scan who have failed to improve with a course of nonoperative management are the best candidates for this procedure.
• Anteroposterior and lateral lumbar radiographs
• Flexion and extension lateral lumbar radiographs (Figure 29-1, A and B)
• Lumbosacral computed tomography (Figure 29-2)
• Bone scan
FIGURE 29-1, A-B
FIGURE 29-2
Treatment Options
• Arthrodesis with or without instrumentation
• Direct screw fixation of defect
• The affected lamina
• The affected pars interarticularis
• The pedicle of the affected vertebra
• Prone on Wilson frame, laminectomy rolls, or Jackson table
Positioning Pearls
• Strive to position patient in normal lumbar lordosis. This is best accomplished by extending the hips.
Positioning Pitfalls
• Avoid significant lumbar flexion. Although this may facilitate the surgical exposure, it is not associated with optimal postoperative sagittal balance or outcome.
Positioning Equipment
• Jackson table, laminectomy rolls
• A standard posterior lumbar exposure is used to access the affected vertebra. The lamina, facets, and proximal transverse process should be exposed (Buck, 1970; Askar, 2003; Chung, 2007; Debusscher, 2007).
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