7% of adolescent idiopathic scoliosis (AIS) patients also present with a pars defect. To date, there are no available data on the results of fusion ending proximal to a spondylolysis in the setting of AIS. The aim of this study was to analyze the outcomes of posterior spinal fusion (PSF) in this patient cohort, to investigate if maintaining the lytic segment unfused represents a safe option. Retrospective review of all patients who received PSF for AIS, presented with a spondylolysis or spondylolisthesis and had a min. 2-years follow-up. Demographic data, instrumented levels and preoperative radiographic data were collected. Mechanical complications, coronal or sagittal parameters, amount of slippage and pain levels were evaluated. Data from 22 patients were available (age 14.4 ± 2.5 years), 18 Lenke 1–2 and four Lenke 3–6. Five patients (24%) had an isthmic spondylolisthesis, all Meyerding I. The mean preoperative Cobb angle of the instrumented curves was 58 ± 13°. For 18 patients the lowest instrumented vertebra (LIV) was the last touched vertebra (LTV); for two LIV was distal to the LTV; for two, LIV was one level proximal to the LTV. The number of segments between the LIV and the lytic vertebra ranged from 1 to 6. At the last follow-up, no complications were observed. The residual curve below the instrumentation measured 8.5 ± 6.4°, the lordosis below the instrumented levels was 51.4 ± 13°. The magnitude of the isthmic spondylolisthesis remained constant for all included patients. Three patients reported minimal occasional low back pain. The LTV can be safely used as LIV when performing PSF for the management of AIS in patients with L5 spondylolysis

There is conflicting information regarding the recommendations of bracing, physical therapy and cessation of sports for young athletes with symptomatic spondylolysis. The purpose of this study was to identify factors affecting the prognosis and to find the optimal method of non-operative treatment. The patients in our study were athletes who visited our children's hospital for low back pain with lumbar spondylolysis and were treated non-operatively from 1990 to 2002. Clinical and radiological outcomes were reviewed retrospectively. The effects of bracing, physical therapy, cessation of sports, duration of symptoms before the first hospital visit, lateralisation of spondylolysis, age, gender, onset of low back pain after lumbar trauma during sports, bone scan uptake, vertebral level of the lesion, associated scoliosis or spina bifida and radiological bony healing were analysed using univariate and multivariate analysis with logistic regression. The mean age of patients was 13 years (range 7 to 18 years). The mean follow-up was 4.2 years (range 1.2 to 12 years). Of 132 patients, 48 patients had excellent results with no pain during sports, 76 good, 6 fair, and 4 poor. Cessation of sports, early non-operative intervention, and a unilateral spondylolysis appeared to be factors associated with excellent outcomes. However, bracing, physical therapy, age, gender, level of lesion, history of trauma, increased uptake on bone scan, or associated scoliosis or spina bifida were not factors. Bony healing was not related to the clinical outcome. The non-operative treatment of spondylolysis in children can yield excellent clinical outcomes, and the absence of bony healing has no influence on clinical outcome. Factors in this study found to correlate with an excellent outcome include unilateral spondylolysis, acute spondylolysis, and treatment with cessation of sports for 12 weeks

We report a prospective case-series study to evaluate the results of non-operative and operative treatment of symptomatic unilateral lumbar spondylolysis. Non-operative treatment results in healing in most patients with symptomatic unilateral spondylolysis. Surgery however is indicated when symptoms persist beyond a reasonable time affecting the quality of life in young patients particularly the athletic population. We treated 41 patients [31 male, 10 female] with suspected unilateral lumbar spondylolysis. Thirty-one patients were actively involved in sports at various levels. Patients with a positive stress reaction on SPECT imaging underwent a strict protocol of activity restriction, bracing and physical therapy for 6 months. At the end of six months, patients who remained symptomatic underwent a Computed Tomography [CT] scan to confirm the persistence of a spondylolysis. Seven patients subsequently underwent a direct repair of the defect using the modified Buck's Technique. Baseline Oswestry disability index [ODI] and Short-Form-36 [SF-36] scores were compared to two year ODI and SF-36 scores for all patients. In the non-operated group, the mean pre-treatment ODI was 36 [SD=10.5], improving to 6.2 [SD=8.2] at two years. In SF-36 scores, the physical component of health [PCS] improved from 30.7 [SD=3.2] to 53.5 [SD =6.5] [p<0.001], and the mean score for the mental component of health [MCS] improved from 39 [SD=4.1] to56.5 [SD=3.9] [p<0.001] at two years. 20/31 patients resumed their sporting career within 6 months of onset of treatment, a further 4/31 patients returned to sports within one year. The seven patients who remained symptomatic at six months underwent a unilateral modified Buck's Repair. The most common level of repair was L5 (n=4). The mean pre-operative ODI was 39.4 (SD=3.6) improving to 4.4 (SD=4) at the latest follow-up. The mean score of PCS [SF-36] improved from 29.6 [SD=4.4] to 51.2 [SD=5.2] (SD=5.2) (p<0.001) and the mean score of MCS (SF-36) improved from 38.7 (SD=1.9) to 55.5 (SD=5.4) (p<0.001). A specific protocol of conservative treatment for patients with a unilateral lumbar spondylolysis resulted in a high rate of success with 83% of patients avoiding surgery. If symptoms persist beyond a reasonable period (i.e. 6 months) and reverse gantry CT scan confirms a non-healing defect of the pars interarticularis one may consider a unilateral direct repair of the defect with good outcome ultimately

The hook screw method is a direct repair technique that permits ‘restitutio ad integrum’ for a functional segment. The surgical method of treating spondylolysis and grade 1 spondylolisthesis by spondylytic hook screw reduction and bone grafting in 34 patients is reported. Of these patients, 32 showed good to excellent results. Surgical technique. The bone on either side of the defect is roughened. Then the screws are inserted after pre-drilling into the base of the articular process inclined at 400 to the vertebral endplate and diverging 15 to 20 degrees from each side. Then the special hooks, hooked under the lamina, are fixed to the screws by nuts over a spring so as to obtain compression over the defect. Autologous cancellous bone graft is placed in the defect. Materials and methods. A total of 34 patients were included in this study from 1998 to 2006, 32 male and 2 female patients. Pre-operative and post-operative Oswestry Lumbar Disability Index score (OLDI) and SF 36 scores recorded. Results. The response rate was 100%. The mean age of the patients was 34 years. Mean pre-operative OLDI score was 42 and post-operatively was 14. The results were subdivided into excellent, very good, good, no change and poor. An excellent result meant a greater than 15 point improvement on OLDI score; very good a 10-15 point improvement; good results a 5-10 point improvement. An excellent result was reported by 76% of patients, good to excellent results by 94% of patients and good and very good by 23 % of patients. 1 patient had no change and 1 was poor. Conclusion. Direct repair of spondylolysis can be recommended for young patients to save a functional segment. The above mean 6 year follow-up shows encouraging results