Minimally invasive direct repair of bilateral lumbar spine pars defects in athletes

Gabriel A Widi, Seth K Williams, Allan D Levi, Gabriel A Widi, Seth K Williams, Allan D Levi

Abstract

Spondylolysis of the lumbar spine has traditionally been treated using a variety of techniques ranging from conservative care to fusion. Direct repair of the defect may be utilized in young adult patients without significant disc degeneration and lumbar instability. We used minimally invasive techniques to place pars interarticularis screws with the use of an intraoperative CT scanner in three young adults, including two athletes. This technique is a modification of the original procedure in 1970 by Buck, and it offers the advantage of minimal muscle dissection and optimal screw trajectory. There were no intra- or postoperative complications. The detailed operative procedure and the postoperative course along with a brief review of pars interarticularis defect treatment are discussed.

Figures

Figure 1
Figure 1
Flexion/extension preoperative rays of patient A showing increased separation of the pars defect with flexion.
Figure 2
Figure 2
Intraoperative picture showing the METRx tube directed at the pars defect (left side of picture, which is towards the patient's head) and the guidewire for the screw (right side of the picture). In this case, a single midline cephalad incision was used to access both pars defects with the METRx tube, and a single midline caudal incision used the pass the guidewires and screws. Alternatively, two paired para-sagittal incisions can be used to access each pars defect and a single incision used to pass the guide wires and screws.
Figure 3
Figure 3
An 18 mm METRx tube was then directed towards the pars defect using fluoroscopy. The pars defect was decorticated with a high-speed drill, and local autograft and BMP were placed in the defect. Note that this step is done prior to placing the wire. This fluoroscopy image shows a currete in the pars defect after it is prepared with the bur.
Figure 4
Figure 4
((a) and (b)) The UCSS cannula is advanced towards the undersurface of the lamina and then the guide wire drilled across the pars defect.
Figure 5
Figure 5
((a) and (b)) Cortical partially-threaded screws are passed across the pars defect.
Figure 6
Figure 6
Three-month post-operative CT shows appropriate intraosseous screw placement with healing of the pars defect and no signs of nonunion.

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