A universal pedicle screw and V-rod system for lumbar isthmic spondylolysis: a retrospective analysis of 21 cases

Xiong-sheng Chen, Sheng-yuan Zhou, Lian-shun Jia, Xiao-min Gu, Lei Fang, Wei Zhu, Xiong-sheng Chen, Sheng-yuan Zhou, Lian-shun Jia, Xiao-min Gu, Lei Fang, Wei Zhu

Abstract

Objective: To investigate the surgical outcome of a universal pedicle screw-V rod system and isthmic bone grafting for isthmic spondylolysis.

Methods: Twenty-four patients with isthmic spondylolysis at L5 and grade 0-I spondylolisthesis (Meyerding classification) received isthmic bone graft and stabilization using the universal pedicle screw-V rod system. Back pain was evaluated using the visual analog scale (VAS) and time to bone healing, improvement in spondylolisthesis and intervertebral space height at L5/S1 and L4/L5 were assessed.

Results: Twenty-one patients were followed up for 24 months and included in the analysis. Back pain was markedly improved at 3 months postoperatively with a statistical difference in VAS scores compared with preoperative VAS scores (P<0.001). The VAS scores were 0 to 3 at 6 months postoperatively in all patients and no back pain was reported in all patients except 2 patients who complained of back pain after prolonged sitting. X-ray examination showed a bone graft healing time of 3 to 12 months. Grade I spondylolisthesis improved to grade 0 in 4 patients and no noticeable change was observed in the remaining 17 cases. The intervertebral space height at L5/S1 was statistically increased (P<0.05) while no statistically significant change was seen at L4/L5. There was no statistically significant difference in the ROM of the intervertebral disks of L5/S1 and L4/5 before and after surgery.

Conclusions: The universal pedicle screw-V rod system and isthmic bone grafting directly repairs isthmic spondylolysis and reduces back pain, prevents anterior displacement of the diseased segment and maintains intervertebral space height, thus offering a promising alternative to current approaches for isthmic spondylolysis.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1. Vertebral stabilization by the pedicle…
Figure 1. Vertebral stabilization by the pedicle screw-V rod system.
Force F (arrow indicates direction of F) compresses the isthmic bone graft through the V rod, the spinous process and the vertebral plate. Meanwhile, the pedicle screw-V rod system prevents anterior displacement of the diseased segment and does not affect flexion and axial rotation of the spine.
Figure 2. X-ray manifestations of isthmic bone…
Figure 2. X-ray manifestations of isthmic bone graft healing.
(a) The isthmic bone graft was partially healed; (b) the isthmic bone graft was fully healed; (c) the oblique view shows healing of the isthmus; no “dog neck sign” was observed. Arrow indicates the isthmus.
Figure 3. Measurement of intervertebral space height.
Figure 3. Measurement of intervertebral space height.
The intervertebral space height (h) is determined by the distance from the midpoint of the superior endplate to the midpoint of the inferior endplate.
Figure 4. Preoperative and postoperative VAS scores.
Figure 4. Preoperative and postoperative VAS scores.
*P<0.05.
Figure 5. A 21-year old male patient…
Figure 5. A 21-year old male patient with isthmic spondylolysis for 7 months failed conservative therapy.
Preoperative oblique x-ray and CT scan using bone windows reveal isthmic spondylolysis at L5 (a and b). At 6 months postoperatively, the oblique view shows an indistinct interface between the isthmus and bone graft with increased density (c). CT scan on bone windows shows healing of the isthmic bone graft (d).
Figure 6. A 22-year old male patient…
Figure 6. A 22-year old male patient with isthmic spondylolysis for 2 years failed conservative therapy.
Preoperative oblique x-ray and CT scan using bone windows reveal isthmic spondylolysis at L5 (a and b). At 6 months postoperatively, the oblique view shows an indistinct interface between the isthmus and bone graft with increased density (c). CT scan on bone windows shows healing of the isthmic bone graft (d).
Figure 7. Preoperative and postoperative intervertebral space…
Figure 7. Preoperative and postoperative intervertebral space heights of 21 patietns with isthmic spondylolysis.
*P<0.05.
Figure 8. a. Spondylolisthesis of L5/S1 at…
Figure 8. a. Spondylolisthesis of L5/S1 at 0 grade overextension prior to surgery.
b. Spondylolisthesisof L5/S1 at I gradeoverflexion, indicating lack of dynamic stabilization. c. Displacement of L5/S1 at 0 gradelateral overextension 4 years post surgery. d. Displacement of L5/S1 at 0 gradeoverflexionwith no apparent limitation of range of motion of the intervertebral disk of L5/S1 4 years post surgery. The bony outgrowth at the anterior inferior edge of L5 (indicated by arrow) becomes smaller at 4 years postoperatively (c) compared with preoperative image (a, arrow), suggesting that L5 and S1 achieved good stabilization following surgery.
Figure 9. A 39 year old male…
Figure 9. A 39 year old male patient with isthmic spondylolysis at L5.
a grade II disk degeneration of L5/S1 before surgery; b grade III disk degeneration was noted at L5/S1 4 years post operation. No change in vertebral height was noted and the endplate was smooth. The intervertebral disk of L4/5 showed no apparent changes compared with preoperative findings.

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