Direct repair surgery with screw fixation for young patients with lumbar spondylolysis: patient-reported outcomes and fusion rate in a prospective interventional study.
METHODS
Prospective interventional study.


OBJECTIVE
To thoroughly investigate the therapeutic outcomes of direct repair (DR) for young patients with lumbar spondylolysis.


BACKGROUND
DR surgery with screw fixation for a pars defect of lumbar spondylolysis is considered a notable surgical option. However, prior studies do not provide clear information on the significance of DR and its outcomes in young patients with lumbar spondylolysis because most previous studies in this area were conducted with spondylolysis patients of all ages and with low-quality study designs that were retrospective in design and had a small sample size and short follow-up time.


METHODS
A total of 47 young patients with lumbar spine spondylolysis who were surgically treated with DR surgery and followed up for 1 year after surgery were enrolled in this study. The primary outcome was degree of pain assessed by visual analogue scale, which separately recorded pain intensity and pain frequency. Secondary outcomes included (1) patient satisfaction, (2) clinical outcomes based on Oswestry Disability Index score and a 12-item short form health survey, (3) fusion rate of pars defect based on computed tomographic scans, and (4) surgery-related complications.


RESULTS
The degree of lower back pain (intensity and frequency) significantly improved at final follow-up compared with preoperative level. However, 6 patients (13%) had no significant improvement, and pain frequency tended to worsen 6 months after the operation. Only 25 patients (53%) were satisfied with DR surgery. One-year postoperative clinical outcomes (Oswestry Disability Index and 12-item short form health survey) significantly improved compared with preoperative levels, but the 2 scores also tended to decrease after 6 months. The union rate of the pars defect was 55% (26/47). There was no significant difference in clinical outcomes between fusion group and nonunion group of the pars defect at the final follow-up. Two patients (4%) experienced surgery-related complications.


CONCLUSIONS
The authors suggest that DR surgery in young patients with lumbar spondylolysis may produce unsatisfactory outcomes at 1 year after surgery.


METHODS
2.
*Department of Orthopaedic Surgery, Armed Forces Yangju Hospital, Yangju, Korea †Department of Family Medicine, Myongji Hospital, Kwandong University College of Medicine, Goyang, Korea; and ‡Spine Center and Department of Orthopaedic Surgery, Pohang Semyeng Christianty Hospital, Pohang, Kyeongbuk, Republic of Korea.
Gun Woo
GW
Lee
Sun-Mi
SM
Lee
Bo-Gun
BG
Suh
D000328:Adult; D001863:Bone Screws; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D063868:Patient Outcome Assessment; D017060:Patient Satisfaction; D011446:Prospective Studies; D013123:Spinal Fusion; D013169:Spondylolysis / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult