title: Irrigation endoscopic assisted percutaneous pars repair: technical note.
abstract: Spondylolysis is a common source of low back pain in children and adolescents. Despite the benign natural history of the pathology, however, it should be noted that as part of conservative management many young individuals are forced to discontinue their routine sports activities. In cases resistant to conservative management, direct repair of a pars defect is considered a safe and effective option in young adults with preserved discs. Recently, some reports of minimally invasive pars repair have been described, aiming at preservation of the paraspinal muscles and improvement of the postoperative course.
  
  
  
  The study aimed to present a new minimally invasive endoscopic technique for pars repair.
  
  
  
  This is a technical note.
  
  
  
  Seven consecutive patients complaining of back pain due to spondylolysis and resistant to conservative management were included.
  
  
  
  Outcome was assessed using the modified Macnab criteria, and bone union was assessed on postoperative radiographs.
  
  
  
  Two portals of 0.5 cm were used on each side, 1 cm lateral to the midline. One portal is used for the endoscope and the second for the surgical instruments. Following endoscopic debridement of the defect, the inferior portal was used for percutaneous placement of the Buck screw. There was no source for external funding for this study and no potential conflict of interest to disclose.
  
  
  
  Outcome was excellent in six cases and good in one case. All patients returned back to their normal level of activities. Complete radiographic union was seen in all patients. The mean period of postoperative hospital stay and follow-up was 8 hours and 21 months, respectively.
  
  
  
  The irrigation endoscopic technique has previously shown promising results in lumbar discectomy and laminectomy. Similar results were observed in the current study on the ability to achieve minimally invasive pars defect debridement and a smooth postoperative course. This is a pilot study and larger patient series and different surgeons' experience are required for further evaluation of the technique.
authors.affiliation: Department of Orthopedic Surgery, Faculty of Medicine, Cairo University, 21A Abdelaziz Al Seoud, Manial-EL Roda, Cairo, Egypt. Electronic address: Heshamsol1@yahoo.com.
authors.forename: Hesham Magdi
authors.initials: HM
authors.lastname: Soliman
mesh_terms: D000293:Adolescent; D000328:Adult; D001863:Bone Screws / Q000009:adverse effects; D017586:Diskectomy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D004724:Endoscopy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006801:Humans; D007796:Laminectomy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D008159:Lumbar Vertebrae / Q000601:surgery; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D011183:Postoperative Complications; D013169:Spondylolysis / Q000601:surgery
keywords: Endoscopic pars repair; Low back pain; Minimally invasive Buck screw; Minimally invasive pars repair; Percutaneous pars repair; Spondylolysis