Objective: Spondylolysis is a common cause of low back pain, especially in the young athletic population. It involves a defect, either unilateral or bilateral, of the pars interarticularis. Numerous techniques have been developed for the surgical treatment of spondylolysis, each with its own strengths and weaknesses. This article aims to describe a modified minimally invasive technique using cortical bone trajectory screws with a U-rod to stabilize the lumbar spondylolysis.
Methods: Adult patients who presented between July 2020 and August 2024 with low back pain due to spondylolysis were included in this study. Imaging studies of the lumbar spine were performed to confirm the spondylolysis. All patients were confirmed to be treated conservatively for at least 12 months prior to surgical intervention. A 2.5 cm midline incision was made at the level of the spondylolysis. Under fluoroscopic guidance, two screws were inserted into the level of the spondylolysis in the cortical bone trajectory, and the screws were connected with a U-shaped bent rod.
Results: Four adult patients (one male, three females) were included. The mean age was 38.5 ± 16.1 years. Average intraoperative blood loss was 6 ± 3 mL. Mean postoperative hospital stay was 3 ± 0.5 days. Both postoperative visual analog scale (VAS) and Oswestry disability index (ODI) scores showed significant improvement. Lumbar spine CT scans performed 1-year post-operation confirmed fusion of the pars defect in seven of the eight defects.
Conclusion: We described a modified minimally invasive technique for the treatment of spondylolysis. This approach offers the advantage of being minimally invasive, leading to less blood loss, short hospital stays, and fast recovery. It also requires less technical expertise than traditional pars screw placement and utilizes readily available instrumentations. Patients reported improved pain scores, and imaging confirmed successful fusion of the pars defect.
| [1] |
W. J. Beutler, B. E. Fredrickson, A. Murtland, C. A. Sweeney, W. D. Grant, and D. Baker, “The Natural History of Spondylolysis and Spondylolisthesis: 45-Year Follow-Up Evaluation,” Spine 28, no. 10 (2003): 1027–1035.
|
| [2] |
T. Sakai, K. Sairyo, N. Suzue, H. Kosaka, and N. Yasui, “Incidence and Etiology of Lumbar Spondylolysis: Review of the Literature,” Journal of Orthopaedic Science 15, no. 3 (2010): 281–288.
|
| [3] |
F. Rossi and S. Dragoni, “Lumbar Spondylolysis: Occurrence in Competitive Athletes. Updated Achievements in a Series of 390 Cases,” Journal of Sports Medicine and Physical Fitness 30, no. 4 (1990): 450–452.
|
| [4] |
P. Hardcastle, P. Annear, D. H. Fau - Foster, et al., “Spinal Abnormalities in Young Fast Bowlers,” Journal of Bone and Joint Surgery 74, no. 3 (1992): 421–425.
|
| [5] |
U. K. Debnath, “Lumbar Spondylolysis - Current Concepts Review,” Journal of Clinical Orthopaedics & Trauma 21 (2021): 101535.
|
| [6] |
A. M. D. Plessis, Q. Wessels, A. V. Schoor, and N. Keough, “Congenital Malformations in the Vertebral Column: Associations and Possible Embryologic Origins,” Anatomy & Cell Biology 55, no. 4 (2022): 399–405.
|
| [7] |
S. J. Raffa, E. M. Luther, and A. D. Levi, “Repair of Isthmic Pars Interarticularis Fractures: A Literature Review of Conventional and Minimally Invasive Techniques,” Journal of Neurosurgical Sciences 63, no. 3 (2019): 318–329.
|
| [8] |
C. A. Reitman and S. I. Esses, “Direct Repair of Spondylolytic Defects in Young Competitive Athletes,” Spine Journal 2, no. 2 (2002): 142–144.
|
| [9] |
F. C. Sherman, R. K. Rosenthal, and J. E. Hall, “Spine Fusion for Spondylolysis and Spondylolisthesis in Children,” Spine 4, no. 1 (1979): 59–67.
|
| [10] |
E. V. Cheung, M. J. Herman, R. Cavalier, and P. D. Pizzutillo, “Spondylolysis and Spondylolisthesis in Children and Adolescents: II. Surgical Management,” JAAOS - Journal of the American Academy of Orthopaedic Surgeons 14, no. 8 (2006): 488–498.
|
| [11] |
J. E. Buck, “Direct Repair of the Defect in Spondylolysthesis,” Journal of Bone & Joint Surgery British Volume 52-B, no. 3 (1970): 432–437.
|
| [12] |
R. O. Nicol and J. H. S. Scott, “Lytic Spondylolysis: Repair by Wiring,” Spine 11, no. 10 (1986): 1030.
|
| [13] |
E. Morscher, B. Gerber, and J. Fase, “Surgical Treatment of Spondylolisthesis by Bone Grafting and Direct Stabilization of Spondylolysis by Means of a Hook Screw,” Archives of Orthopaedic and Trauma Surgery 103, no. 3 (1984): 175–178.
|
| [14] |
P. Gillet and M. Petit, “Direct Repair of Spondylolysis Without Spondylolisthesis, Using a Rod–Screw Construct and Bone Grafting of the Pars Defect,” Spine 24, no. 12 (1999): 1252–1256.
|
| [15] |
J. A. Ulibarri, P. A. Anderson, T. Escarcega, D. Mann, and K. J. Noonan, “Biomechanical and Clinical Evaluation of a Novel Technique for Surgical Repair of Spondylolysis in Adolescents,” Spine 31, no. 18 (2006): 2067–2072.
|
| [16] |
M. J. Goldstein, J. Bruffey, and R. K. Eastlack, “New Minimally Invasive Technique for Direct Pars Interarticularis Osteosynthesis Using Cortical Screws and Spinous-Process Modular Link,” Spine 41, no. 23 (2016): E1421–E1424.
|
| [17] |
J. Sys, J. Michielsen, P. Bracke, M. Martens, and J. Verstreken, “Nonoperative Treatment of Active Spondylolysis in Elite Athletes With Normal X-Ray Findings: Literature Review and Results of Conservative Treatment,” European Spine Journal 10, no. 6 (2001): 498–504.
|
| [18] |
M. E. Steiner and L. J. Micheli, “Treatment of Symptomatic Spondylolysis and Spondylolisthesis With the Modified Boston Brace,” Spine 10, no. 10 (1985): 937–943.
|
| [19] |
K. Sairyo, T. Sakai, N. Yasui, and A. Dezawa, “Conservative Treatment for Pediatric Lumbar Spondylolysis to Achieve Bone Healing Using a Hard Brace: What Type and How Long?: Clinical Article,” Journal of Neurosurgery: Spine 16, no. 6 (2012): 610–614.
|
| [20] |
G. Klein, C. T. Mehlman, and M. McCarty, “Nonoperative Treatment of Spondylolysis and Grade I Spondylolisthesis in Children and Young Adults: A Meta-Analysis of Observational Studies,” Journal of Pediatric Orthopaedics 29, no. 2 (2009): 146–156.
|
| [21] |
E. Virkki, M. Holstila, T. Kolari, et al., “Rigid Thoracolumbar Orthosis Does Not Improve Outcomes of Acute Adolescent Spondylolysis as Compared with Placebo. Bony Union Predicts Improved Health-Related Quality of Life Outcomes at 2-year Follow-Up,” Spine 50, no. 7 (2025): 454–462.
|
| [22] |
W. Y. Kang, J. W. Lee, E. Lee, Y. Kang, J. M. Ahn, and H. S. Kang, “Efficacy and Outcome Predictors of Fluoroscopy-Guided Facet Joint Injection for Spondylolysis,” Skeletal Radiology 47, no. 8 (2018): 1137–1144.
|
| [23] |
H. Arima, Y. Suzuki, D. Togawa, Y. Mihara, H. Murata, and Y. Matsuyama, “Low-Intensity Pulsed Ultrasound Is Effective for Progressive-Stage Lumbar Spondylolysis With MRI High-Signal Change,” European Spine Journal 26, no. 12 (2017): 3122–3128.
|
| [24] |
M. Tsukada, T. Takiuchi, and K. Watanabe, “Low-Intensity Pulsed Ultrasound for Early-Stage Lumbar Spondylolysis in Young Athletes,” Clinical Journal of Sport Medicine 29, no. 4 (2019): 262–266.
|
| [25] |
A. Leone, A. Cianfoni, A. Cerase, N. Magarelli, and L. Bonomo, “Lumbar Spondylolysis: A Review,” Skeletal Radiology 40, no. 6 (2011): 683–700.
|
| [26] |
A. A. Linton and W. K. Hsu, “A Review of Treatment for Acute and Chronic Pars Fractures in the Lumbar Spine,” Current Reviews in Musculoskeletal Medicine 15, no. 4 (2022): 259–271.
|
| [27] |
S. Tawfik, K. Phan, R. J. Mobbs, and P. J. Rao, “The Incidence of Pars Interarticularis Defects in Athletes,” Global Spine Journal 10, no. 1 (2019): 89–101.
|
| [28] |
M. Kimura, “My Method of Filing the Lesion With Spongy Bone in Spondylolysis and Spondylolistesis,” Seikei Geka 19, no. 4 (1968): 285–296.
|
| [29] |
B. Jeanneret, “Direct Repair of Spondylolysis,” Acta Orthopaedica Scandinavica 64, no. 251 (1993): 111–115.
|
| [30] |
J. Buck, “Further Thoughts on Direct Repair of the Defect in Spondylolysis,” Journal of Bone and Joint Surgery 61 (1979): 123.
|
| [31] |
U. K. Debnath, B. E. Scammell, B. J. C. Freeman, and J. R. McConnell, “Predictive Factors for the Outcome of Surgical Treatment of Lumbar Spondylolysis in Young Sporting Individuals,” Global Spine Journal 8, no. 2 (2018): 121–128.
|
| [32] |
Z. Askar, D. Wardlaw, and M. Koti, “Scott Wiring for Direct Repair of Lumbar Spondylolysis,” Spine 28, no. 4 (2003): 354–357.
|
| [33] |
N. Mohammed, D. P. Patra, V. Narayan, et al., “A Comparison of the Techniques of Direct Pars Interarticularis Repairs for Spondylolysis and Low-Grade Spondylolisthesis: A Meta-Analysis,” Neurosurgical Focus 44, no. 1 (2018): E10.
|
| [34] |
S. Nozawa, K. Shimizu, K. Miyamoto, and M. Tanaka, “Repair of Pars Interarticularis Defect by Segmental Wire Fixation in Young Athletes With Spondylolysis,” American Journal of Sports Medicine 31, no. 3 (2003): 359–364.
|
| [35] |
F. Giudici, L. Minoia, M. Archetti, A. S. Corriero, and A. Zagra, “Long-Term Results of the Direct Repair of Spondylolisthesis,” European Spine Journal 20, no. 1 (2011): 115–120.
|
| [36] |
G. V. Johnson and A. G. Thompson, “The Scott Wiring Technique for Direct Repair of Lumbar Spondylolysis,” Journal of Bone and Joint Surgery British Volume 74, no. 3 (1992): 426–430.
|
| [37] |
F. Hefti, W. Seelig, and E. Morscher, “Repair of Lumbar Spondylolysis With a Hook-Screw,” International Orthopaedics 16, no. 1 (1992): 81–85.
|
| [38] |
V. Dreyzin and S. I. Esses, “A Comparative Analysis of Spondylolysis Repair,” Spine 19, no. 17 (1994): 1909–1914.
|
| [39] |
M. N. Songer and R. Rovin, “Repair of the Pars Interarticularis Defect With a Cable-Screw Construct. A Preliminary Report,” Spine 23, no. 2 (1998): 263–269.
|
| [40] |
Y. Tokuhashi and H. Matsuzaki, “Repair of Defects in Spondylolysis by Segmental Pedicular Screw Hook Fixation: A Preliminary Report,” Spine 21, no. 17 (1996): 2041–2045.
|
| [41] |
J. P. Grogan, S. Hemminghytt, A. L. Williams, G. F. Carrera, and V. M. Haughton, “Spondylolysis Studied With Computed Tomography,” Radiology 145, no. 3 (1982): 737–742.
|
| [42] |
X. Huang, Y. Teng, R. Ma, et al., “Evaluation of V-Type Titanium Cable Internal Fixation for the Treatment of Young Adult Fifth Lumbar Spondylolysis: Technical Notes and a Retrospective Clinical Study,” Journal of Orthopaedic Surgery and Research 19, no. 1 (2024): 747.
|
| [43] |
M. Tatsumura, S. Okuwaki, H. Gamada, et al., “A Novel Technique for Pars Defect Direct Repair With a Modified Smiley Face Rod for Spondylolysis and Isthmic Spondylolisthesis,” Spine Surgery and Related Research 7, no. 4 (2023): 396–401.
|
Rights & permissions
2026 The Author(s). Orthopaedic Surgery published by Tianjin Hospital and John Wiley & Sons Australia, Ltd.
PDF
(1158KB)
