A physiological method for the repair of young adult simple isthmic lumbar spondylolysis.

BACKGROUND: Anterior or posterolateral spondylodesis has been reported as a widely used surgical treatment for lumbar spondylolysis and spondylolisthesis. However, the expenditure of energy for both the physician and the patient is relatively great. The risk of complications is significant and the loss of one motion segment must be accepted. The latter is problematical, especially in young adult patients who only have symptomatic isthmic lumbar spondylolysis. METHODS: For these patients, direct repair of the defect is recommended. We used a spondylolysis hook screw and bone grafting for direct repair of the pars defect. The results were analyzed according to the clinical results and functional x-ray exams. RESULTS: The clinical results were good or excellent. The roentgenologic examinations at 6 months showed the presence of bone trabeculation across the pars defect in all cases. The physiological motion of the lumbar spine was preserved without limitation, and all of the patients had resumed daily activities or work without discomfort. CONCLUSION: There were no complications among our cases. Particularly, according to our anatomical investigations, normal structures were safe from injury as long as the proper technique was followed. A spondylolysis hook screw with bone grafting can preserve the physiological motion of the offending levels. This method is a much more physiologically appropriate surgical method for non-complicated and symptomatic lumbar spondylolysis in the young adult.