Paul Sponseller, MD, discusses the surgical treatment of Symptomatic Spondylolysis.
In this video, we'll be discussing surgical repair of symptomatic spanned a license with trans laminar screws. The ideal indications for this technique include a failure of conservative therapy for at least three months. A defector gap of less than five, no appreciable slip and a healthy disc. In some cases these indications may be modifiable imaging should be used to assess whether the indications have been met. MRI can assess disk status and CT scan can evaluate the glamorous size and trajectory and continuity. This technique offers a low profile solution that is motion sparing with stability and a mechanical advantage compared to other techniques, it's been shown to be more stable Method of fixation that can correct relatively large defects, showing efficacy with defects up to five. The technique is used in adolescent athletes, especially such as gymnasts, soccer players, lacrosse players and others with symptomatic spanned analysis who have failed conservative therapy for at least three months and are looking to get back to an active and pain free healthy lifestyle Again, These are images from a 15 year old athlete who presented with persistent low back pain and was diagnosed with L. four sponsored Ulisses After failure of four months conservative therapy, she elected to have internal fixation of the defect C. T. Scan shows bilateral powers defects. That is greater on the left side. MRI shows that the deaths are healthy and intact. There is some bone marrow edema, correct operative positioning is important for this procedure. After general anesthetic. The patients turn prone on the Jackson table with pressure padding. I like to minimize the lumbar large doses. The patient's arm should be placed upwards for unobstructed lateral imaging. We don't recommend inter operative neuro monitoring. We also recommend a device such as the sea armor so that lateral images can be easily taken repeatedly inter operatively. Flora Skopje is used to precisely localize the level of defect and plan the location of the incision. Dissection should preserve the inter spineless ligaments and the capsules of the assets above and below the level of the defect mobility that post your element can be checked to verify that you're at the right level. The section is also carried out to the tip of the transverse processes exposed. The distal surface of the involved lamb inna while preserving the ligament in flavor. Um Since the screw will enter on the distal surface, then an angle curate is used to localize and fresh in the span of a license defect. If there is a fully established defect, a guide wire can be placed per catania slee if the angle is low as it was in this case. Sometimes for instance at L5. This step can be done through the same incision because the angle is more sharp Started. The guide wire on the thickest portion of the lamb in about five from the articular process, the guide wire should be aimed at the pedal, which is seen as the inferior articular process of the level above. Then the spot. A license gap should be compressed as the wire is advanced. Flora. Skopje should be used at this time checking an ap and lateral. The guide wires should be directed toward the mid portion of the pentacle is seen on the P. A. View. If it's just a little bit off, you can over drill and then redirect your guide wire to get it in the middle of the pentacle. That's the best way to make slight changes over drill measure and tap using the guide wires. Bone grafting should be used to strengthen the surgical repair of displaced fractures. It may not be needed if the fracture is un displaced or incomplete. In the current case, we used bone graft harvested from the superior surface of the iliac crest through the same incision. So that requires less muscle dissection and causes less pain. This can usually be done through the same incision. Unless the defect is high, such as L. three or above obtain the bone and pat cancel his bone in the defect. Bone grafts should also be placed to bridge the lamb inna to the transverse process bilaterally and help reinforce or strengthen the vulnerable area. Osteo biologics may be an option instead of autographed typically partially threaded 4.5 or 5.5 millimeter screws are used in this case we were able to use 5.5 millimeter screws. The screws should gently compress the defect and you should feel it and see it compress. However caution should be exercised to avoid fracturing the laminar by compressing too hard. These ap and lateral films demonstrate correction and compression of the defect. The patient can usually be discharged on postoperative day one. We do not recommend sports, rapid bending or twisting for three months to let the graft hell. We recommend that patients bend from the hips and the knees, Supervised rehab and return to sport can then start about three months post operatively. Thank you.