Direct Pars Repair Surgery Using Two Different Surgical Methods : Pedicle Screw with Universal Hook System and Direct Pars Screw Fixation in Symptomatic Lumbar Spondylosis Patients

OBJECTIVE: The authors performed a retrospective study to assess the clinical and radiological outcome in symptomatic lumbar spondylolysis patients who underwent a direct pars repair surgery using two different surgical methods; pedicle screw with universal hook system (PSUH) and direct pars screw fixation (DPSF), and compared the results between two different treated groups. METHODS: Forty-seven consecutive patients (PSUH; 23, DPSF; 15) with symptomatic lumbar spondylolysis who underwent a direct pars repair surgery were included. The average follow-up period was 37 months in the PSUH group, and 28 months in the DPSF group. The clinical outcome was measured using visual analogue pain scale (VAS) and Oswestry disability index (ODI). The length of operation time, the amount of blood loss, the duration of hospital stay, surgical complications, and fusion status were also assessed. RESULTS: When compared to the DPSF group, the average preoperative VAS and ODI score of the PSUH group were less decreased at the last follow-up; (the PSUH group; back VAS : 4.9 vs. 3.0, leg VAS : 6.8 vs. 2.2, ODI : 50.6% vs. 24.6%, the DPSF group; back VAS : 5.7 vs. 1.1, leg VAS : 6.1 vs. 1.2, ODI : 57.4% vs. 18.2%). The average operation time was 174.9 minutes in the PSUH group, and 141.7 minutes in the DPSF group. The average blood loss during operation was 468.8 cc in the PSUH group, and 298.8 cc in the DPSF group. The average hospital stay after operation was 8.9 days in the PSUH group, and 7 days in the DPSF group. In the PSUH group, there was one case of a screw misplacement requiring revision surgery. In the DPSF group, one patient suffered from transient leg pain. The successful bone fusion rate was 78.3% in the PSUH group, and 93.3% in the DPSF group. CONCLUSION: The present study suggests that the technique using direct pars screw would be more effective than the method using pedicle screw with lamina hook system, in terms of decreased operation time, amount of blood loss, hospital stay, and increased fusion success rate, as well as better clinical outcome.