Article ; Online: Is there a place for surgical repair in adults with spondylolysis or grade-I spondylolisthesis-a systematic review and treatment algorithm.
The spine journal : official journal of the North American Spine Society
2021 Volume 21, Issue 8, Page(s) 1268–1285
Abstract: Objectives: Pars repair is less explored in adults due to associated disc degeneration with advancing age. The aim of our systematic review was to define optimal characteristics of adults with spondylolysis/grade-I spondylolisthesis suitable for pars ... ...
| Abstract | Objectives: Pars repair is less explored in adults due to associated disc degeneration with advancing age. The aim of our systematic review was to define optimal characteristics of adults with spondylolysis/grade-I spondylolisthesis suitable for pars repair and evaluate the feasibility, effectiveness, and safety of standard repair techniques in these adults. Methods: This systematic review is reported in line with PRISMA-P and protocol is registered with PROSPERO (CRD42020189208). Electronic searches were conducted in PubMed, Embase, Scopus, and Web of Science in June 2020 using systematic search strategy. Studies involving adults aged ≥18-years with spondylolysis/grade-1 isthmic spondylolisthesis treated with standard pars repair techniques were considered eligible. A two-staged (titles/abstracts and full-text) screening was conducted independently by three authors followed by quality assessment using the Joanna Briggs Institute critical appraisal checklist for selection of final articles for narrative synthesis. Results: A total of 5,813-articles were retrieved using systematic search strategy. First screening followed by removal of duplicates resulted in 111-articles. Second (full-text) screening resulted in exclusion of 64-articles. A final 47-articles were considered for data extraction after quality assessment. A total of 590-adults were enrolled across 47-studies; 93% were 'young adults' (18-35 years); 82% were males. Persistent low back pain was the common presenting complaint. Lysis defect was primarily bilateral (96.4%) and L5 was the most involved level (68.5%). Majority had no disc degeneration (83.5%) and had spondylolysis as the primary diagnosis (86%); only 14% had grade-I spondylolisthesis. Pars infiltration test was conducted in 22-studies and discography in 8-studies. Duration of prior conservative therapy was 3 to 72-months. Buck's repair was the commonest technique (27-studies, 372-adults). Successful repair was reported in 86% of patients treated with Buck's and ≥90% treated with Scott's, Morscher's and pedicle-screw-based techniques. Improvement in pain/functional outcomes, union rate and rate-of-return to sports/activity was high and comparable across all techniques. Intraoperative blood loss was low with minimally invasive versus traditional repair. The overall complication rate was 11.9%, with implant failure being the major complication. Conclusions: Our systematic review establishes a definite place for lysis repair in carefully selected adults with spondylolysis/grade-I spondylolisthesis. We propose a treatment algorithm for optimizing patient selection and outcomes. We conclude that adults with age 18 to 45 years, no/mild disc or facet degenerative changes, positive diagnostic infiltration test, and normal preoperative discography will have successful outcomes with pars repair, regardless of the technique. |
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| MeSH term(s) | Adolescent ; Adult ; Algorithms ; Humans ; Lumbar Vertebrae/diagnostic imaging ; Lumbar Vertebrae/surgery ; Male ; Meta-Analysis as Topic ; Middle Aged ; Spinal Fusion ; Spondylolisthesis/diagnostic imaging ; Spondylolisthesis/surgery ; Spondylolysis/diagnostic imaging ; Spondylolysis/surgery ; Treatment Outcome ; Young Adult |
| Language | English |
| Publishing date | 2021-03-21 |
| Publishing country | United States |
| Document type | Journal Article ; Systematic Review |
| ZDB-ID | 2037072-6 |
| ISSN | 1878-1632 ; 1529-9430 |
| ISSN (online) | 1878-1632 |
| ISSN | 1529-9430 |
| DOI | 10.1016/j.spinee.2021.03.011 |
| Database | MEDical Literature Analysis and Retrieval System OnLINE |
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