Effectiveness Of Two Kinds Of Internal Fixation Combined With Isthmic Repair In Treatment Of Lumbar Spondylolysis

Objective To compare the clinical results of pedicle screw-lamina hook fixation and single-segment pedicle screw-rod fixation combined with isthmus repair for lumbar spondylolysis.Methods A retrospective analysis of the clinical data of 54 cases of spondylolysis who accepted operation from January 2008 to January 2016 in our hospital.They were divided into two groups,30 patients were fixed by pedicle screw-lamina hook fixation,24 patients were fixed by single-segment pedicle screw-rod fixation.The operation time,intraoperative blood loss,the number of intraoperative fluoroscopy,postoperative drainage volume,postoperative ground time,and hospitalization time of the two groups compared.The postoperative complications were also compared between the two groups.According to the results of imaging examination,the bone graft fusion of the two internal fixation methods was evaluated.The bone graft fusion was graded according to the Brown fusion standard,and the isthmus fusion results were statistically analyzed.The VAS score,ODI score and modified Macnab score were used to analyzed and compared the clinical efficacy of the two groups.Results The average follow-up time was 3.4(1.5-10.5)years.There is a statistically significant difference in the operation time and intraoperative blood loss between the two groups(P<0.05).There is no significant difference in the number of intraoperative fluoroscopy,postoperative drainage,postoperative ground time,and hospitalization time(P>0.05).There are no significant differences in ODI score,VAS score,and bone graft fusion rate between the two groups(P>0.05).In the single-segment pedicle screw-rod fixation group,one patient who with lower extremity symptoms had adjacent segments degenerated,,and 2 patients had internal fixation fractures.There are significant differences in internal fixation-related complications(internal fixation fracture,adjacent segment degeneration)(P<0.05).There are no complications such as nerve injury,infection,and scalp effusion in both groups.Conclusion Pedicle screw-lamina hook fixation combined with single-segment pedicle screw-rod fixation combined with isthmus bone grafting for the treatment of lumbar spondylolysis both can obtain a satisfactory isthmus fusion rate,thereby alleviating low back pain and improving quality of life.Pedicle screw-lamina hook fixation has the advantages of relatively simple operation,less operation time,and less intraoperative blood loss.Single-segment pedicle screw-rod fixation may be more likely to have internal fixation-related complications than pedicle screw-laminar hook fixation.