Repair of pars defect in a patient accompanied with disc herniation by a modified Buck's

It has been generally accepted that spondylolysis will decrease the segmental stability of the lumbar spine, increase the load exerted on the disc at the spondylolytic level and the level above, accelerating disc degeneration.

Here we describe the Buck's technique enhanced with pedical screw-rod-hook construct and discuss the indication of direct repair of pars defect with disc herniation at caudal level and disc degeneration at cranial level of spondylolysis.

A 19 year-old man had suffered low back trouble in the course of 5 years and unilateral sciatica of 7 months. To treat it the limited disc discectomy was performed first.

Buck's screwing with modified angle of insertion enhanced with pedical screw-rod-hook construct and allograft surrounding the defect was finally accomplished. At the follow-up of one month after operation, he had no back pain or sciatica, and no disability in daily activities (VAS: 0), the modified Prolo Scale score was 8.

Direct repair of spondylolysis with disc degeneration at cranial adjacent level combined with disc herniation at spondylolytic level may be debatable. We take it as an alternative to the established treatment.