Early Outcome of Repair of Symptomatic Pars Defect by Intra-Laminar Screws and Bone Graft

Out of wide range of surgical techniques direct repair techniques are emphasized to avoid fusion related complications in pars defects. To assess the clinical, functional and radiological outcome of direct operative repair of pars defects by intra-laminar screws and bone graft, this retrospective study was done in Bangabandhu Sheikh Mujib Medical University and in our private settings, within the period of July 2005 to December 2012. Records of 12 patients (age range, 21-35 years) with symptomatic pars defect, 07 men and 05 women (mean 28 years) who underwent direct pars repair with intralaminar screws and bone graft were reviewed. The surgical time, intra-operative blood loss, post operative hospital stay and time to achieve union was recorded. Self evaluated back pain [using Visual Analogue Score (VAS)] and disability [using Oswestry disability (ODI) questionnaire] was analyzed. Clinical outcome was assessed [using Modified Prolo Scale], Radiological fusion (using Shin criteria), restoration of total lumbar lordosis (TLL) and overall functional outcome [using Odom's Criteria] was calculated. Chi-squared test and paired-t test were used for statistical analysis using SPSS. The VAS, ODI and clinical outcome had significant (p<0.05) improvement as had the radiological fusion and TLL. Overall satisfactory outcome was achieved in 91.67% cases. Despite of no intra-operative or post-operative complications, pseudarthrosis developed in 01 case which could be managed conservatively. Direct repair of spondylitic defect with intra-laminar screws and bonegraft is satisfactory in properly selected cases.