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Triple Procedure for Direct Pars Repair: An Innovative, Non-fusion Approach for Managing Spondylolysis in Late
Vibhu Krishnan Viswanathan1,2, Malmarugan Ramachandran1, Sathish Muthu2,3
1Department of Orthopaedics, Devadoss Hospital, Madurai, Tamil Nadu, India.
Introduction:
Pars repair can be a useful non-fusion technique to treat young patients presenting with symptomatic lumbar spondylolysis. We hereby describe an innovative technique (triple procedure) to effectuate healing of pars defect in a symptomatic 19-year-old.
Case Report:
A 19-year-old male patient presented with persistent mechanical low back pain, which was recalcitrant to conservative measures. We treated him surgically with the triple procedure involving bilateral intralaminar screws, autogenous iliac crest bone graft, and temporary intersegmental fixation with unilateral pedicle screw-rod construct. He recovered well symptomatology after the procedure, and the lytic pars defect healed satisfactorily (final follow-up at 2 years).
Conclusion:
The combination of bilateral intralaminar fixation, unilateral intersegmental pedicle screw fixation and bone graft application can offer excellent clinical benefit in relatively older patients with spina bifida occulta.
