Comparative analysis between pedicle screw-vertebral plate hook and temporary intersegmental pedicle screw in isthmic lumbar spondylolysis
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Published on: November 8, 2024
Jingyuan Li1,2, Zhijun Cai2, Yulei Wang3
1Department of Traumatology and Orthopedics, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, 830054, China.
Background:
Although temporary intersegmental pedicle screw (TIPS) fixation improves stability of the treated segment, its isthmic fusion rate relative to that achieved with pedicle screw-vertebral plate hook (PSVPH) fixation remains unclear. Both PSVPH and TIPS are widely used in clinical practice. This study compared the clinical and radiological outcomes of PSVPH and TIPS for the treatment of lumbar spondylolysis.
Methods:
A retrospective analysis was conducted on 67 patients with lumbar spondylolysis who underwent surgical treatment with PSVPH (n = 35) or TIPS (n = 32) between October 2010 and October 2021. Clinical outcomes included incision length, operative time, intraoperative blood loss, visual analog scale (VAS) score, Oswestry Disability Index (ODI), and Japanese Orthopedic Association (JOA) score. Radiographic assessments comprised range of motion, disc height of stabilized and adjacent segments, adjacent segment degeneration, and bony fusion. Three-dimensional reconstruction of lumbar computed tomography was used to evaluate fusion, and Hounsfield units of the isthmic region were measured to assess bone healing during follow-up. Independent Student's t-tests and chi-square tests were applied for intergroup comparisons.
Results:
A total of 67 patients were included in the analysis. Incision length, operative time, and blood loss were all significantly reduced in the PSVPH group compared with the TIPS group (all P < 0.001). The 1-week postoperative VAS back pain score was significantly lower in the PSVPH group (P < 0.001). JOA scores at 3, 6, 12, and 24 months showed significantly greater improvement in the PSVPH group (P = 0.003, 0.034, < 0.001, and 0.001, respectively). At 24 months, the range of motion of the stabilized segment was significantly greater in the PSVPH group than in the TIPS group (P < 0.001). Postoperative intervertebral height of the stabilized segment in the PSVPH group at 1 week and 24 months was significantly lower than that in the TIPS group (P = 0.001; P < 0.013). Adjacent segment intervertebral height at 24 months was higher in the PSVPH group (P = 0.012), whereas adjacent segment range of motion was significantly lower (P = 0.012). The incidence of adjacent segment degeneration at 24 months was 2.9% in the PSVPH group and 25% in the TIPS group (P = 0.022). Hounsfield units in the isthmic region at 3 and 6 months postoperatively were significantly higher in the PSVPH group than in the TIPS group (both P < 0.001). The bony fusion rate at 24 months was 91.4% (32/35) in the PSVPH group and 84.3% (27/32) in the TIPS group.
Conclusions:
The healing rate achieved with TIPS was comparable to that of PSVPH. However, TIPS was associated with greater invasiveness, slower healing, and a higher incidence of adjacent segment complications. PSVPH demonstrated superior safety and clinical effectiveness compared with TIPS for the treatment of lumbar spondylolysis.
