Repair of Pars Interarticularis Defect Utilizing a Pedicle and Laminar Screw Construct

2019 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Ryan Snowden ◽  
Rick Sasso
Keyword(s):  
Laminar Screw ◽  
Pars Interarticularis

Repair of pars interarticularis defect utilizing a pedicle and laminar screw construct: a new technique based on anatomical and biomechanical analysis

2012 ◽  
Vol 17 (1) ◽  
pp. 61-68 ◽  
Author(s):  
Rakesh D. Patel ◽  
Humberto G. Rosas ◽  
Michael P. Steinmetz ◽  
Paul A. Anderson
Keyword(s):  
Pedicle Screw ◽  
Spinal Canal ◽  
Biomechanical Analysis ◽  
Laminar Screw ◽  
Functional Spinal Unit ◽  
Significant Difference ◽  
Flexion Extension ◽  
Pars Interarticularis ◽  
Before And After ◽  
Biomechanical Tests

Object The theoretical advantage of pars interarticularis repair over spinal fusion to correct pars defects is that the treatment is a direct osteosynthesis that preserves motion at the involved functional spinal unit. Several techniques and constructs have been used to achieve greater rigidity, but these techniques may risk entry into the spinal canal, and adverse events are common. A pedicle and laminar screw construct placed entirely outside the spinal canal may offer greater stiffness and achieve higher pars defect healing rates. The purpose of this study was to biomechanically assess an intralaminar screw construct in cadaveric lumbar spines in comparison with other types of constructs typically used in pars repair and to quantify the sizes of screws that can be placed safely in both normal and spondylolytic vertebrae. Methods The L-4 and L-5 laminae in patients with spondylolysis and in controls who underwent CT (n = 41, each group) were measured by analysis of conventional axial CT images and multiplanar reformations constructed on a Vitrea workstation to determine the feasibility of translaminar fixation with a 4.5-mm-diameter screw. Biomechanical tests for torsion and flexion-extension were performed on 8 fresh human cadaveric lumbar spines before and after modeling for bilateral spondylolytic defects. Three pars repair techniques were tested at each level and in the following sequence: pedicle screw–cable, pedicle screw–rod–hook, and pedicle screw–intralaminar screw. Results The majority of laminae can accept 4.5 × 25-mm screws. The cable construct allowed the greatest motion and least stability across the defect in all biomechanical tests. The hook and laminar screw constructs performed similarly in all tests and exhibited no significant difference in stiffness. Conclusions A surgically placed intralaminar screw construct may be a safe and effective alternative to current pars repair methods.

Gout in the Axial Skeleton

2009 ◽  
Vol 36 (3) ◽  
pp. 609-613 ◽  
Author(s):  
RUKMINI M. KONATALAPALLI ◽  
PAUL J. DEMARCO ◽  
JAMES S. JELINEK ◽  
MARK MURPHEY ◽  
MICHAEL GIBSON ◽  
...  
Keyword(s):  
Facet Joint ◽  
Case Reports ◽  
Case Series ◽  
Lumbar Vertebrae ◽  
Axial Skeleton ◽  
Ct Images ◽  
Common Finding ◽  
Appendicular Skeleton ◽  
Pars Interarticularis ◽  
A Prospective Study

Objective.Gout typically affects the peripheral joints of the appendicular skeleton and rarely involves the axial joints. The literature on axial gout is limited to case reports and case series. This preliminary study was conducted to identify the frequency and characteristics of axial gout.Methods.Six hundred thirty medical records with ICD codes 274.0, 274.82, and 274.9 for peripheral gout were reviewed. Ninety-two patients had clinical or crystal-proven gout, of which 64 had prior computed tomography (CT) images of the spine performed for various medical reasons. These CT images were reviewed for features of axial gout, which include vertebral erosions mainly at the discovertebral junction and the facet joints, deposits of tophi, and erosions in the vertebral body, epidural space, ligamentum flavum and pars interarticularis.Results.Nine of the 64 patients had radiographic changes suggestive of axial gout. Lumbar vertebrae were most commonly involved, with facet joint erosions being the most common finding. Isolated involvement of the sacroiliac joints was seen in 2 patients. Axial gout had been diagnosed clinically in only one patient.Conclusion.Radiologic changes of axial gout were more common than recognized clinically, with a frequency of 14%. Since not all patients had CT images, it is possible that the frequency of axial involvement was even greater. A prospective study is needed to further define this process.

Clinical and radiologic outcome of laminar screw at C2 and C7 for posterior instrumentation—review of 25 cases and comparison of C2 and C7 intralaminar screw fixation

2010 ◽  
Vol 73 (2) ◽  
pp. 112-118 ◽  
Author(s):  
Jae Taek Hong ◽  
Jin Seok Yi ◽  
Jong Tae Kim ◽  
Chul Ji ◽  
Kyung Sik Ryu ◽  
...  
Keyword(s):  
Screw Fixation ◽  
Posterior Instrumentation ◽  
Laminar Screw

An Experimental Model of Adult-Onset Slip Progression in Isthmic Spondylolisthesis

2001 ◽  
Author(s):  
Avinash G. Patwardhan ◽  
James Simonds ◽  
Alexander J. Ghanayem ◽  
Leonard Voronov ◽  
Arif Ali ◽  
...  
Keyword(s):  
Experimental Model ◽  
Common Type ◽  
Leg Pain ◽  
Low Back ◽  
Isthmic Spondylolisthesis ◽  
Adult Onset ◽  
Pars Interarticularis ◽  
The One ◽  
Lumbar Spondylolisthesis

Abstract Spondylolisthesis is defined as a slippage of a vertebral body on the one below. Isthmic spondylolisthesis, caused by stress fracture or a developmental anomaly at the pars interarticularis, is the most common type of lumbar spondylolisthesis with a 6% incidence in adults. Isthmic lumbar spondylolisthesis is a frequent cause of disabling low-back and leg pain. The goal of this study is to improve the quality of treatment of these patients.

THE COMPARISION OF RADIOLOGICAL DISTANCE DIFFERENCE BETWEEN THE PARS INTER-ARTICULARIS AND PEDICLE, AS A REPRODUCIBLE AND CONSISTENT GUIDE FOR PEDICULAR SCREW FIXATION TECHNIQUE, IN SPINAL LUMBAR SURGERIES.

2021 ◽  
pp. 61-63
Author(s):  
Bharath. V ◽  
Hemanth Kumar ◽  
Ashwanth Narayan ◽  
Venkatachalam .K ◽  
Ashwin. VY ◽  
...  
Keyword(s):  
Ct Images ◽  
Steady Increase ◽  
Lateral Border ◽  
X Ray ◽  
Screw Insertion ◽  
Pedicular Screw ◽  
Pars Interarticularis ◽  
Upward Direction ◽  
Anatomical Relationship ◽  
Distance Difference

The Inter-Pedicular and Inter-Pars distance was measured in a plain AP radiography (X-Ray) of 150 and 75 CT images normal patients between 18- 47 years of age. The aim of the study is to measure the normal Inter-Pedicular and Inter-Pars distance. We found that by studying the anatomical relationship between the inner or medial Pedicular border and the Pars outer or lateral border, gives the Orthopaedic Surgeon a reproducible and consistent guide towards exacting a pedicular screw placing. We found that both X-Ray and CT images shows steady increase in the Ipr and Ipd from L1 to L5, there is a minimal difference from L1-L2 and marked difference seen from L3 to L5, and showing the differences in distances are more in the males, compared to females. The Means of all the groups compared also proves that there is steady raise in the diameter of the IPR and IPD from L1 to L5, where there is dramatical and signicant change in the upward direction, noted from L3 to L5. The mean difference is almost constant from L1to L2. So this study, did essentially to help, establish that, the inner medial border of pedicle, is in near relationship to, the outer lateral border of the Pars-Interarticularis, which helps in establishing the latero-medial entry point for the pedicular screw insertion in the lumbar spine.

The association of lumbosacral transitional vertebral anomalies with acetabular dysplasia in adult patients with hip-spine syndrome

2021 ◽  
Vol 103-B (8) ◽  
pp. 1351-1357
Author(s):  
Joshua Sun ◽  
Avneesh Chhabra ◽  
Uma Thakur ◽  
Louis Vazquez ◽  
Yin Xi ◽  
...  
Keyword(s):  
Acetabular Dysplasia ◽  
Intraclass Correlation ◽  
Final Diagnosis ◽  
Hip Pain ◽  
Pars Interarticularis ◽  
Vertebral Anomalies ◽  
Lumbosacral Transitional Vertebra ◽  
Standard Radiographs ◽  
Time Of Presentation ◽  
The Relationship

Aims Some patients presenting with hip pain and instability and underlying acetabular dysplasia (AD) do not experience resolution of symptoms after surgical management. Hip-spine syndrome is a possible underlying cause. We hypothesized that there is a higher frequency of radiological spine anomalies in patients with AD. We also assessed the relationship between radiological severity of AD and frequency of spine anomalies. Methods In a retrospective analysis of registry data, 122 hips in 122 patients who presented with hip pain and and a final diagnosis of AD were studied. Two observers analyzed hip and spine variables using standard radiographs to assess AD. The frequency of lumbosacral transitional vertebra (LSTV), along with associated Castellvi grade, pars interarticularis defect, and spinal morphological measurements were recorded and correlated with radiological severity of AD. Results Out of 122 patients, 110 (90.2%) were female and 12 (9.8%) were male. We analyzed the radiographs of 122 hips (59 (48.4%) symptomatic left hips, and 63 (51.6%) symptomatic right hips). Average age at time of presentation was 34.2 years (SD 11.2). Frequency of LSTV was high (39% to 43%), compared to historic records from the general population, with Castellvi type 3b being the most common (60% to 63%). Patients with AD have increased L4 and L5 interpedicular distance compared to published values. Frequency of pars interarticularis defect was 4%. Intraclass correlation coefficient for hip and spine variables assessed ranged from good (0.60 to 0.75) to excellent (0.75 to 1.00). Severity of AD did not demonstrate significant correlation with frequency of radiological spine anomalies. Conclusion Patients with AD have increased frequency of spinal anomalies seen on standard hip radiographs. However, there exists no correlation between radiological severity of AD and frequency of spine anomalies. In managing AD patients, clinicians should also assess spinal anomalies that are easily found on standard hip radiographs. Cite this article: Bone Joint J 2021;103-B(8):1351–1357.

MDP-SPECT Versus Hybrid MDP-SPECT/CT in the Evaluation of Suspected Pars Interarticularis Fracture in Young Athletes

2018 ◽  
Vol 28 (6) ◽  
pp. 635-639 ◽  
Author(s):  
Santhosh Gaddikeri ◽  
Manuela Matesan ◽  
Jacqueline Alvarez ◽  
Daniel S. Hippe ◽  
Hubert J. Vesselle
Keyword(s):  
Young Athletes ◽  
Pars Interarticularis
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