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Comparison of surgical treatment with direct repair versus conservative treatment in young patients with spondylolysis: a prospective, comparative, clinical trial

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Authors
Lee, Gun Woo; Lee, Sun-Mi; Ahn, Myun-Whan; Kim, Ho-Joong; Yeom, Jin S.
Issue Date
2015
Publisher
Elsevier
Citation
The Spine Journal, vol.15, pp. 1545-1553
Keywords
SpondylolysisLumbar spinePars defectDirect repairNonsurgical treatment1-year follow-up
Abstract
BACKGROUND CONTEXT: Although direct repair (DR) with screw fixation at the pars
defect is a common surgical treatment for lumbar spondylolysis, it is unknown whether DR
leads to better outcomes for young patients with spondylolysis than traditional nonsurgical
treatment.
PURPOSE: The purpose of the study was to investigate whether DR was associated with better
outcomes for lumbar spondylolysis in young patients than traditional conservative treatment.
STUDY DESIGN: This is a prospective cohort study.
PATIENT SAMPLE: Of 1,784 patients with low back pain in the reference period, 149 young
patients with spondylolysis who followed up for at least 1 year were enrolled in the study.
OUTCOME MEASURES: The primary outcome was pain intensity at the lower back measured
with a Visual Analog Scale. Secondary outcomes included the functional outcome as measured with
the Oswestry disability index (ODI) and the 12-item short-form health survey (SF-12) consisting of
the physical component summary (PCS) and mental component summary (MCS) scores, the radiologic
outcome as measured with lumbar spine radiographs and computed tomography scans, and
complications of treatment.
METHODS: This was a prospective comparative study between two groups of patients who were
treated with either conservative treatment or surgery for lumbar spondylolysis. Enrolled patients
self-selected their own treatment and were allocated to either the traditional care group with
conservative treatment (87 patients) or the surgery group (62 patients). All patients were followed
up for at least 1 year.
RESULTS: Pain intensity at the lower back did not differ significantly between groups at the final
follow-up. Likewise, the ODI and SF-12 (PCS and MCS) scores did not differ significantly between
groups (p5.13, .71, and .68, respectively). The change in the gap distance of the pars defect at the
final follow-up was significantly different between groups (traditional care group: þ0.860.4 mm;
surgery group: –0.760.5; p5.01). The union rate at 1 year after surgical treatment was 52% (32/
61). The rate of complications was significantly higher in the surgery group (31%) than the
traditional care group (20%) (p5.02).
CONCLUSIONS: Conservative treatment for young patients with spondylolysis may produce similar
clinical outcomes and fewer complications over 12-month follow-up than surgical treatment with
DR.
Language
English
URI
http://hdl.handle.net/10371/94797
DOI
https://doi.org/10.1016/j.spinee.2015.02.019
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College of Medicine/School of Medicine (의과대학/대학원)Orthopedic Surgery (정형외과학전공)Journal Papers (저널논문_정형외과학전공)
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