• Nallammai Muthiah, Alp Ozpinar, James Eubanks, Marc Peretti, Yagiz Ugur Yolcu, Austin Anthony, and Raymond F Sekula.
• University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
• World Neurosurg. 2022 Jul 1; 163: e263-e274.

ObjectiveLumbar spondylolysis occurs in 5%-8% of adults. This study aimed to report clinical and radiographic outcomes of direct pars repair in adults with lumbar spondylolysis.MethodsWe conducted a retrospective review of all patients treated for lumbar spondylolysis via open fracture reduction and direct pars repair with cannulated screws using a lag technique. Demographics, clinical presentation, perioperative and intraoperative imaging, and postoperative data were collected. We subsequently performed a systematic review to describe radiographic and clinical outcomes following direct pars repair.ResultsThree patients were identified (mean age 40.3 years; range, 21-72 years; 2 male). All patients had bilateral L5 pars fractures treated via open, direct repair with cannulated screws. There were no intraoperative complications. Length of stay was <24 hours for each patient. All patients reported back/radicular symptom relief and returned to full-time manual labor by latest follow-up. Noncontrast lumbar computed tomography performed 14-20 months postoperatively confirmed that all patients had good bilateral screw placement without fracture. Two patients (21 and 28 years old at surgery) had evidence of fusion across fracture sites, while 1 patient exhibited radiolucency around the screws and no progression of spondylolisthesis. Additionally, we reviewed 8210 articles and included 15 in a systematic review of direct pars repair. Fusion rates were 67%-100%, with improved average Oswestry Disability Index and visual analog scale back pain scores by latest follow-up.ConclusionsLumbar spondylolysis treatment with open fracture reduction and direct pars repair with cannulated screws in adults is safe and may result in mechanical back/radicular pain relief, even in the absence of radiographic fusion.Copyright © 2022. Published by Elsevier Inc.

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