• Mathew R Voisin, Christopher D Witiw, Ryan Deorajh, Daipayan Guha, Adetunji Oremakinde, Shelly Wang, and Victor Yang.
• Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada. Electronic address: mvoisin@qmed.ca.
• World Neurosurg. 2018 Jan 1; 109: e609-e614.

Background/ObjectiveMultilevel spondylolysis is a rare cause of progressive lower back pain, and patients who fail conservative management are treated surgically. Direct repair methods can maintain mobility and lead to decreased morbidity compared with spinal fusion in single-level spondylolysis. In this paper, we present a patient with nonadjacent multilevel spondylolysis who underwent the "smiley face" technique of direct multilevel repair without fusion using 3-dimensional intraoperative spinal navigation.MethodsBilateral spondylolysis at L3 and L5 with associated spondylolisthesis in a 50-year-old male was repaired using the "smiley face" technique. Patient-reported outcomes, including the Oswestry Disability Index (ODI) and visual analog scale scores for back and leg pain, were assessed preoperatively along with 6 weeks and 4 months postoperatively.ResultsPostoperative computed tomography imaging showed precise screw insertion and rod placement along with stable hardware alignment in follow-up imaging. The patient's ODI and lower back visual analog scale scores decreased from 25 to 8 and 7.5 to 4, respectively, correlating to an excellent outcome on ODI.ConclusionDirect repair and avoidance of fusion is possible and can provide good functional outcomes in patients with nonadjacent multilevel spondylolysis and associated spondylolisthesis.Copyright © 2017 Elsevier Inc. All rights reserved.

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