Abstract
The hook screw method is a direct repair technique that permits ‘restitutio ad integrum’ for a functional segment. The surgical method of treating spondylolysis and grade 1 spondylolisthesis by spondylytic hook screw reduction and bone grafting in 34 patients is reported. Of these patients, 32 showed good to excellent results.
Surgical technique
The bone on either side of the defect is roughened. Then the screws are inserted after pre-drilling into the base of the articular process inclined at 400 to the vertebral endplate and diverging 15 to 20 degrees from each side. Then the special hooks, hooked under the lamina, are fixed to the screws by nuts over a spring so as to obtain compression over the defect. Autologous cancellous bone graft is placed in the defect.
Materials and methods
A total of 34 patients were included in this study from 1998 to 2006, 32 male and 2 female patients. Pre-operative and post-operative Oswestry Lumbar Disability Index score (OLDI) and SF 36 scores recorded.
Results
The response rate was 100%. The mean age of the patients was 34 years. Mean pre-operative OLDI score was 42 and post-operatively was 14. The results were subdivided into excellent, very good, good, no change and poor. An excellent result meant a greater than 15 point improvement on OLDI score; very good a 10-15 point improvement; good results a 5-10 point improvement. An excellent result was reported by 76% of patients, good to excellent results by 94% of patients and good and very good by 23 % of patients. 1 patient had no change and 1 was poor.
Conclusion
Direct repair of spondylolysis can be recommended for young patients to save a functional segment. The above mean 6 year follow-up shows encouraging results.
