BACKGROUND: Back pain in adult patients with a pars‐interarticularis defect may be due to movement at the defect or abnormal inter‐segmental movement at the adjacent degenerate disc. We hypothesize that the defect may be the only source of pain in certain adults, even if the MRI scan shows an abnormal disc and spinal fusion may be unnecessary.
OBJECTIVE: To form a protocol of management in adults with pars defect and adjacent level disc degeneration. To study the results of primary lysis repair using ‘AO Morscher clamp’ in patients with ‘spondylolysis’ or ‘Grade 1 ‘spondylolisthesis’.
METHODS: This is a prospective study involving adults with ‘spondylolysis’ or ‘Grade 1 ‘spondylolisthesis’ not responding to conservative management. We developed a protocol to investigate these patients with a lysis block and discography, to offer them appropriate treatment. On this basis fourteen patients were offered a lysis repair and bone grafting using ‘Morscher's clamp’ & six were offered spinal fusion. Outcome was assessed using Visual Analogue Score (VAS) and Oswestry Disability Index (ODI) done pre‐operatively and six months & 2 years post‐op.
RESULTS: Out of twenty patients (28 to 45 years; 8males and 12 females), fourteen patients underwent primary lysis repair using ‘AO Morscher clamp’ showing union of pars by 4 months (Follow‐up duration of 2 years). Six patients underwent fusion. Mean VAS improved from 7.2 to 1.2 in lysis repair group and 7.8 to2.4 in the fusion group. Mean ODI improved from 68 % to 24% for the lysis repair group. All patients had full range of spinal movement postop.
CONCLUSION: A thorough pre‐operative workup of patients with pars defect and adjacent level disc degeneration showed that pain is due to the pars defect in 70% of our cohort. This subgroup of patients could successfully be treated with ‘lysis repair’ rather than a more morbid procedure –'spinal fusion'.