Retrospective Comparative Study of Pedicle Screw Fixation via Quadrant Retractor and Buck's Technique in the Treatment of Adolescent Spondylolysis.

OBJECTIVE: To compare the effectiveness and practicality of pedicle screw fixation via the Quadrant retractor and Buck's technique in the treatment of adolescent spondylolysis. METHODS: A total of 31 patients who underwent pedicle screw fixation or Buck's technique at our hospital from 2012 to 2017 were selected for this retrospective study. The patients were divided into a pedicle screw group (16 patients) and a Buck's technique group (15 patients) according to surgical procedure. Age, sex, disease duration, involved segments, preoperative Oswestry disability index (ODI) scores, visual analogue scale (VAS) scores for low back pain (LBP), intraoperative blood loss, incision length, operative time and length of hospital stay were documented. ODI scores, VAS scores for LBP and fusion rates at 1 month, 6 months, 1 year and 3 years postoperatively were used to evaluate surgical outcomes. RESULTS: The average follow-up period was 32.75 ± 11.99 months in the pedicle screw group and 31.02 ± 9.64 months in the Buck's technique group. No significant differences in demographic data and perioperative data were found between the two groups (P > 0.05). The ODI scores and VAS scores for LBP in both groups were significantly improved at 3 years postoperatively compared with the values before surgery (ODI%: 45.74 ± 2.47 vs 10.99 ± 3.00; 45.29 ± 6.94 vs 15.73 ± 6.89. VAS: 5.94 ± 0.68 vs 1.50 ± 0.52; 6.13 ± 0.74 vs 2.13 ± 0.92, P < 0.05). The ODI scores of the patients in the pedicle screw group at 1 month to 3 years postoperatively were lower than those of the patients in the Buck's technique group (P < 0.05). Moreover, the VAS scores for LBP of the patients in the pedicle screw group at 6 months and 3 years postoperatively were lower than those of the patients in the Buck's technique group (P < 0.05). No significant difference in the VAS scores for LBP was found between the two groups at 1 month postoperatively (3.88 ± 0.50 vs 4.20 ± 0.56, P = 0.10). Three years postoperatively, good fusion of the pars interarticularis was achieved in all patients in the pedicle screw group, but four patients in the Buck's technique group did not achieve good fusion (P = 0.02). CONCLUSION: Both pedicle screw fixation and Buck's technique can achieve good outcomes in the treatment of adolescent spondylolysis. Pedicle screw fixation via the Quadrant retractor for the treatment of spondylolysis is associated with more satisfactory effects in terms of LBP relief and fusion results.

Comparison of MED and PELD in the Treatment of Adolescent Lumbar Disc Herniation: A 5-Year Retrospective Follow-Up.

OBJECTIVE: To compare the efficacy and safety of minimally endoscopic discectomy (MED) and percutaneous endoscopic lumbar discectomy (PELD) in the treatment of adolescent lumbar disc herniation (ALDH). METHODS: We retrospectively collected data from 30 patients with ALDH who underwent MED and 48 patients with ALDH who underwent PELD at our hospital between January 2010 and January 2012. Baseline data included age, sex, symptom duration, and surgical segment. Perioperative data included duration of surgery duration, blood loss, and duration of postoperative hospitalization. The Oswestry Disability Index (ODI) and visual analog scale (VAS) for both the lower back and leg were recorded as surgical outcomes. All surgical outcomes were recorded before surgery, at 1 week after surgery, at 6 months after surgery, and at final follow-up. RESULTS: There were no significant differences in baseline data between the MED and PELD groups. Both groups showed improvements in ODI and VAS scores before surgery and at the final follow-up time point (P < 0.05); however, the MED group had a higher mean ODI score at 1 week (12.44 ± 6.39 vs. 7.25 ± 6.40; P = 0.02) and 6 months (9.33 ± 7.43 vs. 3.97 ± 7.64; P = 0.04) after surgery. In addition, mean VAS scores for lower back pain were higher in the MED group at 1 week (1.93 ± 1.39 vs. 0.91 ± 0.85; P = 0.01), 6 months (1.80 ± 1.15 vs. 0.61 ± 0.94; P = 0.00), and final follow-up (1.87 ± 1.46 vs. 0.65 ± 0.88; P = 0.00), as was mean VAS score for radicular pain at 1 week after surgery (1.48 ± 0.76 vs. 0.74 ± 0.81; P = 0.01). One patient in each group experienced recurrent lumbar disc herniation. No other complications were reported in either group. CONCLUSIONS: Both PELD and MED are effective and safe surgical techniques for the treatment of ALDH; however, compared with MED, PELD is more advantageous for lower back pain and provides more rapid resolution of radicular pain.