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Trans-isthmic pars interarticularis screw fixation under CT and fluoroscopic guidance: technical success and clinical outcome in patients with symptomatic low-grade lumbar isthmic lysis

  • Interventional
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

To assess the technical success of trans-isthmic screw fixation with simultaneous CT and fluoroscopic guidance in patients with symptomatic low-grade isthmic spondylolisthesis.

Methods

Fifty patients (28 women and 22 men; mean age ± standard deviation: 50 years ± 18.9) presenting with symptomatic low back pain with isthmic spondylolisthesis refractory to medical management were treated by means of trans-isthmic pars interarticularis percutaneous screw fixation. The procedure was performed under local anesthesia with double CT and fluoroscopic guidance. Primary outcome was technical success of the procedure, which was assessed with a post-procedure CT using the same success criteria as surgical screw placement with regard to entry point, trajectory, and screw tip. Secondary outcome was pain decrease assessed by the Visual Analog Scale (VAS).

Results

Ninety-nine procedures were performed in 50 patients and 99 screws were inserted. Postoperative CT assessment showed satisfactory screw placement in 96 cases, reflecting a technical success rate of 96.9%. No complications occurred during or after the procedure. Pain assessment showed a pain decrease of VAS score from a median of 7 (min 5, max 10; MAD 1.4) to 2 (p < 0.0001) (min 0, max 7, MAD 1.7) with a mean follow-up of 39 months.

Conclusion

Trans-isthmic screw fixation performed under CT and fluoroscopic guidance presents a high technical success and appears as a safe procedure and effective procedure in patients with symptomatic low-grade isthmic lysis.

Key Points

• Trans-isthmic pars interarticularis percutaneous screw insertion is feasible under double CT and fluoroscopic guidance by a radiologist with a high technical success.

• This technique can be performed under local anesthesia only.

• In patients with chronic low back pain, isthmic screwing allows long-term pain improvement.

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Abbreviations

ALIF:

Anterior lumbar body fusion

BMI:

Body mass index

CT:

Computed tomography

MAD:

Mean absolute deviation

ODI:

Oswestry Disability Index

PLIF:

Posterior laminectomy and interbody fusion

TLIF:

Transforaminal lumbar body fusion

VAS:

Visual Analogue Scale

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Funding

The authors state that this work has not received any funding.

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Authors and Affiliations

  1. Muskulo-Skeletal Radiology Department, Pasteur II University Hospital Nice, 30 voie Romaine, Nice, France

    Nicolas Amoretti, Elodie Cervantes, Nicolas Stacoffe & Pauline Foti

  2. Neurosurgery Department, Pasteur II University Hospital Nice, 30 voie Romaine, Nice, France

    Stephane Litrico

  3. Interventional and Diagnostic Neuroradiology Unit, Grenoble University Hospital, Boulevard du Grésivaudan, 38000, Grenoble, France

    Adrian Kastler

Authors
  1. Nicolas Amoretti
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  2. Elodie Cervantes
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  3. Nicolas Stacoffe
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  4. Pauline Foti
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  5. Stephane Litrico
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  6. Adrian Kastler
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Correspondence to Adrian Kastler.

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The scientific guarantor of this publication is Nicolas Amoretti.

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The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

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Amoretti, N., Cervantes, E., Stacoffe, N. et al. Trans-isthmic pars interarticularis screw fixation under CT and fluoroscopic guidance: technical success and clinical outcome in patients with symptomatic low-grade lumbar isthmic lysis. Eur Radiol 31, 8264–8271 (2021). https://doi.org/10.1007/s00330-021-07921-x

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  • DOI: https://doi.org/10.1007/s00330-021-07921-x

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