Direct reduction and repair of spondylolysis with grade 1 slip using the smiley face rod: a case report

January 15, 2021

doi: 10.2185/jrm.2020-039.

Epub 2021 Jan 5.

Affiliations

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Shun Okuwaki et al.

J Rural Med.

2021 Jan.

doi: 10.2185/jrm.2020-039.

Epub 2021 Jan 5.

Affiliations

¹ Department of Orthopedic Surgery, Kenpoku Medical Center Takahagi Kyodo Hospital, Japan.
² Department of Orthopedics Surgery and Sports Medicine, University of Tsukuba Hospital Mito Clinical Education and Training Center Mito Kyodo General Hospital, Japan.
³ Department of Orthopedics Surgery, Faculty of Medicine, University of Tsukuba, Japan.

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Abstract

Objective: Lumbar spondylolysis, caused by stress fracture of the pars interarticularis may lead to a bony defect or spondylolisthesis. In adolescents, its surgical treatment employs the smiley face rod method for direct reduction of pseudoarthrotic spondylolysis and spondylolisthesis. Clinical outcomes of this treatment have been occasionally described; however, implant removal has not been discussed previously. We present a patient with lumbar spondylolysis with grade 1 slip at the 5th lumbar vertebra (L5) per the Meyerding classification. Patient: A 14-year-old boy presented with chronic severe lower back pain. Since conservative therapy did not resolve pain or enable resuming sports activities, the smiley face rod repair was performed 7 months after the initial treatment. Result: Anterior slippage of the L5 was surgically reduced. The patient wore a brace for 3 months postoperatively, and partial bone fusion was noted 6 months postoperatively. He resumed his sports activity 8 months postoperatively, and absolute bone fusion was confirmed 18 months postoperatively. Implant removal was performed 3 years postoperatively. Grade 1 slip was corrected with absolute bone fusion, and long-term follow-up revealed good results in terms of healing and rehabilitation. Conclusion: Smiley face rod method that allows for implant removal after bone fusion is suitable for adolescents.

Keywords:

direct reduction; implant removal; lumbar spondylolysis; smiley face rod method; spondylolisthesis.

Figures

**Figure 1**

Preoperative anteroposterior (A) and lateral (B) radiographs of the lumbar spine. The
dynamic views are shown in flexion (C) and extension (D). Radiographs revealed pars
defects at the 5th lumbar vertebra (L5) with grade 1 slip per the Meyerding
classification. The anterior translational movement was 6.9 mm and the Taillard index
was 16.9%.

**Figure 2**

Preoperative computed tomography (CT) and magnetic resonance imaging (MRI) of L5:
Sagittal CT scan of the right (A) and left side (B). The axial CT image (C) of the
pars defect. Short tau inversion recovery axial image (D) showing no bone marrow
edema.

**Figure 3**

Postoperative anteroposterior (A) and lateral (B) radiographs

**Figure 4**

Postoperative axial computed tomography (CT) scan showing compression over the pars
defect (A). CT scans demonstrate fracture healing 3 months postoperatively (B) and
partial bone union 6 months postoperatively (C). Eighteen months postoperatively,
the CT scan indicates the union of the pars defect (D).

**Figure 5**

Follow-up computed tomography (CT) images of the lumbar spine on the right side
(A–D), postoperative CT scan at 3 months, 6 months, and 18 months postoperatively,
and of the left side (E–H).

**Figure 6**

Postoperative radiographs show reduction with smiley face rod method 1-year
postoperatively; anteroposterior (A), lateral (B), dynamic flexion (C), and
extension (D). The slipped vertebra is reduced, and no slippage and screw loosening
are seen on the lateral radiograph.

**Figure 7**

Postoperative radiograph after the implant removal; anteroposterior view (A),
lateral view (B), and dynamic flexion (C) and extension (D). Radiographs show
maintained reduction and reduced instability.

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