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Background and objective <p>Symptomatic lumbar spondylolysis often disables young athletes. We compared three motion-preserving techniques—modified Scott (MST), pedicle screw system (PSS), and dual-stability construct (DSC)—for pars healing and functional recovery.</p> Methods <p>We retrospectively reviewed 103 active adults (18–40 years) with L3/L4/L5 spondylolysis treated at a single centre between 2017 and 2023. Patients were allocated to modified Scott (MST, <i>n</i> = 33), pedicle-screw (PSS, <i>n</i> = 27) or dual-stability construct (DSC, <i>n</i> = 43). All underwent isthmic debridement, autologous grafting and identical rehabilitation. CT (computed tomography) evaluated pars healing; VAS (Visual Analogue Scale) and JOA-L (Japanese Orthopaedic Association) scores, complications and Magnetic resonance imaging (MRI) Pfirrmann grading were recorded.</p> Results <p>At 17.5 ± 6.5 months, DSC achieved the highest healing rate (95.3%) versus PSS (88.9%) and MST (60.6%) (<i>P</i> &lt; 0.001). DSC and PSS were independent predictors of healing (Risk ratios (RR) 12.9 and 4.6 vs. MST). JOA improvement was greatest with DSC (80.53%) and PSS (79.89%) versus MST (67.74%). MST exhibited 12% implant failure (spinous cut-through). No adjacent-disc degeneration was observed in PSS or DSC, supporting short-term motion preservation. CT type II/III defects and overweight status predicted non-union.</p> Conclusion <p>PSS and DSC offer significant advantages over MST for treating symptomatic lumbar spondylolysis in young active adults, with DSC yielding the most favorable outcomes. The dual-stability construct, integrating intra- and intersegmental fixation, enhances pars healing and maintains disc health, supporting its use as a motion-preserving and biomechanically robust technique. These findings may guide surgical decision-making and contribute to improved recovery and functional restoration in athletic youth.</p>

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Comparative outcomes of motion-preserving techniques for lumbar spondylolysis in young athletes

  • 期刊论文

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  • 发表日期：

    2025年10月31日

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  • Hui Wang,
  • Peng Niu,
  • Xiu Yang,
  • Xin Lin,
  • Guanyin Wu,
  • Xiaotang Sun,
  • Feiyue Lin

摘要

Background and objective

Symptomatic lumbar spondylolysis often disables young athletes. We compared three motion-preserving techniques—modified Scott (MST), pedicle screw system (PSS), and dual-stability construct (DSC)—for pars healing and functional recovery.

Methods

We retrospectively reviewed 103 active adults (18–40 years) with L3/L4/L5 spondylolysis treated at a single centre between 2017 and 2023. Patients were allocated to modified Scott (MST, n = 33), pedicle-screw (PSS, n = 27) or dual-stability construct (DSC, n = 43). All underwent isthmic debridement, autologous grafting and identical rehabilitation. CT (computed tomography) evaluated pars healing; VAS (Visual Analogue Scale) and JOA-L (Japanese Orthopaedic Association) scores, complications and Magnetic resonance imaging (MRI) Pfirrmann grading were recorded.

Results

At 17.5 ± 6.5 months, DSC achieved the highest healing rate (95.3%) versus PSS (88.9%) and MST (60.6%) (P < 0.001). DSC and PSS were independent predictors of healing (Risk ratios (RR) 12.9 and 4.6 vs. MST). JOA improvement was greatest with DSC (80.53%) and PSS (79.89%) versus MST (67.74%). MST exhibited 12% implant failure (spinous cut-through). No adjacent-disc degeneration was observed in PSS or DSC, supporting short-term motion preservation. CT type II/III defects and overweight status predicted non-union.

Conclusion

PSS and DSC offer significant advantages over MST for treating symptomatic lumbar spondylolysis in young active adults, with DSC yielding the most favorable outcomes. The dual-stability construct, integrating intra- and intersegmental fixation, enhances pars healing and maintains disc health, supporting its use as a motion-preserving and biomechanically robust technique. These findings may guide surgical decision-making and contribute to improved recovery and functional restoration in athletic youth.