Russian Journal of Pediatric SurgeryRussian Journal of Pediatric SurgeryДетская хирургия1560-95102412-0677Eco-Vector94010.17816/ps940AEVERUReviewsНаучные обзорыReview ArticleSurgical repair of spondylolysis: open and minimally invasive approaches, analysis of clinical and radiological outcomes. A systematic reviewХирургическое восстановление спондилолиза: открытые и малоинвазивные доступы, анализ клинических и радиологических исходов. Систематический обзорhttps://orcid.org/0000-0002-0333-31057738-5108ChelpachenkoOleg B.ЧелпаченкоОлег Борисович
Russian Federation

MD, Dr. Sci. (Medicine), Assistant Professor

д-р мед. наук, доцент

Chelpachenko81@mail.ruhttps://orcid.org/0009-0008-4958-6256SmakhtinArtjom A.СмахтинАртем Андреевич
Russian Federation
maracun@yandex.ruhttps://orcid.org/0009-0002-5274-39416085-7940PimburskiyIvan P.ПимбурскийИван Петрович
Russian Federation
bdfyltvbljd@yandex.ruhttps://orcid.org/0000-0001-6966-10404890-8742YatsykSergey P.ЯцыкСергей Павлович
Russian Federation

MD, Dr. Sci. (Medicine), Professor, Corresponding Member of the Russian Academy of Sciences

д-р мед. наук, профессор, чл.-корр. РАН

macadamia@yandex.ruhttps://orcid.org/0000-0002-7542-82189703-4935ButenkoAndrey S.БутенкоАндрей Сергеевич
Russian Federation
butenko.as@nczd.ruhttps://orcid.org/0000-0003-3698-60118712-1738ZherdevKonstantin V.ЖердевКонстантин Владимирович
Russian Federation

MD, Dr. Sci. (Medicine)

д-р мед. наук

drzherdev@mail.ruNational Medical Research Center for Children's HealthНациональный медицинский исследовательский центр здоровья детейClinical and Research Institute of Emergency Pediatric Surgery and Trauma ― Dr. Roshal's ClinicНаучно-исследовательский институт неотложной детской хирургии и травматологии ― Клиника доктора РошаляRussian Medical Academy of Continuous Professional EducationРоссийская медицинская академия непрерывного профессионального образования14062026060720263021101230306202608062026Copyright ©; 2026,Copyright ©; 2026, Эко-вектор2026Эко-векторhttps://creativecommons.org/licenses/by-nc-nd/4.0/https://jps-nmp.ru/jour/article/view/940

Spondylolysis and isthmic spondylolisthesis are common causes of chronic low back pain, particularly among young and physically active individuals. Surgical repair of the pars interarticularis is considered a motion-preserving alternative to spinal fusion in patients with unsuccessful conservative treatment. Despite the variety of available techniques, their comparative effectiveness remains a matter of debate.

Aim is to compare the principal techniques of direct spondylolysis repair, identify the most effective approach, and determine the patient characteristics associated with optimal outcomes following pars interarticularis repair.

A systematic review was conducted in accordance with the PRISMA guidelines. Literature searches were performed in the PubMed and eLIBRARY databases covering the period from 2006 to 2026. Studies investigating surgical treatment of spondylolysis and/or isthmic spondylolisthesis using the Buck, Tokuhashi-Matsuzaki, U-rod techniques, and their modifications were included. A narrative synthesis of the data was performed. Study quality was assessed using the JBI and NOS appraisal tools. Fifty-two studies involving 781 patients were included in the final analysis. The Tokuhashi-Matsuzaki and U-rod techniques were the most frequently utilized. The overall mean computed tomography-confirmed fusion rate was 84.9%. The highest fusion rate was observed with the U-rod technique (97.0%). Clinical outcomes were favorable, with return-to-activity rates ranging from 73.9% to 97.0% and mean recovery times between 2.8 and 8.5 months. Complication rates were low, with infection rates up to 1.9% and implant-related complications up to 1.0%. Minimally invasive approaches demonstrated comparable effectiveness while being associated with reduced blood loss and shorter hospital stays. Surgical repair of spondylolysis is an effective and safe treatment option in carefully selected patients. Techniques providing greater biomechanical stability achieve superior radiological and clinical outcomes. Treatment success appears to depend primarily on appropriate patient selection, whereas the choice of a specific repair technique plays a secondary role.

Спондилолиз и истмический спондилолистез являются частой причиной хронической боли в поясничной области, особенно у молодых и физически активных пациентов. Хирургическое восстановление межсуставной части дуги позвонка рассматривается как органосохраняющая альтернатива спондилодезу при неэффективности консервативного лечения. Несмотря на разнообразие существующих способов, их сравнительная эффективность остаётся предметом обсуждения. Цели обзора ― сравнить основные способы прямого восстановления спондилолиза и определить наиболее эффективный; выявить характеристики пациентов, оптимально подходящих для хирургического восстановления межсуставной части (pars interarticularis).

Проведён систематический обзор в соответствии с рекомендациями PRISMA. Поиск литературы осуществлялся в базах данных PubMed и eLIBRARY за период с 2006 по 2026 год. Включались исследования, посвящённые хирургическому лечению спондилолиза/истмического спондилолистеза с использованием техник Buck, Tokuhashi–Matsuzaki, U-rod и их модификаций. Выполнен нарративный синтез данных. Качество исследований оценивалось с использованием инструментов JBI и NOS. В окончательный анализ включены 52 исследования (n = 781). Наиболее часто применялись способы Tokuhashi–Matsuzaki и U-rod. Средняя частота костного сращения по данным компьютерной томографии составила в целом 84,9%. Наиболее высокие показатели сращения отмечены при использовании способа U-rod ― 97,0%. Клинические исходы были благоприятными: доля пациентов, вернувшихся к активной жизни, составила 73,9–97,0%, средние сроки восстановления ― 2,8–8,5 месяца. Частота осложнений была низкой: инфекция ― до 1,9%, имплантассоциированные осложнения ― до 1,0%. Малоинвазивные доступы демонстрировали сопоставимую эффективность при меньшей кровопотере и дням госпитализации. Хирургическое восстановление спондилолиза является эффективным и безопасным методом лечения у тщательно отобранных пациентов. Техники, обеспечивающие более стабильную фиксацию, демонстрируют лучшие радиологические и клинические результаты. Успех лечения в значительной степени определяется правильным отбором пациентов, тогда как выбор конкретного способа играет второстепенную роль.

spondylolysisisthmic spondylolisthesislumbar spineminimally invasive surgerysurgical treatmentpars interarticularis repairdirect repairsystematic reviewспондилолизистмический спондилолистезпоясничный отдел позвоночникамалоинвазивная хирургияхирургическое лечениевосстановление межсуставной части дуги позвонкапрямое восстановлениесистематический обзорTawfik S, Phan K, Mobbs RJ, Rao PJ. The incidence of pars interarticularis defects in athletes. Global Spine J. 2020;10(1):89–101. doi: 10.1177/2192568218823695.Cyron BM, Hutton WC. Is spondylolysis a fatigue fracture? Spine (Phila Pa 1976). 1977;2(3):202–209. doi: 10.1097/00007632-197709000-00006Federal State Statistics Service (Rosstat) [Internet]. Population of the Russian Federation by age group, 2024. (In Russ.) Moscow: Rosstat; 2024. Available from: https://rosstat.gov.ru/ Accessed: 2025 Dec 15.Fredrickson BE, Baker D, McHolick WJ, et al. The natural history of spondylolysis and spondylolisthesis. J Bone Joint Surg Am. 1984;66(5):699–707.Mohammed N, Patra DP, Narayan V, et al. A comparison of the techniques of direct pars interarticularis repairs for spondylolysis and low-grade spondylolisthesis: a meta-analysis. Neurosurg Focus. 2018;44(1):E10. doi: 10.3171/2017.11.FOCUS17581Buck JE. Direct repair of the defect in spondylolisthesis. Preliminary report. J Bone Joint Surg Br. 1970;52(3):432–437.Tokuhashi Y, Matsuzaki H. Repair of defects in spondylolysis by segmental pedicular screw hook fixation: a preliminary report. Spine. 1996;21(17):2041–2045. doi: 10.1097/00007632-19960901000023Gillet P, Petit M. Direct repair of spondylolysis without spondylolisthesis, using a rod-screw construct and bone grafting of the pars defect. Spine. 1999;24(12):1252–1256. doi: 10.1097/00007632199906150-00014Kumar N, Gowda V, Kumar A, Wong H. Pars repair technique & rationale of treatment in adults: GP128. In: 37th International Society for the Study of the Lumbar Spine (ISSLS) Annual Meeting, 2010 Apr 13–17. Auckland, New Zealand: Spine Journal Meeting Abstracts; 2010.Endler P, Ekman P, Ljungqvist H, et al. Long-term outcome after spinal fusion for isthmic spondylolisthesis in adults. Spine J. 2019;19(3):501–508. doi: 10.1016/j.spinee.2018.08.008Ghobrial GM, Crandall K, Lau A, et al. Minimally invasive direct pars repair with cannulated screws and recombinant human bone morphogenetic protein: case series and review of the literature. Neurosurg Focus. 2017;43(2):E6. doi: 10.3171/2017.5.FOCUS17153Takeuchi M, Tezuka F, Chikawa T, et al. Consecutive double-level lumbar spondylolysis successfully treated with the double “smiley face” rod method. J Med Invest. 2020;67(1.2):202–206. doi: 10.2152/jmi.67.202Goncalves-Ramírez FJ, Serrano MT, Lee ShH, et al. Headless compression screw in the neuronavigation-guided and microscope-assisted treatment of spondylolysis. Neurocirugía (Engl Ed). 2018;29(3):122–130. doi: 10.1016/j.neucir.2017.07.008Sairyo K, Sakai T, Yasui N. Minimally invasive technique for direct repair of pars interarticularis defects in adults using a percutaneous pedicle screw and hook-rod system. J Neurosurg Spine. 2009;10(5):492–495. doi: 10.3171/2009.2.SPINE08594Tian W, Zhang Q, Han XG, et al. Robot-assisted direct repair of spondylolysis: a case report. Medicine (Baltimore). 2020;99(4):e18944. doi: 10.1097/MD.0000000000018944Fayed I, Conte AG, Voyadzis J. Success and failure of percutaneous minimally invasive direct pars repair: analysis of fracture morphology. World Neurosurg. 2019;126:181–188. doi: 10.1016/j.wneu.2019.03.026Mobbs RJ, Choy WJ, Singh T, et al. Three-dimensional planning and patient-specific drill guides for repair of spondylolysis/L5 pars defect. World Neurosurg. 2019;132:75–80. doi: 10.1016/j.wneu.2019.08.112Higashino K, Sairyo K, Katoh S, et al. Minimally invasive technique for direct repair of the pars defects in young adults using a spinal endoscope: a technical note. Minim Invasive Neurosurg. 2007;50(3):182–186. doi: 10.1055/s-2007-982511Lee GW, Lee SM, Ahn MW, et al. Comparison of surgical treatment with direct repair versus conservative treatment in young patients with spondylolysis: a prospective, comparative, clinical trial. Spine J. 2015;15(7):1545–1553. doi: 10.1016/j.spinee.2015.02.019Chung CH, Chiu HM, Wang ShJ, et al. Direct repair of multiple levels lumbar spondylolysis by pedicle screw laminar hook and bone grafting: clinical, CT, and MRI-assessed study. J Spinal Disord Tech. 2007;20(5):399–402. doi: 10.1097/01.bsd.0000211253.67576.90Peng B, Li D, Pang X. Surgical management of 3-level lumbar spondylolyses. Medicine (Baltimore). 2015;94(27):e1127. doi: 10.1097/MD.0000000000001127Brennan RP, Smucker PhY, Horn EM. Minimally invasive image-guided direct repair of bilateral L-5 pars interarticularis defects. Neurosurg Focus. 2008;25(2):E13. doi: 10.3171/FOC/2008/25/8/E13Yamashita K, Higashino K, Sakai T, et al. The reduction and direct repair of isthmic spondylolisthesis using the smiley face rod method in adolescent athlete: technical note. J Med Invest. 2017;64(1.2):168–172. doi: 10.2152/jmi.64.168Yurac R, Bravo JT, Silva Á, Marré B. Spondylolysis repair using a minimally invasive modified buck technique with neuronavigation and neuromonitoring in high school and professional athletes: technical notes, case series, and literature review. World Neurosurg. 2021;155:54–63. doi: 10.1016/j.wneu.2021.07.134Chen X, Zhou ShY, Jia LSh, et al. A universal pedicle screw and V-rod system for lumbar isthmic spondylolysis: a retrospective analysis of 21 cases. PLoS One. 2013;8(5):e63713. doi: 10.1371/journal.pone.0063713Li Y, Li H, Chang X, et al. Retrospective comparative study of pedicle screw fixation via quadrant retractor and buck’s technique in the treatment of adolescent spondylolysis. Orthop Surg. 2022;14(1):111–118. doi: 10.1111/os.13165Zhao Y, Wang H, Jiao G, et al. Comparison of direct pars repair techniques for spondylolysis in young patients: pedicle screw hook system versus pedicle screw rod. Altern Ther Health Med. 2024;30(10):472–477.Noggle JC, Sciubba DM, Samdani AF, et al. Minimally invasive direct repair of lumbar spondylolysis with a pedicle screw and hook construct. Neurosurg Focus. 2008;25(2):E15. doi: 10.3171/FOC/2008/25/8/E15Linhares D, Rodrigues PC, da Silva MR, et al. Minimum of 10-year follow-up of V-rod technique in lumbar spondylolysis. Eur Spine J. 2019;28(7):1743–1749. doi: 10.1007/s00586-018-5833-4Debnath UK, Freeman BJ, Grevitt MP, et al. Clinical outcome of symptomatic unilateral stress injuries of the lumbar pars interarticularis. Spine (Phila Pa 1976). 2007;32(9):995–1000. doi: 10.1097/01.brs.0000260978.10073.90Jamshidi AM, Soldozy S, Levi AD. Percutaneous direct pars repair in young athletes. Neurosurgery. 2023;92(2):263–270. doi: 10.1227/neu.0000000000002210Üçer M. Minimally invasive approach toward percutaneous direct pars repair: an observational study. World Neurosurg. 2021;146:e1301–e1306. doi: 10.1016/j.wneu.2020.11.165Yagi K, Kishima K, Tezuka F, et al. A Technical pitfall of decompression with direct repair of a ragged edge using the smiley-face rod method: a case report. J Med Invest. 2022;69(3.4):308–311. doi: 10.2152/jmi.69.308Nakayama Y, Yamashita K, Sugiura K, et al. Surgical management of stress fracture of the contralateral pedicle in a baseball player with unilateral lumbar spondylolysis: a case report. J Med Invest. 2020;67(3.4):382–385. doi: 10.2152/jmi.67.382Eldin MM. Minimal access direct spondylolysis repair using a pedicle screw-rod system: a case series. J Med Case Rep. 2012;6:396. doi: 10.1186/1752-1947-6-396Zhang Q, Chen Z, Lin Y, et al. The long-term outcomes after smiley face rod surgery in young lumbar spondylolysis patients. Sci Rep. 2025;15(1):22251. doi: 10.1038/s41598-025-04362-0Syundyukov AR, Nikolaev NS, Kuzmina VA, et al. Minimally invasive reconstruction of vertebral arch in spondylolisthesis in children and adolescents. Modern technologies in medicine. 2021;13(5):62–69. doi: 10.17691/stm2021.13.5.08 EDN: KCVBGVBarakat AS, Soliman WS, Elgharabawy AF, et al. Repair of spondylolysis using a pedicle screw U-shaped rod construct: a preliminary study of 25 young patients with a mean follow-up of 24 months. J Craniovertebr Junction Spine. 2021;12(2):170–177. doi: 10.4103/jcvjs.jcvjs_36_21Kim DY, Jin SR, Hur SM, et al. Direct repair of symptomatic lumbar spondylolysis using rod-screw-cable system. World Neurosurg. 2024;183:e625–e631. doi: 10.1016/j.wneu.2023.12.155Aebi M. Direct screw fixation of the spondylolysis without fusion. Eur Spine J. 2010;19(10):1803–1805. doi: 10.1007/s00586-010-1572-xRajasekaran S, Subbiah M, Shetty AP. Direct repair of lumbar spondylolysis by Buck’s technique. Indian J Orthop. 2011;45(2):136–140. doi: 10.4103/0019-5413.77133Narendran N, Nilssen PK, Walker CT, Skaggs DL. New technique and case report: robot-assisted intralaminar screw fixation of spondylolysis in an adolescent. Xanthoma Neurospine J. 2023;16:100284. doi: 10.1016/j.xnsj.2023.100284Debusscher F, Troussel S. Direct repair of defects in lumbar spondylolysis with a new pedicle screw hook fixation: clinical, functional and CT-assessed study. Eur Spine J. 2007;16(10):1650–1658. doi: 10.1007/s00586-007-0392-0Zayan M, Hussien MA, El Zahlawy H. Pars interarticularis repair using pedicle screws and laminar hooks fixation technique in patients with symptomatic lumbar spondylolysis. SICOT-J. 2022;8:13. doi: 10.1051/sicotj/2022013Okuwaki S, Tatsumura M, Gamada H, et al. Association of pars defect type with clinical outcome after smiley face rod methods for terminal-stage spondylolysis. Spine Surg Relat Res. 2023;8(1):58–65. doi: 10.22603/ssrr.2023-0084Guo X, Li Z, Guo Z, Li W. Factors associated with non-fusion after direct pars repair of lumbar spondylolysis with pedicle screw and lamina hook: a clinical and CT-assessed study. BMC Musculoskelet Disord. 2024;25(1):152. doi: 10.1186/s12891-024-07252-0Dong QY, Yang XF, Wu HL, et al. Comparison of the smiley face rod method versus intervertebral fusion for the treatment of L5 spondylolysis in adults. Front Med (Lausanne). 2024;11:1499773. doi: 10.3389/fmed.2024.1499773Akar A, Pehlivanoglu T, Aydogan M. Mid-term results of young adult patients who underwent autograft and direct pars repair using U-rod technique for lumbar spondylolysis. J Turk Spinal Surg. 2025;36(2):52–55. doi: 10.4274/jtss.galenos.2025.44153Okuwaki S, Tatsumura M, Gamada H, et al. Direct reduction and repair of spondylolysis with grade 1 slip using the smiley face rod: a case report. J Rural Med. 2021;16(1):56–61. doi: 10.2185/jrm.2020-039Teruya S, Okuwaki S, Gamada H, et al. Preoperative pars defect length predicts bone union after direct repair for lumbar spondylolysis using the modified smiley face rod technique: a retrospective cohort study. Asian Spine J. 2025;19(5):776–783. doi: 10.31616/asj.2025.0090Gao Y, Zhao C, Luo L, et al. Surgical reduction and direct repair using pedicle screw-rod-hook fixation in adult patients with low-grade isthmic spondylolisthesis. Biomed Res Int. 2022;2022:8410519. doi: 10.1155/2022/8410519Mansour MA, Mostafa HN. Pars screw fixation for symptomatic spondylolysis: a safe, cost-effective, and motion-preserving solution in resource-limited settings. Brain Spine. 2025;5:104390. doi: 10.1016/j.bas.2025.104390Li DM, Li YC, Jiang W, Peng BG. Application of a new anatomic hook-rod-pedicle screw system in young patients with lumbar spondylolysis: a pilot study. World J Clin Cases. 2022;10(17):5680–5689. doi: 10.12998/wjcc.v10.i17.5680Fan J, Yu GR, Liu F, et al. Direct repair of spondylolysis by TSRH’s hook plus screw fixation and bone grafting: biomechanical study and clinical report. Arch Orthop Trauma Surg. 2010;130(2):209–215. doi: 10.1007/s00402-009-0897-6Zhang T, Ma L, Liu H, et al. Comparing the Wiltse approach and classical approach of pedicle screw and hook internal fixation system for direct repair of lumbar spondylolysis in young patients: a case-control study. Medicine (Baltimore). 2023;102(37):e34813. doi: 10.1097/MD.0000000000034813Jiang J, Lin T, Chen X, et al. Using the pedicle screw-U rod system for the treatment of double-level lumbar spondylolysis and isthmic spondylolisthesis. Front Surg. 2024;11:1308389. doi: 10.3389/fsurg.2024.1308389Muthiah N, Ozpinar A, Eubanks J, et al. Direct pars repair with cannulated screws in adults: a case series and systematic literature review. World Neurosurg. 2022;163:e263–e274. doi: 10.1016/j.wneu.2022.03.107Stewart JJ, Zhao DY, Pivazyan G, et al. Minimally invasive robot-assisted direct pars repair: illustrative cases. J Neurosurg Case Lessons. 2024;8(11):CASE2415. doi: 10.3171/CASE2415Abdelhameid AK, Hassanin BG, Kenawy RK. Surgical outcome of minimally invasive U-shaped rod strategy in cases of L5 pars articularis fracture. Egypt J Hosp Med. 2023;91(1):4145–4151. doi: 10.21608/ejhm.2023.294356Li DM, Peng BG. Surgical treatment of four segment lumbar spondylolysis: a case report. World J Clin Cases. 2021;9(17):4408–414. doi: 10.12998/wj cc.v9.i17.4408Tatsumura M, Okuwaki S, Gamada H, et al. A novel technique for pars defect direct repair with a modified smiley face rod for spondylolysis and isthmic spondylolisthesis. Spine Surg Relat Res. 2023;7(4):396–401. doi: 10.22603/ssrr.2023-0021Güdü BO, Aydın AL, Dilbaz S, et al. Clinical results of restoration of pars interarticularis defect in adults with percutaneous intralaminar screw fixation. World Neurosurg. 2022;164:e290–e299. doi: 10.1016/j.wneu.2022.04.097