RESTORATION OF THE VERTEBRAL ARCH INTEGRITY IN SPONDYLOLYSIS USING PERSONALIZED IMPLANTS

Abstract

Aim of the study To analyze the results of surgical treatment of young patients with spondylolysis using custom‑made implants. Material and Methods The article presents the results of surgical treatment for 36 patients with L5 spondylolysis and grade I–II spondylolisthesis, utilizing custom-made implants to stabilize the vertebral arch defect. The study involved an analysis of patient complaints and medical history, as well as an assessment of sagittal balance. CT imaging was used to evaluate congenital anomalies of the L5 and S1 vertebral arches and bodies, the location and stage of spondylolysis (according to the K. Fujii classification), and the integrity of the spinal fusion. MRI was employed to determine the stage of spondylolysis (according to Hollenberg) and the degree of intervertebral disc degeneration (according to Pfirrmann). Functional outcomes and quality of life were assessed using the PedsQL, VAS, and ODI questionnaires preoperatively and three months postoperatively. Results The study group comprised 22 (61.1%) female and 14 (38.9%) male patients. Patient ages ranged from 10 to 41 years, with a median age of 15.5 years. The follow-up period ranged from 3 to 46 months. Twenty-five patients (69.4%) were athletes. Classification according to the Hollenberg spondylolysis staging system revealed that stage II was the most common (38.9%). Regarding the Pfirrmann grade of intervertebral disc degeneration, grade I was the most frequent (47.2%). Grade I spondylolisthesis was diagnosed in 24 patients, grade II in 5, and spondylolysis without anterior vertebral body displacement in 7. Significant postoperative improvement in quality of life was reported by 35 of the 36 patients (97.2%). Postoperative complications occurred in 5 cases (13.9%). Conclusion The use of patient‑specific implants is an effective and technically feasible option for the surgical correction of spondylolysis and low-grade spondylolisthesis. The proposed technique demonstrated advantages over standard fixation methods. A full return to daily and sports activities was observed in the vast majority of cases, confirming the viability of the developed approach.