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360 fusion after failed repair of pars defect

Started by RichardT on 05/20/2016 5:10am

I had two good years after successful Buck repair of pars defect but unfortunately the Buck repair eventually failed. See my posts elsewhere under pars defect repair etc. I am a physically active doctor having played rugby for ten years then rowing then regular road cycling and skiing. Developed severe LBP at age 46 and diagnosed with degenerative L5/S1 disc with bilateral pars defect and grade 1 spondylolisthesis. Minimal relief with PT.. Short term relief f rom direct pars block injection. Had direct pars defect/spondylolysis repair using Buck technique of titanium screws across pars with bone auto-graft, This was great for 2 years. Full pain relief, returned to cycling and three x ski trips. Thought it was all fine.

Then after lifting heavy bags up several flights of stairs (oops) had recurrence of LBP as the graft had cracked. To cut a long story short (including failed attempt at revision of Bucks) I ended up in really bad state with severe LBP and severe bilateral foot pain from S1 nerve compression.. So i finally bit the bullet and I have had a 360 fusion at L5/S1. That is 2 stage surgery. First an anterior operation to insert STALIF graft and cage. Then one week later a minimal access PLIF with pedicle screws and rod. Got instant relief after the ALIF as 15mm disc height restored. Now day 3 post second surgery and already walking stairs and going home.

This is much more major surgery but was my only option. Will see how it goes.

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6 weeks post op and the result is amazing.
Abdominal operation was very uncomfortable for a few days and the posteroir minimal access instrumentation (MAS PLIF) was painful weeks 2-6.
The post op X rays are amazing. Normal lordosis restored by the STALIF implant with is a 15 mm wedge shaped implant.
pain improved and back feeling stronger each day.
No regrets for trying the Buck repair but I now realise this is the definitive repair


Hello Richard,
After the bucks repair, had your fracture(s) totally fused?

Be well



I had a good result but with the disc underneath in bad shape I cracked my grafts eventually


Hi Richard
I hope you are still well & would like to hear your opinion of things...

1. Now that stem cells are able to be used to regenerate discs, do you think the bucks repair would be a good choice in todays realm.
2. Did you develop adjacent vertebral pains elsewhere now that you have had fusion, and your body has to move with locked up vertebras.
3. Do you still need pain killers and antidepressants like many people I've spoken to who are post fusion surgeries do.

I have bilateral pars fractures with associated desiccated disc on l4/l5 with grade 2 spondylolysis.

I have been an incredibly talented gymnast, could walk on my hands 100ft & now struggle just to walk on my feet without agonising pain.

My understanding is that arthritis and diseases that lock up body joints are detrimental to patient health so I cant understand why medical practice fuses vertebral joints unless no option is left.

Unfortunately fusions are most surgeons first choice, when there are probably better first choices like screwing the pars back onto the vertebra it came off, so it works like it should rather than creating a whole new biomechanic system.

your thoughts greatly appreciated