Pars screw fixation for symptomatic spondylolysis: A safe, cost-effective, and motion-preserving solution in resource-limited settings.

Background: Symptomatic spondylolysis is a debilitating cause of low back pain in young adults, often necessitating surgical intervention when conservative treatments fail. While spinal fusion has been the traditional approach, direct pars screw fixation-pioneered by Buck in 1970-offers a motion-preserving alternative that may reduce long-term complications. Methods: This study evaluated the efficacy of Buck's technique in 14 patients (mean age: 26.5 years) with grade 0 spondylolisthesis and normal disc morphology, all of whom had failed six months of non-operative management. Surgical outcomes, including fusion rates, operative time, blood loss, and clinical results, were assessed. Results: The procedure achieved a 78.5 % fusion rate, with mean operative times of 40 min and blood loss under 100 mL, demonstrating technical efficiency. Clinically, 71.4 % of patients reported excellent or good outcomes at 18-month follow-up, with no neurological complications. Three nonunion cases were attributed to the learning curve and the use of lamina-derived grafts instead of iliac crest bone. The single poor outcome occurred in a patient with undetected disc degeneration, highlighting the importance of strict patient selection. Conclusions: Pars screw fixation is a safe, rapid, and cost-effective solution for symptomatic spondylolysis, particularly in resource-limited settings where operative time and implant costs are critical. Its ability to preserve spinal mobility while addressing the pain generator makes it especially suitable for young, active patients.