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Background: Isthmic spondylolysis commonly occurs at L5 with causing low back pain in younger adults. Pars interarticularis fracture produced by repeated cumulative stress of the pars interarticularis resulting in pars microfracture, leading to bony defect. Persistent back pain and sometimes-radicular pain are common complaint. Objective: The aim of the current study was to evaluate the clinical results and complications after minimally invasive surgical approach of bilateral L5 pars interarticularis fracture by U shaped rod strategy technique. Patients and methods: A total 12 consecutive patients were reviewed retrospectively during the period from February 2019 to February 2022 with bilateral L5 pars interarticularis fracture. Preoperative symptoms, and postoperative results for those patients who underwent minimally invasive surgical approach for treatment of bilateral L5 pars interarticularis fracture, are all recorded. Results: Ten males and 2 females whose age ranged from 16 to 24 years. Clinical symptoms were: persistent low back pain in all patients (100%), radicular pain in 33% of patients (4 cases). The mean operative time was 82.5 (SD 11.8) minutes and the average blood loss was 206.5 (SD 47.8) ml. Post-operative assessments using the Oswestry scale showed improvement in 8 (66.6%). Three cases (25%) complain from mild back pain in exercise or during playing sport however the radiology showed good fusion. Failure of fusion with persistent of the complaint occurred only one case (0.08%) and re-surgery was done with the classic interbody fusion. Conclusion: Direct pars repair using U shaped road technique in bilateral fracture pars articularis in the lumbar spine should be the procedure of choice in the indicated cases with short hospital stay and early recovery to normal life.

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