Spondylolysis and Pars Repair Technique

Abstract

Spondylolysis is an important cause of low back pain in children and adolescents, especially in those involved in athletic activities. Spondylolysis is caused either by a fracture or by a defect in the pars inter-articularis and can be unilateral or bilateral. Among the various hypotheses regarding the etiopathogenesis of pars lysis, the occurrence of chronic micro-fractures secondary to repetitive extension and rotational stresses across pars remains the most convincing explanation to date. The majority of these patients remain asymptomatic. Imaging contributes to the staging and prognostication of the lesions, planning the line of management, and monitoring the response to treatment. Nonoperative treatment with activity restriction, braces, graded physiotherapy, and rehabilitation forms the cornerstone of management. Surgery is indicated in a specific cohort of patients whose symptoms persist despite an adequate conservative trial and includes spinal fusion and pars defect repair techniques. Patients who demonstrate good pain relief after diagnostic pars infiltration can be considered for pars repair. Patients aged ≤25 years, those with an athletic background, unilateral pathologies, and those without associated spondylolisthesis, instability, or disc degeneration are ideal candidates for pars repair. The overall outcome in spondylolysis is good, and 85% to 90% of athletes return to sports at 6 months following conservative or surgical line of treatment. In this current narrative review, we comprehensively discuss the etiology, patho-anatomy, natural history, clinical features, diagnostic modalities, and management of spondylolysis with special emphasis on direct repair techniques of pars.

Pars Interarticularis Fractures Treated with Minimally Invasive Surgery: A Literature Review

“…The technique described by Buck in 1970 involved the internal reduction of the fracture by inserting a single cortical screw across the pars defect after placing the supporting autologous graft into the defect (Figures 3A and 4) [37,38]. After utilizing this direct repair technique on a total of 16 patients, Buck reported only one failure, which was described as the loosening of both screws and an unstable lamina one year after the procedure was performed.…”

Biomechanical Effects of a Novel Pedicle Screw W-Type Rod Fixation for Lumbar Spondylolysis: A Finite Element Analysis

“…Surgery such as direct pars repair, traditional instrumented fusion, or dynamic fixation is recommended if conservative treatment has failed [ 6 , 7 , 8 ]. Direct pars repair surgery can reduce pain, speed healing, decrease the risk of degeneration, and enable patients to resume normal activities [ 8 , 9 ]. However, pars repair surgery can only address pain originating from the pars interarticularis [ 9 ].…”