Repair of isthmic pars interarticularis fractures: a literature review of conventional and minimally invasive techniques

Raffa, Scott J.; Luther, Evan; Levi, Allan D.

doi:10.23736/s0390-5616.19.04646-0

Cited by 4 publications

(15 citation statements)

References 58 publications

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“…Previous studies achieved same results with recovery to work and normal life within 3-6 months. Persistent back pain seen in 10% of previous results was improved with simple medications (26)(27)(28) . Complications such as Breakage of screws, failure of wire, cable and slippage of wire from the transverse process are frequently detected in wiring or laminar hook and Buck screws but rare failures occur in U shaped pars repair surgical techniques.…”

Section: Discussionmentioning

confidence: 94%

Surgical Outcome of Minimally Invasive U-Shaped Rod Strategy in Cases of L5 Pars Articularis Fracture

Abdelhameid¹,

Hassanin²,

Kenawy³

2023

The Egyptian Journal of Hospital Medicine

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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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Section: Discussionmentioning

confidence: 94%

Surgical Outcome of Minimally Invasive U-Shaped Rod Strategy in Cases of L5 Pars Articularis Fracture

Abdelhameid¹,

Hassanin²,

Kenawy³

2023

The Egyptian Journal of Hospital Medicine

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“…Spondylolysis refers to a fracture of the pars interarticularis, occurring either bilaterally or unilaterally, and most commonly involves the L4 and L5 pars segments [3,4]. Interestingly, congenital spondylolysis occurs due to weakening of the neural arch during early fetal development and differs in pathogenesis compared to that of the acute traumatic and pars elongation subtypes of spondylolysis [5]. Furthermore, due to the coronal orientation of the L5/S1 facet joint, the L5 pars interarticularis endures a great amount of stress and is a frequent location of injury [5].…”

Section: Introductionmentioning

confidence: 99%

“…Interestingly, congenital spondylolysis occurs due to weakening of the neural arch during early fetal development and differs in pathogenesis compared to that of the acute traumatic and pars elongation subtypes of spondylolysis [5]. Furthermore, due to the coronal orientation of the L5/S1 facet joint, the L5 pars interarticularis endures a great amount of stress and is a frequent location of injury [5]. Spondylolysis is a relatively common lower back defect, impacting 6-11.5% of the world's population [6].…”

Section: Introductionmentioning

confidence: 99%

“…X-rays are often the initial imaging modalities obtained, but there are a variety of studies such as computed tomography scan (CT), magnetic resonance imaging (MRI), bone scintigraphy, and single-photon emission computed tomography (SPECT) that can aid in diagnosis [10]. In terms of treatment, there are several surgical techniques available to patients who have failed conservative medical management [5]. Minimally invasive surgical techniques have proven to minimize adjacent soft tissue damage, decrease postoperative pain, increase patient satisfaction, and limit the amount of time away from work and/or competitive sports [5].…”

Section: Introductionmentioning

confidence: 99%

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

Minor,

Klein,

Sowah

et al. 2024

JCM

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Recurrent stress on the isthmic pars interarticularis often leads to profound injury and symptom burden. When conservative and medical management fail, there are various operative interventions that can be used. The current review details the common clinical presentation and treatment of pars injury, with a special focus on the emerging minimally invasive procedures used in isthmic pars interarticularis repair. PubMed and Google Scholar database literature reviews were conducted. The keywords and phrases that were searched include but were not limited to; “history of spondylolysis”, “pars interarticularis”, “pars defect”, “conventional surgical repair of pars”, and “minimally invasive repair of pars”. The natural history, conventional presentation, etiology, risk factors, and management of pars interarticularis injury are discussed by the authors. The surgical interventions described include the Buck’s repair, Morscher Screw-Hook repair, Scott’s Wiring technique, and additional pedicle screw-based repairs. Minimally invasive techniques are also reviewed, including the Levi technique. Surgical intervention has been proven to be safe and effective in managing pars interarticularis fractures. However, minimally invasive techniques often provide additional benefit to patients such as reducing damage of surrounding structures, decreasing postoperative pain, and limiting the time away from sports and other activities.

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“…Similar treatment strategies have been described in other areas of the spinal column. 2,6,9 In the subset of patients in whom compression is not reduced after traction alone, alternative decompressive approaches must be performed. [10][11][12] The authors provide a detailed video describing the preoperative evaluation and surgical management of a patient with a nonneoplastic periodontoid pannus secondary to craniocervical instability and spondylotic changes.…”

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confidence: 99%

Commentary: Transcondylar Odontoid Resection and Stabilization for Craniovertebral Degenerative Compression: 2-Dimensional Operative Video

Luther¹,

Kaur²,

Komotar³

et al. 2021

Operative Surg.

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Repair of isthmic pars interarticularis fractures: a literature review of conventional and minimally invasive techniques

Cited by 4 publications

References 58 publications

Surgical Outcome of Minimally Invasive U-Shaped Rod Strategy in Cases of L5 Pars Articularis Fracture

Surgical Outcome of Minimally Invasive U-Shaped Rod Strategy in Cases of L5 Pars Articularis Fracture

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

Commentary: Transcondylar Odontoid Resection and Stabilization for Craniovertebral Degenerative Compression: 2-Dimensional Operative Video

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