Spondylolysis Pars Repair

Spondylolysis is a known spinal condition affecting up to 15% of the population in which a vertebrae has a definable fracture or crack in a segment of bone known as the pars interarticularis.

This is not a congenital condition, but rather acquired, appearing at the age of five and upwards. Athletes, in particular gymnasts, are susceptible because of the extreme stresses they place on their spine, particularly in hyperextension.

Most spondylolysis can be detected via x-ray and in certain cases a CAT scan or MRI is necessary as an adjunct study, and most can be managed with conservative management in the way of anti-inflammatory medications, cessation of painful activities, brace treatment, and occasionally injections.

When the back pain is not relieved by those treatments, or if pain begins to radiate to the legs because of nerve irritation as the body attempts a primitive repair of the lysis or fracture, then surgery may be warranted. Basic surgeries include either a fusion surgery, which would attempt to fuse one bone to the next, or a direct repair.

Direct repair is more often performed in a younger population in which there is no disc or shock absorber disease at the level of the spine or in adjacent levels.

Two common techniques include a screw and hook compression technique or a direct screw repair technique.

At the Center for Musculoskeletal Disorders, we have had significant success, particularly using the screw and hook compression technique. Enclosed is one of our X-rays on a recent 16-year-old basketball athlete who had a painful pars spondylolysis at L5 disc lumbar vertebrae for over a year with failed conservative pain management.