Medical Questions > Conditions and Diseases > Back Pain Forum

Surgery to repair pars fracture (Page 1)

Must Read
What structures make up the spine? We review basic spine anatomy here...before identifying potential causes of back pain....
Click here to learn about the most common causes of back pain, and things that increase your risk of backache. We cover lower back pain and upper back pain....
Back pain symptoms may seem obvious. But do you know when symptoms of back pain are more serious or when to see a doctor? Learn what action to take & when...
I am curious if anyone has either had or considered having surgery to directly repair a pars fracture in a case of spondylosis, instead of fusion. I am a 43yr old male, formerly very athletic who is extremelty limited in activity due to low back pain. X-rays, MRI, CT and spec bone scan confirm that I have bilateral L5 pars fracture and that my L5S1 disc is good and only mild degernation in L4/L5. No slipage or pain into my legs either. Only instability.

Anybody in a similar condition or may have considered surgery to directly repair the pars fracture, instead of fusion? thanks.
Did you find this post helpful?
First Helper bg190
|

replied March 13th, 2008
Experienced User
Probably not a good idea. Pars fractures are defects in the posterior spinal arches that are composed of irregular curved shapes of bone that is relatively thin. Cementing the fracture would not provide enough stability against further fracture and translational sheer forces. Plating would be very difficult due to the curvature of the inferior articular process that are fractured. Rods would be too large for a direct repair. Stress forces on whatever arthrodesis construct employed would probably eventually break down. Most with pars fractures have at least microinstability of the spinal column at that level.
|
Did you find this post helpful?

replied March 13th, 2008
My understanding from my doc, is that there are a number of techniques that have been used successfully in treating pars fracture. Those techniques include iring, interfragmentary screws, pedicle screw-rod constructs, and pedicle screw-rod-hook constructs. See edited to remove link My doc has a good video discussing the various techniques: edited to remove link

But, in the same video the dr. states that direct pars repairs is not for adults, as the spoondylo is never the cause of pain. Do you have any experience with pars fractures? Anybody ever deal with this.

thanks, scott
|
Did you find this post helpful?

replied March 13th, 2008
Experienced User
Pars fractures are indeed not always painful, therefore do not necessarily warrant repair unless there is demonstrated instability of the complex. The pedicle screw/hook situations are indirect repair of the pars by using larger adjacent bony structures for support.
|
Did you find this post helpful?

replied March 14th, 2008
That is exactly, what my doc told me algosdoc. He looked at the MRI and said my discs are in pretty good shape, especially the L5S1, so he believes its the pars defect is causing me the pain. He also did a number of physical tests to confirm. He stated that he wanted me to have the pars defect injected with lidocaine to confirm, and then we could discuss in detail the possibility of repairing the pars. (he also said not to repair the pars unless I have alot of pain. The other test would be a discogram to see if the discs were pain generators, but he thought the pars injectinon would be alot easier on me. He also mentioned that if it is not the pars, he would not consider me for fusion as I do not have any pain in my legs, sciatica, etc. and would rather see me continue with conservative therapy.

So, do you believe I am on the right path with this doc? The challenge for me is that if I am not active, I do not have pain. I would love to be active again, I have 3 small kids and was very athletic, skiing, biking, etc. But, would not consider fusion since I am not in contant pain and there is no apparent nerve impingement. What do you think of surgery to directly repair the pars in my case? thanks.
|
Did you find this post helpful?

replied January 9th, 2010
I have a question, I am not at all active, as I've had a lot of bone pain(all over, but started in my hip) for about 3 years. So not at all active for 3 years, had an x-ray of back and hips last year, showed nothing. Pain got really bad about a month go- x-ray showed"bilateral pars fracture at L5-s1 with grade 1 antral listhesis of L1on S1. I don't understand how I could have gotten fractures when I barelky move off the couch anymore? The doctor says I may have been born this way and I'd just have to deal with it, but if this was so, wouldn't have shown last year? or on the MRI 2 years ago? I can'tstand for more than a minute without getting stabbing pins all up and down leg, and if I walk downhill particularl my legs shake real baf and have to take tiny steps. I assumed this was due to inactivity-muscle loss, but is it possible it's from this?
|
Did you find this post helpful?

replied January 9th, 2010
Extremely eHealthy
hi jbch
i'm not a doc but i read a lot on the spine.
the bone called pars can weaken internally due to low density or arthritis. that would make it more suseptable to a fracture.
i believe i read somewhere that infants have never been born with pars defect.
also i've read that a dr can inject pain killing sustances into the area to see if pain is reduced. if it is then pain is being generated by that defect.
i believe a discogram would have to be preformed to determine if the pain is from the antral listhesis....
it looks like further testing is needed to determine source of pain and a plan of action....pete
|
Did you find this post helpful?

replied January 9th, 2010
I'm no doc, but here is my understanding from talking to a number of docs on the issue. Algosdoc, who is a doc, is right when he says the pars fractures do not cause pain themselves. If you do some online research, the fractures to the pars usually happen when you are a kid. MRIs do not show bone fractures, only x-rays or cat-scans. So, you probably have had them all your life. The progression for pars fractures is that the vertabrae becomes unstable and eventually may slip. In your case, your L5 has slipped by evidence of your listhesis. So, the pars are not causing your pain, the listhesis and resulting nerve impingement is. If you were to have fusion, you would remove the disk material impinging the nerves and also stabilize the unstable structure.

Though, some docs believe nerves grow in the fractured area of the pars in an attempt to heal the fracture. These docs believe people like me then have pain when there is force applied across the pars fracture, when the nerves pick up the movement. But, this kind of pain is more localized and would typically not run down your legs, etc. That is exactly my pain.

Again, that's my understanding. I hope it was helpful.

Scott
|
Did you find this post helpful?

replied January 9th, 2010
Scott and Pete,
Thank you both for your answers, they were helpful I tried google, etc, and something else always came up in the name, never as specific s here, I believe I understand a little better now-Thank you so much-
|
Did you find this post helpful?

replied February 9th, 2010
well i hate to be the one to bust the bubble here but obviously algosdoc does not know to much about a pars fracture becaue i am a 24 year old that had the surgery 4 months ago for two pars fractures on both sides of my l5 and i went to the mayo clinic for everything and the pars fracture will cause pain i can promise you that much because the ppl at the mayo clinic are some of the best docs and surgeons you are going to find and they are the ones who told me that the pars was causing pain
|
Did you find this post helpful?

replied April 13th, 2012
pars defect repair surgery
can you please include what Dr operated and what mayo clinic and if it was successful. I need surgery and it hard to find a great surgeon who performs pars defect repair surgery. I live in Atlanta but will travel anywhere.
|
Did you find this post helpful?

replied April 13th, 2012
can you please include what Dr operated and what mayo clinic and if it was successful. I need surgery and it hard to find a great surgeon who performs pars defect repair surgery. I live in Atlanta but will travel anywhere.
|
Did you find this post helpful?

replied July 5th, 2012
Can you tell me how your recovery has been from the surgery? I have a 15 year old son with pars fracture on L3 both sides and we are considering surgery as well.

Thanks.
|
Did you find this post helpful?

replied October 2nd, 2012
I have been dealing with my sons pars pain for 3 yrs and we finally found a knowledgeable surgeon who knows what he is talking about and can repair it. He said if its not better in 6 months the best solution is surgery. My son was just operated on and his leg pain went away immediately. The out look for his back pain is also very positive. I can tell you surgeons I found that have performed the pars defect repair. Most recommend fusion which is better than nothing but not your first choice. I don't want anyone to get the run around like we did, let me know how I can give you more info and I will help. Most surgeons haven't performed the operation needed and don't understand why you are having such significant pain so they can't give good advice because they don't have the experience.
|
Did you find this post helpful?
Users who thank jaybo55 for this post: sheryltc 

replied October 6th, 2012
We've been dealing with our son's problem for 3 years too! I posted further down on your other post - we are also in the Atlanta area. We have had the run around for sure - I am very interested in how your son is doing and who you found that did the surgery.
Looking forward to hearing back from you - Thanks!!!
|
Did you find this post helpful?

replied October 31st, 2012
My son is 16 yrs old. We went to a Chriopractor today for lower back pain. He took xrays and found L-3 pars defect that has been there for a very long time. It shows a great deal of build up around the "fx". This, apparantly, shows that it is an old defect. The pain he has is unrelated to this defect. He never had any significant pain in that area. I'm not sure what to expect. I will be seeing a specialist soon. Can someone give me some pointers
|
Did you find this post helpful?

replied September 25th, 2012
pars defect repair
How was your recovery from the pars fracture surgery? What Mayo Clinic do you go to? And who is the doctor that did you surgery?

I hope that you have had complete success & healing!
|
Did you find this post helpful?

replied October 1st, 2012
My Daughter just went through direct repair of a bilateral pars fracture at L4. She is a Division 1 recruit in track and field for throwing the shot put and discus. She had mimimally invasive surgery where they decortified the bone, inserted 4mm screws across the fractures and used Bone morphogenetic proteins (BMP)to aid in the fusion process, at Mayo in Rochester on Aug. 3. She is 9 weeks post op and has no pain other than surgical pain (the first three weeks post-op). The Dr.s at Mayo are wonderful and are extremely confident she will compete this spring and continue on in college. She new from the onset of the low back pain and the diagnosis of the pars fracture that it wasn't going to conservatively heal. After our first consultation with the Dr.s from Mayo she told me that she knew her body and that this wasn't going to get better. Six more weeks of rest and rehab and their was no improvment so at that point we decided to have the surgery. Time will tell but hopefully by early December she will be back lifting and preparing for the spring season.
|
Did you find this post helpful?

replied October 1st, 2012
Thank you so much for your reply! I am so glad to hear that your daughter is doing well - I hope and pray that she continues to heal and will be able to continue her college athletics.
My son was a cross country/track long distance runner. He was not able to continue running - and has had to completely give even running recreationally.
I know there is a Mayo clinic in Jacksonville FL. Did you go the one in Rochester b/c it was closer to you? Or were you referred to that one due to the specific problem?

I am so encouraged by your story and will share with my son. He has seen 3 different orthopedic back specialists in the Atlanta area - and all said he was too young for surgery - which makes no sense as he was a high school senior at diagnosis.
|
Did you find this post helpful?

replied October 2nd, 2012
We have a Mayo affiliated hospital in Eau Claire WI where we live but had the surgery done in Rochester. They would not do the surgery in Eau Claire because they didn't have all the equipment needed. There was a pediatric orthopedic surgeon that comes to Eau Claire once a month that saw her first. He was in on the surgery along with another orthopedic surgeon from Rochester that is world renowned. Rochester is only about 1 hr. and 45 min. away. She had surgery on Friday and was home Tuesday at noon. She is riding an elliptical 30 minutes a day and only doing core strengthening exercises at this time. Because of the fusion of the pars fracture they are anticipating a 4-6 month period before total healing when she should be able to return to full training.
|
Did you find this post helpful?

replied October 2nd, 2012
We have a Mayo affiliated hospital in Eau Claire WI where we live but had the surgery done in Rochester. They would not do the surgery in Eau Claire because they didn't have all the equipment needed. There was a pediatric orthopedic surgeon that comes to Eau Claire once a month that saw her first. He was in on the surgery along with another orthopedic surgeon from Rochester that is world renowned. Rochester is only about 1 hr. and 45 min. away. She had surgery on Friday and was home Tuesday at noon. She is riding an elliptical 30 minutes a day and only doing core strengthening exercises at this time. Because of the fusion of the pars fracture they are anticipating a 4-6 month period before total healing when she should be able to return to full training.
|
Did you find this post helpful?

replied May 9th, 2013
That is very encouraging to hear about your daughters surgery and its sucess. i dont know if you still are around this site a year later but i am looking into having this same type of surgery and any information you could give me would be great.
|
Did you find this post helpful?

replied October 1st, 2012
My Daughter just went through direct repair of a bilateral pars fracture at L4. She is a Division 1 recruit in track and field for throwing the shot put and discus. She had mimimally invasive surgery where they decortified the bone, inserted 4mm screws across the fractures and used Bone morphogenetic proteins (BMP)to aid in the fusion process, at Mayo in Rochester on Aug. 3. She is 9 weeks post op and has no pain other than surgical pain (the first three weeks post-op). The Dr.s at Mayo are wonderful and are extremely confident she will compete this spring and continue on in college. She new from the onset of the low back pain and the diagnosis of the pars fracture that it wasn't going to conservatively heal. After our first consultation with the Dr.s from Mayo she told me that she knew her body and that this wasn't going to get better. Six more weeks of rest and rehab and their was no improvment so at that point we decided to have the surgery. Time will tell but hopefully by early December she will be back lifting and preparing for the spring season.
|
Did you find this post helpful?

replied October 2nd, 2012
just fyi there is wonderful surgeon in Atlanta that does pars defect repair surgery if you are located in the southeast.
|
Did you find this post helpful?

replied October 6th, 2012
Yes! We are in the Atlanta area!! I read your message above about "dealing with it for 3 years!" That is us too!!! My son was a senior in high school when he was diagnosed. We've been to 3 chiropractors, 2 orthopedic back specialists, a sports injuries specialist at Emory Spine Center in Atlanta and a pain mgmt dr - with no help. He's still having pain. The Emory dr. just could not understand the pain that my son was having.
So I am VERY INTERESTED in your son's treatment & the doctor that he saw. Thank you!!!
|
Did you find this post helpful?

replied October 6th, 2012
Yes! We are in the Atlanta area!! I read your message above about "dealing with it for 3 years!" That is us too!!! My son was a senior in high school when he was diagnosed. We've been to 3 chiropractors, 2 orthopedic back specialists, a sports injuries specialist at Emory Spine Center in Atlanta and a pain mgmt dr - with no help. He's still having pain. The Emory dr. just could not understand the pain that my son was having.
So I am VERY INTERESTED in your son's treatment & the doctor that he saw. Thank you!!!
|
Did you find this post helpful?

replied October 7th, 2012
I dont think I can put a doctors name on this website but I think I can help you and your son if we can talk over the phone or via email. I dont know how to arrange that. My sons surgery is only ten days old and the pain his legs is gone and his back is also getting much better. I am new to these types of blogs. How can we talk outside this website?

Jabo55
|
Did you find this post helpful?

replied October 8th, 2012
You can email me. Please let me know a part of your email so I will know it's you when I receive your email.

thanks!
|
Did you find this post helpful?

replied October 9th, 2012
Sheryltc,

Did you get my private message with the dr. I sent you at! the hospital in atlanta? Please confirm via private message. I got a thank you but couldnt tell if it was just an automated response or not.
|
Did you find this post helpful?

replied October 9th, 2012
No I did not get the email from you. I did get an email from this administration that I can't put my email address on here. And it's been removed.
Do you know of any other way to get the info to me?
|
Did you find this post helpful?

replied October 16th, 2012
Sheryltc, I sent you a private message with the drs name in atlanta. I will also send you my email in the private message so hopefully they will comethrough to you soon. Jaybo55
|
Did you find this post helpful?

replied October 16th, 2012
Where are you sending the private message? I've not rec'd anything in my email box. Is there a way to send private messages on this site?

Just not sure where to find the private message that you sent.
|
Did you find this post helpful?

replied February 9th, 2010
oh and the surgery i had done was bone fusions on both sides and two screws
|
Did you find this post helpful?

replied December 3rd, 2010
Hi I've also got pars defect and am in a lot of pain, trying to look at my options!
Has anyone had direct pars repair as opposed to fusion?
I'm 19 so it sounds like this could be an option, and I'd rather keep the mobility if possible as I've always been very active and hope to return to it.
If anyone's had it done, what was the result like?
Please share any info!
Thanks Smile
|
Did you find this post helpful?

replied February 7th, 2011
pars defect
I have bilateral pars defect at L5-S1. I have been in pain for 10 years 5 of which I have had pain going down my legs and in my hips as well. Ortho after Ortho and Doctor after Doctor told me that my pain was imaginary and I should not hurt that much. It even hurts to touch my back. I finally went to see a Neurosurgeon and he told me 100% that I had a bilateral pars fracture and of course it hurts and causes problems and any dr that disagreed did not deserve a license. We are starting with a pars block and if that does not work then probably surgery. I am currently see a Chiropractor and as this was one of the recommendations I have already eliminated that from helping all the way. I hope everyone gets better and I hope my pain stops soon.
|
Did you find this post helpful?

replied November 7th, 2011
My case
Hi i am 15 years old and i too have a pars fracture on L4. I am very active as i play lacrosse mountain biking and a competitive alpine skier.i was recently diagnosed with it and it threw me for a loup hole. I first started having pain in july while weight lifting. However, they told me that it happened 6-12 months ago. It was a shocker. I first got an xray. They didnt find anything then i got an mri nothing again. Finally i got a cat scan which showed the pars fracture bilaterally on both sides. The second doc i saw said to wait four weeks till i am pain free. He said we may consider surgery if pain still occurs. Its been four weeks and i still have pain eventhough i have been doing a lot of phyisical therapy and swimming. Every thing else i do hurts it. Its not a hurtful pain but its annoying knowing that its still their. I Know a lot of people with the same case however they recieved surgery. Should i skip the ski season for surgery or not ski to help my progress on this? Any suggestions?
|
Did you find this post helpful?

replied July 5th, 2012
I have a 15 year old son the that has pars fracture on L3 both sides. We are considering surgery as well. Did you decide to have surgery? If so, how has your recovery been?

Thanks.
|
Did you find this post helpful?

replied November 7th, 2011
My case
Hi i am 15 years old and i too have a pars fracture on L4. I am very active as i play lacrosse mountain biking and a competitive alpine skier.i was recently diagnosed with it and it threw me for a loup hole. I first started having pain in july while weight lifting. However, they told me that it happened 6-12 months ago. It was a shocker. I first got an xray. They didnt find anything then i got an mri nothing again. Finally i got a cat scan which showed the pars fracture bilaterally on both sides. The second doc i saw said to wait four weeks till i am pain free. He said we may consider surgery if pain still occurs. Its been four weeks and i still have pain eventhough i have been doing a lot of phyisical therapy and swimming. Every thing else i do hurts it. Its not a hurtful pain but its annoying knowing that its still their. I Know a lot of people with the same case however they recieved surgery. Should i skip the ski season for surgery or not ski to help my progress on this? Any suggestions?
|
Did you find this post helpful?

replied April 13th, 2012
there are a number of techniques that have been used successfully in treating pars fracture. Adding more information to get details of pars fracture ask
|
Did you find this post helpful?

replied July 21st, 2012
treatment for old L5 pars fracture
Hi everyone. I have just found out I have a bilateral L5 pars fracture. From a bone scan it appears to be an old fracture. This may explain what happened 6 years ago when I thought I herniated a disc working out with a trainer. I have pain in the R gluteus medius muscle and pins/needles on the side of R ankle and into my foot and toes. My ileopsoas, hamstrings and calf muscles are tighter on the right too. The pain is not bad in AM and gets worse as day progresses. Over the years the pain has been coming on earlier and earlier. Flexion and extension xray shows no spondylolisthesis. A neurosurgeon wants to do a graft repair of the pars and L5/S1 fusion. I just started wearing a brace and it helps some. I would like to avoid surgery if at all possible. My current approach is to wear a brace and try rolfing and PT to realign and strengthen core supporting muscles. If that doesn't work, maybe see the surgeon. Anyone have a similar story?
|
Did you find this post helpful?

replied October 7th, 2012
Surgery should be the last choice but it is an option that can repair the pars fracture. Mynson had similar although more severe symptoms on both sides of his back and legs. He just had surgery and all of his leg pain was gone immediately. You just have to find the right surgeon hopefully near where you live. HSS has one and their are 2 in atlanta. I also know someone in the UK. Goodluck with the pt and bracing.
|
Did you find this post helpful?

replied October 7th, 2012
Surgery should be the last choice but it is an option that can repair the pars fracture. Mynson had similar although more severe symptoms on both sides of his back and legs. He just had surgery and all of his leg pain was gone immediately. You just have to find the right surgeon hopefully near where you live. HSS has one and their are 2 in atlanta. I also know someone in the UK. Goodluck with the pt and bracing.
|
Did you find this post helpful?

replied September 3rd, 2012
I'm 21 years old and just had my life taken away from me! This is due to bilateral pars fractures, degenerative disc disease, bulging disc, and mild spondylothesis. I've been to an ortho, then got a second opinion @ cincinnati spine institute. I've also had a few primary care docs bc it seems as though they think I'm lying abt this pain, I've also lost friends & family due to lack of understanding. Now I feel like I'm losing my own self!! I hate to see others are in pain from this fracture bc I know the hell you're going through but I'm also relieved to see I'm not the only one experiencing pain. The only surgery recommended was something to do with rods being placed, cutting through the front AND back of me, with a painful recovery. The only thing I remember the ortho saying is that "you will never be 100% again and you will still have pain after the surgery." REALLY? Why even go through with the surgery then?? It'd be nice to hear what others have to say abt this, especially if you are close to my age bc people this young w/o experience just do not understand.
***********Praying for all*****************
|
Did you find this post helpful?

replied October 2nd, 2012
I am not a Dr but went thru something similar with my son. My advice is that the pain caused by the pars fractures will not get better without surgery if you have already tried strengthening you core and bracing for six months. Read my previous posts. We and many surgeons tell us my 22 yr old sons pain should be there until we found doctors who had sen enough athlete's to know better and had the experience to operate. You are not crazy you just haven't found the right surgeon. A pars defect surgery recovery is painful for 6 to twelve weeks but there is hope. You have to find a great surgeon who has done this surgery in order to get good advice. Mayo in Rodchester didn't help us when we went there so even there you need to speak face to face with someone that has performed the surgery before. There is hope, don't give up! Find a surgeon you trust! God bless you!
|
Did you find this post helpful?

replied September 3rd, 2012
Hi Loraina. Don't give up! What I keep telling myself is that this isn't rocket science and we just have to find someone who understands the complexity. What bothers me is that I can't seem to get a consensus from people I've seen. If you have a consensus about what's going on, that's good. A clear diagnosis is what I'm after at this point - then I'll see what can be done. There are minimally invasive procedures out there so I would check those out before I would get really invasive procedures you're referring to.
|
Did you find this post helpful?

replied April 6th, 2013
Pars Fracture on L3
My 14 yr old daughter has had pain in her back for going on three years. She is a comp cheerleader and does a lot of tumbling. After many Drs, Chiropractors and therapists (who were treating her for a bulging disc) we finally went to the Texas Back Institute in Plano, TX. They did one xray and told us she has a pars fracture on her L3. After 8 wks of bracing, the pain has not subsided so she is having surgery on May 1st. They will be taking bone from her pelvis and grafting it into the fracture (which is a bilateral complete). She will then be wearing the brace for 3 months at which time we will do an MRI to determine if the bone is healing. The Dr said that surgery is necessary due to the pain not going away from bracing, but it obviously wasn't the first choice. My daughter just wants to be out of pain. Our Dr said that 80% of patients will heal and be able to resume their prior activities. That's what we are praying for as she wants to be a collegiate cheerleader. Hope this helps anyone else going through a similar thing. Don't give up....we live in Arkansas and have been going through this for almost 3 years before we found out what was really wrong with her!
|
Did you find this post helpful?
12 >>