Medical Questions > Conditions and Diseases > Back Pain Forum

Bilateral Pars Interarticularis- L5

My 13yo daughter was just diagnosed with this. The pediatrician didn't know what it was and asked the radiologist. He told her the basics and she looked up in med books. She is referring us to Ped Ortho, that is back specialist. What exactly is this and what should I be asking of the Ortho? I am a RN and understand quite a bit medically, but can't find much info to see what usual treatment is. She has been having low back pain for about a month, with it being severe at nights. Any info would be helpful.
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replied July 14th, 2008
Bilateral Pars Interarticularis
My daughter is very active on a competitive soccer team, a cheerleader, and very active kid. She is a little overweight and we are working on her losing weight in a healthy diet. She is 5'2" tall and 150 lbs. Should she be restricting activity for now? What about swimming and jumping around?
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replied July 15th, 2008
Active User, very eHealthy
Hello Cricketke,

Sorry to read about the issue with your daughter. YES, do ask the Ortho the questions you have raised here.

And then may I suggest that you seek a 2nd opinion. In my view 2nd opinions are always a good idea.

Regarding the activity for your daughter, I believe that is best answered by the Ortho. Give him/her a call and speak with the doctor about the activity questions you pose here.

Hope all goes well for your daughter.

RichT
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replied July 16th, 2008
Active User, very eHealthy
Hello cricketke as you probably know bilateral means both sides.

Pars Interarticularis is a portion of the bone at the rear of the vertebrae that is between the top, and bottom of the two facet joints that guide motion between the vertabra. So they are talking about this part on the left and the right.

I believe the condition is when there is a separation or fracture through the Pars Interarticularis, dividing the main vertebral body at the front from structures at the rear of the vertebra.

Its most commonly seen at L5 the bottom vertebra, and can result in spondylolysis, which is when one vertabra slips forward in relation to the other vertebra, i think you should restrict her activity for now and ask the ortho about it.

all the best
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replied September 3rd, 2011
Hi- My name is Adam

I'm a 22 year old Athlete. I have been struggling with a lower back injury for nearly a year now with not only a lack of improvement, but actual regression in my health. I stared with bilateral stress reactions in the L5 Pars Interarticularis area- I was told to brace and refrain from physical activity which I did do. I went in for a follow up MRI and cat scan (because I was told by bracing and not aggravating the injury, the pain would subside-- which it did not) which revealed the stress reactions had broken through into full bilateral fractures. There is my background, Here is my question/dilemma.

I am an athlete, as I mentioned. Not just a kid who played football in high school, I was a 4 sport varsity athlete and I went on to play 2 sports at the college level. I am beyond my competitive years, but It is very important to me to get back as close the level of my ability/agility before this injury occurred. I understand I may never get to 100% which is disheartening enough, but that is still where I am aiming to get back to. I want to know if I should continue with the non invasive methods of treatment, or should I risk the surgery?

On one hand, it has been a year of using every single non invasive method that any doctor had suggested (Physical therapy, taking prescription drugs, acupuncture, massage, podiatry, a new bed, about 6 different back braces, 2 Epidurals and 2 Facet Blocks) The Facet block was fairly effective in reducing my pain by 35%-40% for the few days following the procedure.

On the Other, I have this feeling that if they put hardware in my back (they are suggesting a "sling" surgery not a fusion) I am committing to a lifetime of back problems and soreness even if it helps, I cannot imagine it not presenting some problems. None of the non invasive methods have worked. I am very much at a loss, I don't know what to do.

Meanwhile, the issue is quite urgent not only because of the the major things I need to accomplish in my life, but because I have been on these pain killers for so long, I must have habituation issues; although nothing would make me happier than to stop taking these damn pain pills, I have a feeling that because I have been using them as a crutch to help go about my days while in a copious amount of pain.

Does anybody have any advice for me? Is the Surgery my next move, or should I not give up yet?
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replied September 3rd, 2011
Hi there Adam, sorry to hear you are going through this too. I started this post with questions regarding my 13 yo. She is now 16 and is still very athletic and competitive. She had a L5-S1 fusion with hardware. It took quite a while healing time (off school 1 full quarter, off sports totally for 9 months). Then a year later she was having a follow-up visit and the doctor told us she had not made any new bone from the bone graft and she had to have a revision of the fusion. They put a block of bone in from the front to hold the bone in place. She healed quickly from that, feeling better in just a few weeks. Now all is going great for the most part. She has been cleared to participate in any sport that she wants to. She plays on HS soccer team and is a cheerleader and on color-guard team(flags for marching band). She does have back pain, especially when standing or walking for long times. (Parades just kill her!) But her determination to do her sports is greater than her will to give in to the pain. She doesn't take anything except over-the-counter meds such as naproxysin. Her pediatrician recently asked her if she regretted having back surgery, her reply was quickly, "NO, it doesn't hurt as much as it did before the surgery. The pain I have now, I can deal with because I know it will let up eventually." So it depends on how determined you are to be active and involved in sports again. There are professional athletes that have this surgery and are able to return to their sport.

My suggestion to you would be to consult with a sports medicine doctor. At this point, I would suggest that you consider surgical options. The problem with pain meds all the time is that it takes more and more to control the pain the longer you are on them. I took my dtr to a spinal surgeon, then when he wanted to do surgery, I got a second opinion from a neurologist and he recommended the same procedure and said that there would be no better surgeon at that than the one she already had been seeing. Find a reputable surgeon. Usually the head of the spine surgery dept at a hospital. They don't get to be the head of a dept if they have a lot of complications or are a sloppy surgeon.

Good luck with your decision. Hope my information helps you some.
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replied September 5th, 2011
Especially eHealthy
Adam_L5,

Defects in the pars interarticularis can be from many different etiologies: They can be congenital (a type of spina bifida); from repetitive microtrauma causing stress reactions and ultimately fractures; dysplastic changes causing elongation the pars; metabolic disorders; and tumors. The defect is known as spondylolysis.

Once the fractures have occurred on both sides of the spinous processes, the anterior and posterior elements of the vertebra are no longer connected through the complete bony ring. But, the vertebrae are held securely with multiple ligaments and fascial tissues.

However, occasionally, these will weaken and the superior vertebra will start to slip forward on the one below it. This is called spondylolisthesis. These are Grade O through 5: 0 - pars defects for no slip; 1 - a slip of 0 to 25% of the vertebral body width; 2 - 25 to 50% slip; 3 - 50 to 75% slip; 4 - 75 to 100% slip; and 5 being a ptosis or complete slip off the anterior aspect of the lower vertebral body.


Treatments depend upon how badly the vertebra has moved. There have been many, many different treatments arise of the years. At one time, an attempt was made at trying to get the fractures to heal, just like any other fracture in the body. This, unfortunately, did not do very well. And it really is not done anymore.

Thus, if the patient is in Grade I or II, usually non-operative methods are tried, and tried. If, despite a great effort at getting these to work, just doesn't help, then surgery is considered. If surgery is done, the vertebrae are fused (arthrodesis) where they are. No attempted to reduce (put the vertebra back into their original positions) is tried, as this runs the risk of damaging the spinal cord or roots.

The patient is often placed into a one and a half hip spica cast (or brace), until the fusion mass is solid. This can take anywhere from 4 to 10 weeks. Once the fusion is solid, then the patient is allowed to do just about anything they want, after rehabilitation is complete. There have been elite athletes treated for this condition, and have returned to full competition.


For the cases, where the vertebra has slipped further than 50%, then you are getting into a very significant problem. These patients are almost always treated surgically, because if the slip continues, the patient could become paralyzed.

In the more severe cases, fusion is still the treatment. If the patient does not have any significant neurological problems, reduction is not attempted, and the segment is fused where it is. If there are neurological problems, then a decompression is also done to take the pressure off the nerves.


So, first, it has to be determined at what stage the spondyloysis is.

And if you are given all of the non-operative treatments a good effort, without success, then you have to do some soul searching. If you stopped competing in high level athletics, would your back pain go away, without surgery? If so, then that has to be considered.

But, if you still want to try to compete, is it worth the possible risks of surgery to have a chance at playing again? Because, there are no guarantees in surgery.


You really need to sit down with your surgeon and discuss all of your treatment options, and the risks associated with each of them. What are the expected outcomes? Will you be able to continue to play, if you have surgery, and how long will it take to get back to normal activities, and back to competing? Only your surgeon known at what stage your spondyloysis is, and if it has slipped any. Every patient and every slip is different, and must be treated individually.


Hope you find a treatment that allows you to do the activities that you wish to do. Good luck.
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replied October 5th, 2011
I too have bilateral pars interarticularis at L5. I was diagnosed in 2009 after months of back pain. It began to keep me up at night. Nothing has really helped. I was taking ibuprofen before going to bed and usually again in the morning, but still having horrible pain. I recently started a nutritional cleansing program and remarkably my pain has disappeared. Not sure what the relationship is, and this was not my goal with the program, but it has certainly been an incredible side affect. I believe it must have something to due with inflammation in the body. I've only been on the products for a week and a half and since about day 3 or 4, have had no back pain at night. Crazy, but I'm SO grateful! Obviously, the defect is still there, but the pain is not!
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replied April 20th, 2013
Here is my story
I am 17. I had lower back pain for months when I started pole vaulting... I knew something was wrong. I went to a chiropractor and he would yank on my back every day and temporarily the pain would go away... but would come back and would be worse... Finally I went to an orthopediac surgeon. He put me in a lovely back brace hoping my broken bone would heal on its own.( mind you its been about a year its been broken) Soooo the brace did not work. He insisted on doing surgery! He wanted to do it within the next few weeks before he moved to hawaii. ummmm okay NOOO! This guy was sketchy. So i got another opinion at shriners hospital. FINALLY I saw someone that was making sense...He told me surgery at my age and my activity level would not benefit me. It would only decrease mobility and I could possibly still have pain. He told me I just have to learn to control the inflammation and pain. My back will not get better nor worse... But it can aggravate me with certain tweaks. It has been about a year since. I take Ibuprofen almost daily and ice after practice everyday. I am still pole vaulting and will continue in college. I have learned to control the pain better but I still can feel discomfort almost all the time. But it is not nearly as bad as what it use to be. It got to the point of me not being able to walk...
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