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  • Reelsavvy
    Member
    Post count: 9

    My son had repair of his pars 15months ago and was doing great. He is a collegiate soccer player. He had bilateral fracture of l5 and no slippage or any other problems. They used the buck technique. In one day while running he experienced severe pain and radiating pain down his leg. Ct revealed fusion of the left pars and pseudoarthrosis of the right pars. Screw in place with no apparent radiolucency. If he runs or does anything strenuous the pain returns. Disco gram revealed perfect disc, MRI normal, emg normal. 2 neurosurgeons and 1 orthopedic say do nothing and treat the pain. Would it be reasonable to retreat the pars with bmp and Scott technique. He is 21 years old. The doctors tell us this is stable and to compete with it and do pain management. I am afraid of re fracture of the left pars and slippage leading to a fusion. Any ideas? I am leaning toward repair.

    Daniel
    Member
    Post count: 14

    Where did you have your pars surgery done? I am looking into it as well. I am also a 21 year old and am looking for options.

    Thanks

    Reelsavvy
    Member
    Post count: 9

    We had it done at medical college of Georgia . We went through all the conservative treatments and got nowhere. After 6 months we had the surgery. Not a cake walk, first 3 weeks were tough. HOw ever, all symptoms were gone. There were two lesions, the older chronic lesion didn’t hold up. They used an iliac crest graft. The newer cases are being done with bmp which I understand is very good. If you are an athlete with no other problems and want to compete I would look into the direct repair. A lot of the doctors know little about it. The amount of literature and studies published over the last year indicated that this may be the way to go. How long have you been dealing with this?

    Daniel
    Member
    Post count: 14

    Thanks for the reply

    I originally fractures mine about 3 years ago and have been doing the conservative things. I am an athlete in pretty good shape so this seems best to me, I have been doing some research of my own as well. I have also realized that most doctors don’t know much about it because of the ones I have talked to. What literature have you been reading?

    Reelsavvy
    Member
    Post count: 9

    One other fact. The surgeries work well on younger people, under age 25. The blood flow and healing ability decreases after 25 .

    Donald Corenman, MD, DC
    Moderator
    Post count: 8455

    Sorry I’m late to the party. To answer all your questions, the technique of repairing pars fractures developed in the 1970s with pedicle screw and hook constructs. The success rate was relatively low. After the development of BMP and intraoperative navigation with CT (O-arm), direct repair of the pars became possible.

    Indications for repair are still being worked out. Patients with a gap greater than 3-3.5mm, an atrophic fracture (the ends of the bone are “whittled down” and have not “tried’ to heal) and any significant disc injury (annular tear or frank degeneration) are relative contraindications.

    Yes, age does matter but older patients can still undergo repair.

    I am currently developing a compression device to be used intraoperatively to try and reduce the gap between bony fragments before fixation. One of the problems with healing is the “osteocyte jumping distance”. This is the distance that the new bone has to cross to join the other fragment.

    A one sided but intact pars should generally not cause too much pain. The whole vertebra is a ring. If you break only one side of the ring, the bone should be stable to a degree. If the one side is only partially healed however, there will be some motion as bone is elastic. The pain could be coming from the non-healed pars or even the healed pars.

    If the fixation is still intact, direct repair of the non-healed side might be worthwhile. If the fixation is not intact, the surgery could still be done but would require refixation. No one has any statistics on the rate or healing with re-repair.

    Dr. Corenman

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