Percutaneous Direct Pars Repair in Young Athletes

Neurosurgery 92:263–270, 2023

Lumbar pars defects are common in adolescent athletes and are often due to recurrent axial loading and traumatic stressors.

OBJECTIVE: To present an updated case series of young athletes who underwent percutaneous direct pars repair after failure of conservative management.

METHODS: A single-center, nonrandomized, retrospective observation study of athletes who were referred for minimally invasive direct pars repair after failure of at least 6 months of conservative management was performed. Summary demographic information, clinical features of presentation, perioperative and intraoperative radiographic imaging, and visual analog scale back pain scores were collected and analyzed.

RESULTS: A total of 21 patients were included (mean age [± SD] 17.47 ± 3.02 years, range 14-25 years), 6 of whom were female (29%). All patients presented with bilateral pars fractures, with L5 being the most frequent level involved (n = 13). The average follow-up time was 31.52 ± 9.38 months (range 3-110 months). The visual analog scale score for back pain was significantly reduced from 7.62 ± 1.83 preoperatively to 0.28 ± 0.56 at the final postoperative examination (P < .01). Fusion was noted in 20 of the 21 patients on final follow-up (95%).

CONCLUSION: Percutaneous direct pars repair is a safe and effective means in treating young adolescents who have failed conservative management. The advantages included minimized muscle and soft tissue dissection, reduced blood loss, and early mobilization and recovery. In young athletes who desire return to high-level physical activity, this surgical technique is of particular benefit and should be considered in this patient population.

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