Blog Post: Spondylolysis/Pars Fracture                                                7-27-2021

Part 5: Surgical Treatment

If the nonsurgical treatment discussed over the last 2 posts fails to adequately relieve the low back pain due to spondylolysis/pars fractures, then surgery might be indicated. 

It is important to note that not all patients have the same pain intensity, frequency or interference with activities.  The radiographs of the spondylolysis/pars fracture may look identical between to patients, but their pain may be very different, one having little pain, while the other significant pain.

The goal of surgery is to get the crack in the bone to heal, which should significantly decrease or eliminate the low back pain.  Just like in other areas of the body in which the bone doesn’t heal, there are specific requirements to successful spondylolysis/pars fracture surgery

What is needed to heal the spondylolysis/pars defect:

1.                      Rigid fixation/stabilization of the unhealed area

2.                      Hold the cracked, bone edges firmly against each other

3.                     Remove soft tissue at cracked bone area and takedown of the unhealed area to healthy, bleeding,                     cancellous bone

4.                      Bone graft

Figure (Pountos)

 

 

What is the surgery to “fix” spondylolysis/pars fractures?

 

The surgical incision to fix the spondylolysis/pars fracture is demonstated below (red line)

The intraoperative picture below.  The incision is made (between the red arrows), then the muscles are moved to the left and right sides (yellow arrows).

 

Dissection is continued down to bone and the spondylolysis/pars fracture is exposed, cleaned of soft tissue then burred down to healthy, bleeding bone (between green arrows, below)

 

 

Below, a pedicle screw is placed through a percutaneous incision (black circle/red center) 

 

The pedicle screw (black circle, red center) is connected to a hook (yellow arrow) by a rod, and then are compressed together to put the cracked bone surfaces together firmly.

 

Bone graft is then spread over the bone surfaces to encourage bone-to-bone healing (outlined in blue) 

 

Below are radiographs, before and after, spondylolysis/pars fracture repair. 

 

References:

Pountos I, Georgouli T, Pneumaticos S, Giannoudis PV.  Fracture non-union: Can biomarkers predict outcome? Injury 2013;44:1725-1732.

More on Spondylolysis/Pars Fracture surgery in next post......