A minimally invasive approach to defects of the pars interarticularis: Restoring function in competitive athletes

Objectives To understand that young athletes have a higher incidence of pars interarticularis defects than the general population. This may be due to an immature spine put under higher stress loads at an early age. Traditionally, surgery was reserved for those who failed conservative therapy, and consisted of open exposure, bone grafting and placement of pedicle screws. This leads to a long recovery period and limited ability to return to competitive sport. Methods Four collegiate and professional level athletes, three high school athletes, and one member of the National Guard presented with back pain from spondylolysis without spondylolisthesis. All underwent minimally invasive surgery (MIS) to directly repair the pars defect, for a total of sixteen pars defects repaired in eight patients. Described is an application of a MIS pars repair technique that has not previously been reported, which recreates the normal anatomy rather fusing across a motion segment. Results Five patients were discharged the day following surgery and three were discharged on postoperative day 2. Six of the patients returned to their previous level of competitiveness. Two were unable to achieve the same level of play, both of whom failed to fuse the spondylolysis. Patients all initially reported clinical improvement postoperatively and there was overall mean improvement on patient reported outcome measures (SF36 physical and mental component scores, visual analog scale, and Oswestry disability index). Conclusion MIS advantages include less muscle tissue disruption and restoration of the natural anatomy. This leads to a more rapid recovery, decreased perioperative pain, minimal blood loss, earlier mobilization and decreased hospital length of stay. Overall this allows the athlete to start therapy earlier and return to competition sooner and at his/her pre-operative competitive level. The described MIS repair technique outcomes are similar to those that have been reported in the literature and have allowed a high rate of return to athletics in high performing patients; critical to their quality of life.