Pars defect is one of the common causes of back pain in adolescents. Computed tomography revealed a bilateral l5 pars defect without. The lesion in spondylolysis is a nonunion that follows a fatigue fracture of pars interarticularis. Nov 20, 2005 traditionally, spondylolisthesis is defined as an anterior displacement of a vertebral body in relation to the segment immediately below. The pars interarticularis is a small segment of bone from the vertebral arch joining the facet joints of the spine. Spondylolysis of the lumbar spine has traditionally been treated using a variety of techniques ranging from conservative care to fusion. When a defect develops in this area of the vertebra, it can lead to separation of the upper, front portion of the bone and the lower, back portion. Of, near, or situated in the part of the back and sides between the lowest ribs and.
Minimally invasive direct repair of bilateral lumbar spine. However, i couldnt help but wonder whether the bilateral pars defects were pre existing or represented an acute fracture due to the trauma. Also known as pars defect, lumbar stress fracture, lumbar spine stress fracture, stress fracture of the pars interarticularis what is a spondylolysis. Spondylolysis is common in young athletes participating in sports, particularly. Jan 22, 2019 lumbar spondylolysis, a unilateral or bilateral stress fracture of the narrow bridge between the upper and lower pars interarticularis, is a common cause of low back pain lbp in adolescent athletes. Pars defects lateral radiograph of the lumbosacral spine reveals a pars interarticularis defect at l5s1 yellow arrow, with mild anterolisthesis of l5 on s1. Mild response to facet injections, but significant relief with l4 pars defect injection for a few days. Spondylolysis spondeelowlyesis is defined as a defect or stress fracture in the pars interarticularis of the vertebral arch.
Spondylolisthesis is a condition in which one of the vertebrae slips out of place onto the bone below it. This is a case of a pars interartcularis defect with anterolisthesis, also called spondylolysis with spondylolisthesis. A spondylolysis is the name given to a stress fracture of the lumbar spine lower back and specifically affects a. Jan 30, 2017 a pars defect is a problem that typically develops in the lumbar portion of the spine. A comparison of the techniques of direct pars interarticularis repairs. Finite element analysis of the spondylolysis in lumbar spine.
An mri scan can evaluate changes in the par interarticularis to diagnose active spondylolysis or inactive spondylolysis. However, i couldnt help but wonder whether the bilateral pars defects were preexisting or represented an acute fracture due to the trauma. Roughly translated, that means the part between two joints. Most commonly, this fracture occurs in the fifth vertebra of the lumbar lower spine, although it sometimes occurs in the fourth lumbar vertebra. Chiropractic management of mechanical low back pain.
This may cause compression on nerve roots exiting through the intervertebral foramen, resulting in pain andor radiculopathy radiating pain, numbness or weakness in. The incidence of pars interarticularis defects in athletes samuel. Clinical outcome of minimally invasive repair of pars. The most recent literature about the effects of facet tropism on spondylolysis, lumbar discopathy, and lumbar degenerative disease has demonstrated that the fja and facet joint coronal positioning increases at lower levels, the rate of facet asymmetry is higher at the levels with pars defect, and facet tropism is most commonly seen at l5s1 than l45 level. Bilateral l5 pars defects present, with associated grade 1 anterolisthesis of l5 on s1 and stenosis of the left neural exit foramen. Congenital laminar defect of the upper lumbar spine associated with pars defect. The lifetime prevalence of lbp in those aged 1117 years has been reported to be as high as 30. Spondylolisthesis refers to a condition of the spine where a vertebra is displaced from its normal position. Traditionally, spondylolisthesis is defined as an anterior displacement of a vertebral body in relation to the segment immediately below. Treatment for spondylolisthesis and spondylolysis in. The incidence of lumbar spondylolysis pars defect has been estimated to be approximately 6% in the general population 1.
Keywords low back pain, spondylolisthesis, anterior lumbar interbody fusion, lumbar interbody fusion, pars interarticularis defect introduction spondylolysis commonly occurs in the population, although progression to symptomatic spondylolisthesis is rare. Utilize the latest physical therapy modalities and rehab devices to reduce swelling and decrease pain. Severe pain, deformity, or nerve compromise from pars defects can be treated with surgery. Threedimensional planning and patientspecific drill guides for. Treatment for spondylolisthesis and spondylolysis in colorado. With type ii spondylolisthesis, theres a problem with the pars interarticularis, a particular region of your vertebra. In other words, in the axial view, it is the bony mass between the facets that is anterior to the lamina and posterior to the pedicle. Statgraphics xvi software statpoint technologies inc, warrenton, va, usa was used for statistical analysis. Less severe cases can benefit from physical therapy andor pain management. The patient with lumbar spondylolysis typically complains of progressive back pain in the lumbar region, exacerbated by extension or twisting of. A pars defect is the name given to a stress fracture of the pars interarticularis which is located in the back portion of the vertebra. Spondylolysis is a unilateral or bilateral bony defect in the pars interarticularis or isthmus of the vertebra.
One patient, who underwent direct repair of l5 pars defect showed spinal stenosis at l45 level after 4 years postoperatively and was treated with the simple decompression. Decompression pars defect treatment bonati spine institute. If a vertebra slips too much, it can press on a spinal nerve and cause pain. Spondylolysis definition back pain and neck pain medical. Only few sporting individuals with symptomatic lumbar pars injuries require surgical repair and it is often difficult to predict the outcome following surgery. In the report is says there are probably l5 pars defects and sacroiliac joints appear grossly normal. Apr 22, 2019 pars defect is a condition that affects the lumbar spine, causing low back pain. In the transverse plane, it lies between the lamina and pedicle. With the condition of spondylolisthesis, the pars interarticularis defect can be on one side of the spine only unilateral or both sides bilateral. In spondylolysis, a crack or stress fracture develops through the pars interarticularis, which is a small, thin portion of the vertebra that connects the upper and lower facet joints. Pars defect definition of pars defect by medical dictionary. Spondylolysis is a fracture of the bone lamina in the pars interarticularis and has. As a result of this defect the upper vertebra slips forward and creates instability within the vertebral segment with following compression of the.
The treatment of pars defect was first described by bucks in 1970, who used screws in. Pars defect may be present since childhood without any. A pars defect, or pars fracture, is a break in the pars interarticularis, which can lead to a separation of the upper, front portion of the vertebra from the lower, back portion. The defect of the pars interarticularis might occur on one or both sides of the back, known as unilateral or bilateral l5 spondylolysis, respectively. Three stages of injury to the pars interarticularisthe portion of the lower spine that joins together the upper and lower jointsexist. Unilateral lumbar spondylolysis on radiography and mri.
However, due to the static nature of mri imaging acquired with the patient lying down, stability at the affected level is uncertain. A pars injection is usually administered in patients with spondylolisthesis for the diagnosis of pars defect, a small fracture in the area of the vertebrae. This break leads to a separation of the upper, front portion of the vertebra from its lower, back portion. All of these areas have a direct impact to the lumbar spine and the pars defect. Pars defect definition of pars defect by the free dictionary. Pdf finite element analysis of the spondylolysis in lumbar spine. Spinal surgeons have used dynamic lumbar spinal plain x.
In spondylolysis, a crack or stress fracture develops through the pars interarticularis, which is a small, thin portion of the vertebra that connects the upper and lower facet joints most commonly, this fracture occurs in the fifth vertebra of the lumbar lower spine, although it sometimes occurs in the fourth lumbar vertebra. The factors that predict the outcome after direct repair of lumbar pars defect was evaluated clinically and statistically. These techniques include bone grafting with the placement of wire. Fracture spondylolysis slippage spondylolisthesiswhen the bone defect left by the fracture leads to one vertebra slipping onto another. Direct repair of the defect may be utilized in young adult patients without significant disc degeneration and lumbar instability.
However, instances of spondylolysis l5l4 also occur. The biomechanics of spondylolysis, part 1 dynamic chiropractic. Lumbar spondylolysis is a unilateral or bilateral defect of the pars. A pars defect or spondylolysis is a stress fracture of the bones of the lower spine. Some people have no symptoms, but low back pain is the most common symptom if symptoms exist. Apr 25, 2018 the most common type of isthmic spondylolisthesis is l5s1 spondylolysis, which is when the lowest lumbar vertebra slides onto the sacrum. Commonly a pars defect in the lumbar spine results in spondylolisthesis, but the severity and type of the anterior slippage is the determining factor in the stability of the involved vertebra. Also called isthmic, this is the most common kind of spondylolisthesis. The pars interarticularis, or pars for short, is the part of a vertebra located between the inferior and superior articular processes of the facet joint. It is best demonstrated on oblique radiographs of the. Commonly a pars defect in the lumbar spine results in spondylolisthesis, but the severity and type of the anterior slippage is the determining factor in. A pars defect of the lumbar spine involves a part of a vertebra called the pars interarticularis.
Jan 31, 2012 one patient, who underwent direct repair of l5 pars defect showed spinal stenosis at l45 level after 4 years postoperatively and was treated with the simple decompression. My mri says pars defect bilaterally with 3mm anterolisthesis of l5 on s1 and significant facet arthopathyhypertrophy at the l4l5 level with mild to moderate foraminal narrowing stenosis. The pars defects are particularly well displayed on the t1 spair and t1 spair inverted acquisitions. Avoid all activities and positions that promote hyperextension of the lower lumbar spine.
A spondylolysis is the name given to a stress fracture of the lumbar spine lower back and specifically affects a region of bone known as the pars interarticularis figure 1. In contrast to singlelevel pars defects that respond well to conservative treatment, there is no. Pars defect is also known as par interarticularis defect or pars fracture of the lumbar spine. The pars interarticularis, or pars for short, is the part of a vertebra located between the inferior and superior articular processes of the facet joint in the transverse plane, it lies between the lamina and pedicle.
Predictive factors for the outcome of surgical treatment. Pars defect synonyms, pars defect pronunciation, pars defect translation, english dictionary definition of pars defect. Chiropractic management of mechanical low back pain secondary. It represents a weakness or stress fracture in one of the bony bridges that connect the upper with the lower facet joints of the vertebra. The vast majority of cases occur in the lower lumbar vertebrae l5, but spondylolysis may also occur in the cervical vertebrae. Forward displacement of a superior vertebral body over the vertebral body below include isthmic, dysplastic and others. In other words, in the axial view, it is the bony mass between the facets that is anterior to the lamina and posterior to the. Although lumbar spondylolysis is generally attributed to repetitive stress imposed by physical activity resulting in fatigue fracture of the pars interarticularis, 1,2 the etiology is likely multifactorial with elements of both inherited predisposition and repetitive trauma. Spondylolysis is a condition in which there is a defect in the pars interarticularis of the vertebra. Spondylolysis is a condition in which there is a defect in a portion of the spine called the pars interarticularis a small segment of bone joining the facet joints in the back of the spine. The defect allows the l5 vertebra your last vertebra in your lumbar spine to slip forward over the sacrum. Regarding surgical treatment, various techniques to directly repair the pars defect have been described 210.
Direct repair of lumbar spondylolysis by bucks technique. Spondylolysis presents predominantly in the lower lumbar segment, where the. A defect in the pars interarticularis of the vertebral arch 4. Anterior slippage of the l5 vertebra on sacrum is indicated by arrow with base. These injuries are thought to be due to chronic repetitive stress at the pars interarticularis, and most commonly occur at the l5s1 level. Unilateral spondylolysis, a unilateral osseous defect or fracture in the pars interarticularis, is a rare and unique entity that accounts for 333% of all cases of spondylolysis, which occurs in approximately 37% of the general population 49. Spondylolysis and spondylolisthesis orthoinfo aaos. Pars defectcausessymptomstreatmentexercisediagnosis. Direct repair of the pars defect is a logical alternative to fusion as it helps to preserve the. Lumbar spondylolysis, a unilateral or bilateral stress fracture of the narrow bridge between the upper and lower pars interarticularis, is a common cause of low back pain lbp in adolescent athletes.
Spondylolysis describes various forms of spinal degeneration that accompany the natural aging process. Defects were bilateral but only one side is depicted here. Spondylolysis presents predominantly in the lower lumbar segment, where the concentration of mechanical stress is high. If the physician is concerned about subtle pars defect, an ap spot view or oblique views are warranted to evaluate the pars region optimally. Spondyolisthesis spondylolisthesis anterolisthesis. Is standalone anterior lumbar interbody fusion a safe and. Pars defect is a condition that affects the lumbar spine, causing low back pain. It gets its name from the part of the vertebra it affects the pars interarticularis.
The most common type of isthmic spondylolisthesis is l5s1 spondylolysis, which is when the lowest lumbar vertebra slides onto the sacrum. Pdf spondylolysis is a fracture of the bone lamina in the pars interarticularis. Spondylolisthesis is defined as a slip of one vertebral body relative to an adjacent vertebral body. Overview diagnosis and tests management and treatment prevention outlook prognosis. Ive done pt, chiro, injections, nerve deadening, ice, narcotics, tens treatment, massage, nsaids, etc and things are still getting worse.
Rfa for transitional segment andor pars defect pain. This is also referred to as spondylolysis with spondylolisthesis. A defect in the pars is a break in this portion of bone. The arch is formed of soft fibrous tissue and there is a weak link with adjacent vertebrae so that the condition of spondylolisthesis may occur. An mri scan can evaluate changes in the par interarticularis to diagnose active spondylolysis or. One case presented with lumbar disc herniation at l45 level which required surgical treatment 2 years postoperatively, after the direct repair of l4 pars defect. We used minimally invasive techniques to place pars interarticularis screws with the use of an intraoperative ct scanner in three.
This spinal condition most commonly presents as a degenerative disease in adults but may be present in adolescents as a result of deformity or trauma. Nonconsecutive spondylolysis involving the lumbar spine is rare. It particularly affects the area of a bone called pars interarticularis in the spinal vertebrae. The role of mri is to determine the severity of any central spinal canal stenosis or neural foramen and to identify a potential cause such as a pars defect.