PARS FRACTURES

A pars defect or spondylolysis is a stress fracture of bones in the lower spine. Unfortunately, these fractures normally happen because of overuse. Also, the fractures can exist on one or both sides of the vertebrae. Pars Fractures cause lower back pain in children and adolescents.

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Pars Fractures

Pars fractures, also known as spondylolysis, are stress fractures that occur in the pars interarticularis, a small bony segment connecting the upper and lower parts of a vertebra. These fractures most commonly affect the lumbar spine (lower back) and can cause pain and instability. This comprehensive document aims to provide an in-depth understanding of the diagnosis and treatment of pars fractures.

Spondylolisthesis occurs when one vertebral body slips or slides forward over the one underneath it due to this type of spinal fracture. This page addresses the etiology, diagnosis, and treatment of various linked lumbar disorders and explains and depicts the anatomy of the low back involved. By definition, facets are formed by two surfaces, one from each neighboring vertebra. And each vertebra has four separate joint surfaces in the back, two above the pedicles and two below the pars interarticularis (mirror images).

Stress, Structural Forces, and Pars Interarticularis

The pars interarticularis connects the joints above and below one vertebra. Doctors refer to the bony bridge that connects these two upper and lower aspects as the pars interarticularis, which means “part between the articulations” in Latin. An isthmus is a thin strip of land that connects two bigger bodies of land, as you may recall from geography. As a result, doctors refer to the pars interarticularis as an “isthmus” since the bone links between the two facet joints.” The bottom two vertebrae of the spine (L4-S1) face down like a sled on a ski slope, and they bear the whole weight of the spine above them. The inferior facets, sometimes known as “door stoppers,” are a buttress that keeps the lower vertebra from slipping down.”

The bony pars interarticularis connects these “doorstops” to the higher structures (pedicles). As you can expect, these structures do not do well with a great deal of stress, particularly when impact occurs. Contact sports, leaping, and particularly extension can cause overload forces (bending backward). The tiny bony structures (cortical bone and trabecula) that make up the pars interarticularis might become stressed and fractured as a result of this strain.

Questions and Answers

What is a Pars Fracture?

A pars fracture, also known as spondylolysis, is a stress fracture that occurs in the pars interarticularis, a small bony segment connecting the upper and lower parts of a vertebra. It appears most commonly in the lower back (lumbar spine) and can result in instability and pain.

What Causes a Pars Fracture?

Repetitive stress or overuse of the spine appears as the most common cause of a pars fracture. As an example, all activities that involve hyperextension or repetitive twisting motions, such as gymnastics, football, weightlifting, or dance can cause a pars fracture. Traumatic injuries, such as falls or accidents, can also lead to pars fractures.

How is a Pars Fracture Diagnosed and Treated?

Diagnosis of a pars fracture typically involves a combination of medical history, physical examination, and imaging studies. X-rays, CT scans, or MRI scans allow doctors to visualize the fracture and assess its severity. Treatment options vary depending on the severity of the fracture and the individual’s symptoms. Conservative treatment, including rest, activity modification, physical therapy, and bracing often becomes the first approach. In cases where conservative treatment fails or the fracture appears severe, doctors may recommend surgical intervention, such as a spinal fusion or direct repair of the pars defect.

Three Types of Pars Fractures:

Atrophic
Hypertrophic
Displaced

Atrophic fractures do not mend easily and this normally occurs because of inadequate immobilization. In this case, the ends of the shattered bone appear very thin, and the body makes a feeble attempt to bring them together. Similarly, a displaced fracture occurs when the vertebra slips forward and the shattered fragment ends do not close and meld to each other. Unfortunately, both have a low ability to heal.

The hypertrophic fracture is characterized by thick, expanded, and co-opted fracture ends (right next to each other). Furthermore, a brace gives these fractures the best chance of healing.

Unilateral (one-sided) fractures will heal quite well. Although, healing without a brace and without limiting activity negatively affects the healing process for a broken pars fracture. Even with the greatest healing fractures (unilateral and hypertrophic), the success rate with a brace and three to six months of limited activity is around 50%. Consequently, children and adults can re-fracturing a pars fracture if they resume their old level and kind of activity. Our doctors surgically treat these fractures with an excellent success rate.

Development of Pars Fractures

If the pars repeatedly get overloaded without enough time between episodes to enable healing, they will ultimately break (fracture) and become incompetent, similar to how bending a metal coat hanger causes it to fail. Genetics provides a significant impact as well. These fractures usually affect both sides of the pars, however, they can also affect just one side (unilaterally). If only one side of the pars breaks, the opposing pars take the brunt of the stress and may eventually fracture. Because there is no protection to prevent shear stresses (slide forces) on discs, fractures can occur on both sides.

The disc acts as a shock absorber and serves as the primary cushion for spinal trauma. However, the disc has a low shear (slide) resistance. The disc is exposed to aberrant stresses that might harm it without the facets in the back protecting it. The unbroken facets prevent these stresses from occurring, and pars fractures can cause the disc to collapse.

The disc can stretch and subsequently tear under extreme tension. The above-mentioned vertebra then begins to slide forward on the one below. (The L5 vertebra, in particular, can begin to move forward on the sacrum.) An isthmic Spondylolysis (lysis meaning “cut” or “break”) happens before the sliding commences. Doctors refer to the condition as isthmic spondylolisthesis if there is a slide accompanying it (oliothesis means to slip in Latin). This fracture appears more common in teenagers who participate in contact sports or whose sport requires them to bend backward (wrestling and gymnastics come to mind).

Children with Pars Fractures

Pars interarticularis fractures affect one out of every twenty children. These fractures usually happen between the ages of 8 and 15. Many times, a child who develops a new fracture will not exhibit any severe symptoms at first or will disregard the discomfort and not inform parents, coaches, or trainers. In many children, the discomfort will subside until the disc gets injured.

In general, children with broken bones heal very quickly. Pars interarticularis fractures, on the other hand, do not heal well. The following three factors provide the reason for poor healing.

These fractures have a relatively limited surface area.
When extensive cancellous surface regions become exposed, bone will heal faster. The “spongy bone” inside the hard cortical bone, cancellous bone, contains many bone-generating cells. Unfortunately, very little cancellous bone exists in the pars interarticularis.
The spine endures some of the most extreme motion and shear pressures. Extreme pressure will cause a bone to crack. It’s tough to get an energetic youngster or teenager to relax in this location. A brace can help a youngster slow down, but it won’t immobilize the region, and mending bone cells don’t like mobility. The type of pars fracture you sustain will influence your rehabilitation.

Diagnosis

The diagnosis of pars fractures involves a combination of clinical evaluation, medical history, physical examination, and imaging studies. Doctors follow the following steps:

Medical History: The healthcare provider will inquire about the patient’s symptoms, including the nature and location of pain, any recent trauma or activities that may have contributed to the injury, and a history of previous spine-related issues.
Physical Examination: The doctor will perform a thorough physical examination, assessing the patient’s posture, range of motion, and tenderness around the affected area. They may also check for signs of nerve involvement or muscle weakness.
Imaging Studies:
X-rays: Plain X-rays of the lumbar spine can help identify pars fractures. A lateral view may reveal a “Scottie dog” appearance, with a fracture line visible in the pars interarticularis.
CT Scan: Computed tomography (CT) scans provide detailed images of the spine and can confirm the presence and severity of a pars fracture. It helps assess bony integrity and identify any associated abnormalities.
MRI Scan: Magnetic resonance imaging (MRI) scans provide doctors with images of the surrounding soft tissues and assess for any nerve compression or disc involvement.

Treatment

The treatment of pars fractures depends on several factors, including the severity of the fracture, symptoms experienced by the patient, and their overall health.

Conservative Treatment:

Rest and Activity Modification: Avoiding activities that exacerbate pain and stress on the spine, such as high-impact sports or heavy lifting, allows the fracture to heal.
Physical Therapy: Specific exercises and stretching routines can help strengthen the surrounding muscles, improve flexibility, and provide stability to the affected area.
Bracing: In some cases, doctors may recommend a brace to limit movement and provide support to the spine during the healing process.
Medications:
Nonsteroidal Anti-inflammatory Drugs (NSAIDs): These medications can help reduce pain and inflammation associated with pars fractures.

Surgical Treatment

In cases where conservative treatment fails to provide relief or if the fracture appear severe, doctors will consider surgery. Surgical options include:
Direct Pars Repair: The surgeon directly repairs the fractured pars interarticularis using screws, wires, or bone grafts to promote healing and stability.
Spinal Fusion: In more complex cases or when instability becomes an issue, doctors will perform a spinal fusion to join two or more vertebrae together, providing long-term stability.

Post-Treatment Rehabilitation

Rehabilitation plays a crucial role in the recovery process after treatment for pars fractures. The following aspects are typically addressed:

Physical Therapy:
Strengthening Exercises: Targeted exercises to improve core strength, stability, and flexibility of the spine and surrounding muscles.
Posture and Body Mechanics: Educate the patient about proper body mechanics, ergonomics, and techniques to prevent future injuries or stress on the spine.
Gradual Return to Activities: Guided progression back to normal activities, ensuring proper technique and monitoring for any recurrence of symptoms.
Patient Education:
Lifestyle Modifications: Encouraging healthy lifestyle choices, including weight management and regular exercise, to support overall spine health and prevent future injuries.
Activity Modification: Providing guidance on modifying activities and avoiding high-impact or repetitive motions that may put excessive stress on the spine.
Pain Management: Educate patients about pain management techniques, including the appropriate use of medications, hot/cold therapy, and self-care measures to alleviate discomfort during the healing process.

Follow-Up and Monitoring: Regular follow-up appointments with healthcare providers are essential to monitor the healing progress, evaluate treatment efficacy, and address any concerns or complications. Imaging studies will continue periodically to assess fracture healing and overall spine health.

Pars Defect

Pain and stiffness in the middle of the lower back indicate pars defect among other conditions as well. Pain normally gets worse with lumbar extension and twisting. Activity exacerbates symptoms, which subside with rest. Pain may radiate down one or both legs in certain patients. The nerves that exit in the spinal canal near the fracture get compressed and irritated, resulting in discomfort. Numbness, tingling, and weakness in the legs are other possible side effects. The majority of individuals with a pars defect do not require surgery and can get relief through drugs and relaxation. Pain gets treated with anti-inflammatory medicines and muscle relaxants. During the acute period of the injury, a patient should wear a lumbar corset back brace. When a patient gets diagnosed, physical therapy gets started. The therapist will begin PT by introducing a series of abdominal and low back muscle-building exercises.

Working these core muscles allows patients to move more easily and reduces the likelihood of future discomfort and issues. Patients should anticipate being in therapy sessions for 6-8 weeks and a full recovery to take up to 6 months. Steroid spinal injections may aid in more severe cases of discomfort. Patients may need surgery if nonsurgical therapy does not relieve their symptoms. Two surgical procedures for a pars deficiency involve Pars repair and lumbar fusion. The challenge with treating this disease in teenagers occurs because teenagers rarely express their grief, and the disorder does not have lots of symptoms. In addition, this condition may get overlooked by pediatricians, but athletic trainers will spot problems and seek referral sources. Treatment becomes more challenging if the condition continues month after month.

Getting the Best Care for Spine Fractures

Potential patients with pars fractures should consider seeking care at the Southwest Scoliosis and Spine Institute for several reasons. Firstly, the institute is renowned for its expertise in treating spinal conditions, including pars fractures. Their team of specialized spine surgeons, orthopedic specialists, and healthcare professionals is experienced in diagnosing and managing pars fractures effectively.

Secondly, the Southwest Scoliosis and Spine Institute with offices in Dallas, Plano, and Frisco, Texas. provides a comprehensive and patient-centered approach to care. They understand the unique challenges and complexities associated with pars fractures and tailor treatment plans to meet individual needs. Whether it’s conservative management with physical therapy and bracing or surgical intervention, patients can trust that the institute will provide the most appropriate and evidence-based treatment options.

Lastly, the institute prioritizes patient education and involvement throughout the treatment process. They take the time to explain the diagnosis, discuss treatment options, and answer any questions or concerns. Patients are empowered with knowledge about their condition, enabling them to make informed decisions about their care. With a focus on compassionate and personalized care, the Southwest Scoliosis and Spine Institute ensures that patients with pars fractures receive exceptional care and support on their journey to recovery.

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National Institute of Health: Treatment of Pars Fracture

If you or your loved one suffers from back pain from a spinal condition, there is hope. We can help. Call Southwest Scoliosis and Spine Institute at 214-556-0555 to make an appointment today.