New Minimally Invasive Technique for Direct Pars Interarticularis Osteosynthesis Using Cortical Screws and Spinous-Process Modular Link

STUDY DESIGN.Case report. OBJECTIVE.To report a case of direct pars osteosynthesis using computed topography (CT) navigation, image guided cortically placed screws with curvilinear subspinous modular link. SUMMARY OF BACKGROUND DATA.Spondylolysis fracture is commonly encountered in athletes who subject their spines to repetitive hyperextension stress. Initial treatment is nonoperative, consisting of rest, activity modification, physical therapy, and/or bracing. When nonoperative treatment is deemed unsuccessful, surgery may be recommended. METHODS.A 17-year-old male, competitive rower, presented with 3 months of a traumatic low-back pain without radicular symptoms. After a 9-month period of nonoperative management, the patient was submitted to surgery. Using navigation, cortical screws were placed in the standard inferomedial to superolateral trajectory crossing the fracture lines. A rod was contoured in a curvilinear fashion and passed through the L4-5 interspinous ligament and connected to the screw tulip heads. RESULTS.Patient did well postoperatively and remained neurologically intact throughout his course. CT performed at 1 year demonstrated healed fracture sites without signs of fixation loosening or failure. Patient underwent removal of retained fixation approximately 16 months after surgery. Patient has returned to rowing and all sports activities with no restrictions and no reported lower back pain. CONCLUSION.This technique offers a novel solution for the treatment of pars fractures through a minimally invasive, relative muscle-sparing approach by not compromising healing potential and preserving the native facet joint.Level of Evidence4