Pars defects and spondylolisthesis

Presented by:
Dr Paul Licina – Spine surgeon
Dr Mark Young – Sports and musculoskeletal physician

Event:
Challenges in the Sporting Spine - 2014

1. Pars defects and
Spondylolisthesis

Dr Paul Licina
Dr Mark Young

2. Pars Interarticularis

3. Pars and Pedicle fracture

Spondylolysis: A defect in the pars interarticularis of the vertebral arch

4. Spondyolisthesis
Spondylolisthesis (anterolisthesis): Forward displacement of a
superior vertebral body over the vertebral body below (include
isthmic, dysplastic and others)

5. Pars Fractures
•Combination of hereditary and lifestyle factors
•Family history, racial preponderance
•Approx 50/50 developmental v repetitive
trauma
•85% L5
•Spinabifida Occulta
•8% of population have pars # (+/- symptoms)
•PM- approx 4% pars #, 2% isthmic
spondylolisthesis

6. Athletic Pars fractures
•??Adolescence
•Extension sports (esp gymnastics, cricket
bowling, divers, throwing athletes, ?ball
sports)
•Usually symptomatic
•Contralateral side
•Some sports L4 > L5

7. Extension produces inferior Pars
tension stress

8. Imaging
•MRI (with “pars protocol”) for diagnosis
•Limited (spiral/helical) CT scan for staging
–early, progressive or terminal (‘pars defect’)

•Xray – ??to monitor spondylolisthesis
•Bone scan – if claustrophobic, or cant have
MRI
–sensitive but not specific

9. Brisbane Radiology
“Pars Protocols”
•Qscan – Sagittal T1, Sagittal T2 fat sat, Axial
T2

•BPI – 3D STIR Sagittal + Axial, 3D T1 + gradient
echo (tailored for water), T2 Axial

•Qld Xray – 3D STIR Coronal & Axial, T2, T1
Sagittal STIR (gradient echo), T2 Axial +/-
limited CT scan

10. Treatment is Multidisciplinary
•Rest from provoking activity – how long?
•Core stability exercises (avoid extension)
•Cross train - sports specific (add pain free cycle at
1-2 weeks & swim 2-3 weeks, run around 6 weeks,
return to sport 12-18 weeks)
•Correct biomechanical factors
•?Vit D/BMD

•?BRACE
•?RE-IMAGE