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DIRECT PARS REPAIR -- anybody know about this?

AnonymousUserAAnonymousUser Posts: 49,671
edited 06/11/2012 - 8:28 AM in Lower Back Pain
My 16 yr old son has L5 bilateral pars defect -- has been in pain for well over year and nothing has helped. I've been researching treatment options and came across something called a DIRECT PARS REPAIR - involves putting screws and some type of GROWTH material to get the broken area to grow back together.

If any one had info regarding this surgery or knows of a DR somewhere in TEXAS that performs it - Please let us know...

We were thinking about scheduling him for L5/S1 fusion in June, I would LOVE to try this first....



  • I've had spondylolisthesis since I was 7 (with a pars defect) and made it to 42 before I was fused. I definitely needed it by then but am so glad I was able to live out 1/2 my life before then. A fusion is a big deal and has a long recovery time. Make sure you get multiple opinions and see what other options are out there.

    Sometimes older people get cracks in their vertebrae and they do some cementing procedure. Maybe that is an option here? I forget what it's called, but it begins with K, maybe kyp- something or other.

    Did they say if your son was born with this? Did he have some sort of trauma? Bones can generally heal without hardware. Maybe if he can heal it, he can strengthen his core, etc to give his trunk some extra support so he's not putting so much pressure on his spine.

    Good luck with everything and research, research, research.
  • My son is 16 years old and has bilateral pars defects of the L5. He has had low back pain for 2 years now and after all the conservative treatments, PT, rest, bracing, 2 rounds of steriod shots and nothing helping his pain, I have found a doctor to do a "Direct Repair" of his pars defects, this is the 4th doctor we have gone to. I talked over the possiblity of doing a direct repair of the pars, because I had done a lot of research online about it. This doctor had never done a direct repair before we went to him, but he had heard of the procedure and said he would talk to some other doctors and do some research on it. In the mean time he order 2 rounds of steriod shots, which took about 3 months, the shots did nothing for his pain, so we went back to the doctor, over the 3 months that it took for the shots, this doctor performed a direct repair on a man in his early 20's, the operation was a success and his patient was doing well post-op. We are now going to schedule this "Direct Repair of the Pars" in early June, after school is out. I pray that it works, my son has been in pain for 2 years now and has had enough.
    My suggestion to you is find a good Ortho surgeon and talk to him about this procedure, there are not many surgeons that have done this, but it seems to be a pretty routine procedure, with great outcomes, espectially for young people. They might be willing to learn how to do it and help your son.



  • Hi there,

    I'm a college basketball player also have a bilateral fracture on my L5 with a bulging disc. I have seen several doctors and team trainers to help, along with chiropractors and physical therapy. I have been dealing with it for 5 years but in January, i missed half my season because the pain was just unbearable. I had an epidural in February and another one 5 days ago. The February one didn't take and I have yet to see improvement from this most recent one. I saw a man named Dr. Maroon in Pittsburgh, who is known to be quite acclaimed for his work. Despite other doctors telling me to get surgery, he was completely against it. He said every conservative method must be exhausted first (and at this point it certainly has) because of my young age. If I get it, I may never be able to play ball again...even tho I can't play in my current situation. Bottom line....he said get an epidural shot on both sides, directly injected into the fracture. Like I said, its only been 5 days so i need to be patient, but suggest the shot first before surgery. surgery is a BIG deal, especially for someone so young. I'm sure your doctors will tell you the same thing.

    I know some good guys in Pittsburgh and Buffalo but sadly i don't know anyone in Texas. Tell your son best of luck.
  • I am 44 also suffer from bilateral L5 pars fractures. I have seen more surgeons than I care to discuss, and have received a variety of opinions from do nothing to multi-level fusion.

    My understanding is that the challenge for direct pars repair is that there are not alot of studies for this procedure when combined with BMP (bone growth material). So, given the complexities of spine surgeries, most doctors will not recommend the procedure until there have been clinical studies that prove the procedure will be successful.

    I have tried it all, PT, acupuncture, epidural shots right into the fractures, etc. and nothing has helped. I have seen 2 surgeons who think this procedure will help me, one in LA and one in Tennessee. They both would do the surgery minimally invasive and expect the surgery to last about hour. Both have mentioned that they have had alot of success with younger patients, i.e. 16 and under. I believe the study cited by Coldwells confirms this.

    PM me if you would like the name of the docs I have seen. Both are fantastic and I am hoping to have surgery this summer.

  • Hi Jewelz,

    Did you ever have the surgery? How are you?

  • Hi Scott,

    Did you ever have the surgery? Did you have a slip? How are you now?

  • MY name is Adam, I am a 22 year old competitive athlete who competed in multiple sports in High school and continued Volleyball at the Division 1 collegiate level. I was diagnosed (bilateral pars defects) as a 20 year old with hopes of continuing to compete after recovery. I also graduated with a Bachelors degree in Sports Medicine.

    **STATEMENT REMOVED. It is a forum violation to offer medical advice. The statement posted here was specific advice, very strongly stated. Statement removd by Cindy.

    ** 2) Note to all reading this: Please rememer that this statement is a member's opinion, based on his own experience, and should not be taken as fact. Note by authority member Neck of Steel (cindy)Make sure the Bonding material he is planning to use is not the one that most surgeons have stopped using because of its link to impotence. I dont know the name of it because my surgeon said using a synthetic bonding agent is less effective than using human bone. The head of UCLA medical said if a surgeon tries to use that stuff, "run in the other direction." Again, i'm not sure of the name of this bonding agent but make sure to raise the concern with your doctor. My surgeon did not use any synthetic materials in fixing my back.

    The most effective and safest procedure is to use direct insertion of the Pedical screws with hooks to support- with the bone graft coming from the Illiac crest. Basically, they make a smaller incision adjacent to the midline incision and take some bone from the back of the hip bone, and use that to help the small fractures grow back together.

    Instead of using some type of bonding cement, they use your own bone. Sometimes even bone from a Cadaver.

    This Method is newer, more effective according to nearly every study, and there is no risk of infertitlity following the procedure.

    For a year, I treated my diagnosis of bilateral pars defects (spondylolisthesis) with every conservative method several orthopedists could suggest. I saw several of the most renown doctors in the Western United States, including the head of [color]EDIT. While generally these are not operated on, that is because most people who have this condition do not experience symptoms. The mention of specific doctor or hospital names is a forum violation. Dr. name and facility removed by Cindy.

    MY surgery was 13 weeks ago. I've just started physical therapy. I'm not back on the court yet, but there is no doubt in my mind... 3 months later, that it was the right decision to have this specific surgery. Fusion would have been devastatingly Overkill, and I am still planning (and able) to give my parents grandchildren. I might even be running around, playing football just like i would have before this ugly situation reared its head.

    IF you really would like somebody to speak to who has had this procedure, let me know - I would be more than willing to oblige if it makes your decision or your sons experience any easier.

    I hope that helped!

    -Adam K
    Los Angeles
  • Adam how is your recovery going?
    I have been advised to have surgery to fuse the bones but I am petrified, I am so active and exercise is my life but it's getting to the point that I cannot live with the pain any longer. I am on my 4th set of injections next week, I had such a good result from the first set but with the 2nd and 3rd I had no results, fingers crossed for the 4th.

    If they don't work I need to really think about surgery. How are you coping with it? Do you think it was worth it?
  • Hi
    My son, 15 years old, is a soccer player (trains every day) He also had a L5 bilateral pars defect with no slip. After months with lots of pain and not being able to play soccer, doctors decided to do the surgery with the morscher hook. Surgery was very successfull. No more pain at all after 6 weeks! He has to wear a brace for another months and is not allowed to do any sports at all for another months as well. He started physical therapy 3 weeks ago, but very slowly and carefully. He feels great and doctors are quite sure he can play soccer again in a few months. So if you think about having the surgery - go ahead!! He feels so much better now! You need to be very careful the first months after surgery, but it's worth it.Be sure to have a doctor with a lot of experience!
  • julia21jjulia21 United States Posts: 6
    Are you still around? I would love to connect with you. How is your son doing? We are looking into direct repair for my son as well. 
  • bowncebbownce AustraliaPosts: 3
    Hi Julia21, I fully understand what you are going through as my son is in the exact same position, he is 17 years, was first diagnosed when 16, we have done all the rehab, followed all the recovery protocols.

    We are seeing the Nureo Surgeon on the 25th of July on the basis that we are going to be encouraged to go down the facute injection route  - we have new MRI and CT scans, will be interesting too see if anything has changed between the 6 months from the last set of films.

    My boy is no pain but is being held back when he starts to increase his physical activity - my boy is a rugby player with professional ambitions - we have to get this fixed.

    I have been looking around the 'medical' world doing my research and have come across the 'bucks' method, I've been in touch with a number of professional both in the US and Australia where we live - we are very serious about undertaking the next step - we have to wait until the 25th to decide what we are going to, its either fixed or he has to stop playing to avoid further issues developing.

    It would be very interesting to understand were you are in this process, I understand from my limited knowledge that the bucks procedure is fairly straight forward and proven with high success rates and recovery.

    I would love to speak to someone who has gone through this same process

    I will let you know more from the 25th       
  • julia21jjulia21 United States Posts: 6
    Hello, my son also went through months and months of physical therapy which helped very little. Any sort of physical activity makes his symptoms worse. For that reason, he has not even participated in physical education at school, for almost three years!

    I took my son to several orthopedic surgeons (the last two recommended steroid injections which my son does not want. He feels that even if it did work, it would be temporary.  The last surgeon said the injections would  "buy" him some time until he gets a little older. Ultimately he would end up needing surgery anyway.

    He has had enough of the pain (aching and burning in his lower back as well as down his leg) which he suffers from on a daily basis. 
    He does not want a  "bandaid" he wants it fixed.

    I need to find a surgeon that has performed  several direct pars repairs with great success. From my understanding, it is very important for the surgeon to have a very "practiced" hand because the screw has to be placed just right.

    It has been really hard on my son as well as my family these past three years. 

    I would travel anywhere in the world to get the right surgeon for my son, but my son can't sit to long because of the pain.  I need to find a surgeon in the US.
    What drs have you dealt with in the US?
    Would you be able to give me more information?

    Good luck with you appointment. I look forward to hearing from you.

  • bowncebbownce AustraliaPosts: 3

    Hi Julia,


    I understand the daily physical challenges your boy faces
    with this condition, you have my full empathy. From our experience in trying to
    find a solution for this, I was


    Contact any of the top sports physicians at some of
    your NFL football clubs, this was an avenue that I was pursuing, I can’t say it
    here but I can provide you with some well-known examples (privately). 10% of
    white/black males (so I’ve been informed) population suffer from this condition,
    so they would have come across this condition I’m sure.

    I’ve been in touch with a Neuro Surgeon in Miami the Surgeon
    was responsible for a study called Minimally invasive Direct Repair of
    Bilateral Lumbar Spine Pars Defects in Athletes, again I can send you the
    report (privately).  The US Surgeon gave
    me a contact here in Australia that he trained while in the US.


    Yesterday was a difficult day for us but we came to the
    right decision, we won’t be going forward with the procedure for the reasons


    Our son is not in any pain, it only limits him in his
    ability to perform at the level of his physical abilities/endurance – his back lets
    him know when it’s had enough.


    He then has to have time out of the game – usually 3 to 4
    weeks before he can start to do anything again, no professional club will go
    near him with this condition.


    The operation itself has its own difficulties/challenges for
    this reason we decided we didn’t want to pursue, we have had to accept that his
    condition is manageable (no pain) but also it should not deteriorate if he
    looks after/maintains himself going forward into the future.


    I will send a message you a private message with details,
    please let me know how you and your boy get on.





  • julia21jjulia21 United States Posts: 6
    Hi Craig please check your messages 

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