What are the prerequisites for successful outcome with a pars repair How is this procedure performed

• Patients who are best suited for pars repair are younger than 25 years old, have no evidence of disc or facet pathology at the level of spondylolysis, and have a slippage less than 2 mm. The procedure requires careful debridement

Figure 38-2. Radiographic measurements of spondylolisthesis. (From Ginsburg GM. Spondylolysis and spondylolisthesis. In: Brown DE, Neumann Rd, editors. Orthopedic Secrets. 2nd ed. Philadelphia: Hanley & Belfus; 1999. p. 200-4, with permission.)

of the pars pseudarthrosis and application of autogenous bone graft to this region. Internal fixation across the pars defect is required (Fig. 38-3). Fixation options include:

• Direct screw fixation across the pars defect (Buck technique)

• Wire fixation between the transverse process and spinous process (Scott technique)

• Wire-screw or cable-screw construct (connects a pedicle screw via a wire or cable passing under the lamina and tightened around the spinous process)

• Screw-hook-rod fixation (ipsilateral pedicle screw and infralaminar hook are connected by a rod)

• An intralaminar link construct (V-shaped rod passes over the posterior aspect of the right and left lamina and underneath the spinous process to connect screws in the right and left pedicles)

• Pedicle screw-intralaminar screw-rod construct

Figure 38-3. Techniques for repair of the pars interarticularis. A, Direct screw fixation. B, Scott wire technique. C, Screw-rod-hook fixation. (A from Reitman CA, Esses SI. Direct repair of spondylolytic defects in young competitive athletes. Spine J 2o02;2:142-4; B from Ginsburg GM. Spondylolysis and spondylolisthesis. In: Brown DE, Neumann RD, editors. Orthopedic Secrets. 2nd ed. Philadelphia: Hanley & Belfus; 1999. p. 200-4, with permission; C from Benzon HT, Rathmell JP, Wu CL, et al. Raj's Practical Management of Pain. 4th ed. St. Louis: Mosby; 2008.)

Figure 38-3. Techniques for repair of the pars interarticularis. A, Direct screw fixation. B, Scott wire technique. C, Screw-rod-hook fixation. (A from Reitman CA, Esses SI. Direct repair of spondylolytic defects in young competitive athletes. Spine J 2o02;2:142-4; B from Ginsburg GM. Spondylolysis and spondylolisthesis. In: Brown DE, Neumann RD, editors. Orthopedic Secrets. 2nd ed. Philadelphia: Hanley & Belfus; 1999. p. 200-4, with permission; C from Benzon HT, Rathmell JP, Wu CL, et al. Raj's Practical Management of Pain. 4th ed. St. Louis: Mosby; 2008.)

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