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Pars defects and
Spondylolisthesis
Dr Paul Licina
Dr Mark Young
Pars Interarticularis
Pars and Pedicle fracture
Spondylolysis: A defect in the pars interarticularis of the vertebral arch
Spondyolisthesis
Spondylolisthesis (anterolisthesis): Forward displacement of a
superior vertebral body over the vertebral body below (include
isthmic, dysplastic and others)
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
Athletic Pars fractures
• ??Adolescence
• Extension sports (esp gymnastics, cricket
bowling, divers, throwing athletes, ?ball
sports)
• Usually symptomatic
• Contralateral side
• Some sports L4 > L5
Extension produces inferior Pars
tension stress
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
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
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
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