From the Research
The treatment for pars defect should begin with conservative measures, but for young athletes who fail conservative management, percutaneous direct pars repair is a safe and effective surgical option, as evidenced by a recent study 1.
Conservative Management
The initial approach to treating pars defect typically involves:
- Rest and activity modification to reduce stress on the lower back
- Physical therapy focusing on core strengthening, hamstring stretching, and proper posture
- Anti-inflammatory medications like ibuprofen or naproxen for pain management
- A lumbar brace may be recommended for 3-6 months to limit extension and rotation while the defect heals, particularly in younger patients
Surgical Options
For patients who do not respond to conservative treatment, or those with significant neurological symptoms, or progressive slippage (spondylolisthesis), surgical options are considered.
- Direct repair of the defect in younger patients without disc degeneration is a viable option, with percutaneous direct pars repair being a minimally invasive technique that offers advantages such as minimized muscle and soft tissue dissection, reduced blood loss, and early mobilization and recovery 1.
- Spinal fusion may be considered for those with instability or spondylolisthesis.
Recent Evidence
A 2023 study published in Neurosurgery 1 demonstrated the effectiveness of percutaneous direct pars repair in young athletes, with significant reduction in back pain and high fusion rates, making it a promising option for this patient population. While other studies have also explored different surgical techniques and conservative management strategies 2, 3, 4, 5, the most recent and highest quality evidence supports percutaneous direct pars repair as a safe and effective means of treating pars defects in young athletes who have failed conservative management.