Spine

<p>In this episode, host Christopher Adams, MD, and leading spine surgeons provide insight into innovative applications of the fully threaded spine compression screw for percutaneous pars fracture repair and review relevant scientific literature. Joining Dr. Adams instudio are Raymond J. Gardocki, MD (Nashville, TN), and Christopher A. Yeung, MD (Phoenix, AZ).</p>

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VID1-009108-en-US | A | BreakThrough™ With Christopher Adams, MD—Percutaneous Pars Fracture Repair Episode 1: Innovative Solutions

Christopher Adams

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Raymond J. Gardocki

Christopher A. Yeung, MD

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BreakThrough™ With Christopher Adams, MD—Percutaneous Pars Fracture Repair Episode 1: Innovative Solutions

Speaker  Hello, welcome to BreakThrough. Today we're going to be discussing the fully threaded compression screw for the treatment of pars fractures with Ray Gardocki from Nashville, Tennessee, and Chris Young from Phoenix, Arizona. Gentlemen, thank you for joining us. Thanks, Chris. Absolutely. So, Ray, to start off, can you give us a brief historical perspective on how and why the treatment of pars fractures has evolved? Speaker  Sure, Chris. Traditionally, pars defects have been treated through essentially benign neglect. So activity modification, bracing vitamin D supplementation, physical therapy and bone stimulation. This can achieve symptomatic relief in about 80% of patients, but tends to achieve union of the fracture in less than 30%. So these patients can all progress to a isthmic spondylolisthesis. And there's about 30,000 fusions a year in the United States for Isthmic Spondylolisthesis. Speaker  That's really interesting. Now, Chris, can you discuss the biomechanics of the spine and how the posterior elements protect the disc from shear forces? Speaker  Sure. The posterior elements are made up of the facet joints. The pars interarticularis the spinous processes, the posterior ligamentous complex, and these all form a strut. Speaker  And the ligament of flavum. Speaker  And ligament of flavum. That's pretty good for a shoulder guy. Thank you. So these all function to basically protect the disc from shear forces. They share load, they share torsion forces and basically prevent the disc from bearing all that load. So it's really important to have an intact posterior element complex. Right. So when the posterior elements are compromised in the case of a fracture then the disc bears all the load that leads to increased motion, increased degeneration increased shear and herniations ultimately spondylolisthesis which may need fusion. Speaker  That's fascinating. Now, historically, both conventional surgical and non-surgical treatment options have had many Limitations in the setting of pars fractures ray with advancements in minimally invasive spine surgery. What are the early surgical options for younger patients that are available today? Speaker  Well, for patients that have been treated conservatively for at least three months that are still symptomatic. When you consider things like reliability of outcome, minimally invasiveness, high union rate, restoration of the anatomy and restoration of the biomechanical function, early fixation with percutaneous fully threaded compression screw is a great option. Speaker  Do you have to wait three months when you're when you're deciding if you're going to operate on a patient? Speaker  Well, for early defects, there's a reasonably high rate of healing on their own. So you want to give them a chance to heal that. But if the defect becomes progressive, that rate goes down. So you really want to optimize the fixation early because you want to get them when there's increased pedicle edema, no disc degeneration, no anterolisthesis and not a massive gap because you're going to get a higher rate of anatomic reduction and restoration of biomechanics. Speaker  Now. Chris, can you comment on the need for minimally invasive percutaneous options? Speaker  Sure. I mean, pars fractures occur in young athletes. Right. And so it's important when you treat them minimize any damage to the muscles soft tissues all to allow a speedy recovery. And so a direct percutaneous approach is certainly attractive compared to the traditional options such as open screw and hook. Scott's wiring. Even the traditional buck screw is an open debridement with iliac crest bone grafting and a fully threaded 4.5 screw that's not compression, so a minimally invasive treatment where you're just doing it percutaneously. Very attractive for these athletes. Speaker  Yeah. So that's a great option. Now, the fully threaded compression screw represents a significant innovation in how we approach pars fracture repair, especially for young active patients. Now you've been at the forefront of utilizing this technique. Can you discuss the literature supporting its use in your own personal experience? Speaker  Sure. I'd love to share two studies and my own experience. So the University of Miami doctor, Alan Levy, had a nice case series of patients treated with minimally invasive pars fracture repair. In this case series, they used fluoroscopically guided screw placement with cannulated screws and biologic augmentation. They also utilized a tubular retractor with a one centimetre incision to directly visualize the fracture, to breed it and place the biologic. Clinical outcomes were really good, so there were 21 patients average age of 17.5. All athletes. They were bilateral pars fractures with the most common levels at L5. They all had greater than six months of nonoperative care. So these were all chronic fractures. And after one year follow up, 20 out of 21 were fused on CT and the Vas score decreased significantly from 7.6 all the way down to 0.3. So the results of this study show that there's a lot of advantages for athletes. There's minimal post-operative pain due to the minimal soft tissue injury. It preserves the soft tissue. It reduces recovery time, and it promotes early return to high level physical activity. So in that first study, they used a fully threaded cortical screw in this new study from Japan. They used a headless compression screw in a cortical bone trajectory. So similar to the last case, early in progressive stage, lesions of lumbar spondylolysis were treated. Speaker  Again, a cortical bone trajectory for enhanced strength and fixation in the bone. Importantly, this study did not use any bone grafting at all, and the screws were nicely embedded in the lamina. There were 14 patients, all adolescent athletes. 100% of them achieved bony fusion, and the time to fusion was pretty quick 4.4 to 7.7 weeks. All of them returned to play within three months and there were no complications or failures reported. So this again shows advantages for athletes for this minimally invasive percutaneous approach. Short recovery time, minimal restrictions. It minimizes physical performance loss and promotes an early return to sports. It also helps prevent recurrence because the fracture is augmented. So my personal experience has mirrored the success in those two studies. To date, I've treated 16 patients with this technique starting in 2020. And actually, I've had nine patients in this most recent year, 2025, all treated with a percutaneous headless compression screw with fluoroscopic guidance or navigation. Out of those 16 patients, 13 patients have achieved at least three months of follow up. And just summarizing those patients, the Vas score was 5.5 Preoperatively and Postoperatively. It was 0.7. All of those patients have returned to play doing very well. And in fact, 11 out of those 13 patients at three months had zero out of ten pain. Speaker  Thank you Chris, that was great. Now we know that the percutaneous pars fracture repair is the preferred method in your outcomes and literature support that. However, Ray, when utilizing the fully threaded compression screw for the surgical treatment of pars fractures, tell us how this has changed your treatment algorithm for younger patients. Speaker  So in patients that have failed conservative management are still symptomatic. We are much more likely to offer early intervention with surgical fixation with a percutaneous fully threaded compression screw Optimizing the anatomic reduction and capitalizing on the patient's native bone healing at the stage of the defect when it's most likely to heal, is paramount to achieving restoration of biomechanical function and preventing the long term risk of future fusions. So this is the one procedure that has spine surgeons. We have the option and possibility of reducing a patient's lifetime risk of fusion. Speaker  It's a really good point. Well, gentlemen, your personal experience and outcomes data speak for themselves at fully threaded. Compression screws are a great option for our patients with pars fractures. Right. Chris thank you for joining us today. Thanks, Chris. Speaker  Thanks for having us. Speaker  Absolutely. Now, to learn more about fully threaded compression screws for the treatment of pars fractures, be sure to tune in to our other BreakThrough episodes, including technique, play by play, making the case, lessons learned, and the patient experience. Thank you for joining us.

BreakThrough™ With Christopher Adams, MD—Percutaneous Pars Fracture Repair Episode 1: Innovative Solutions

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