Name: BreakThrough™ With Christopher Adams, MD—Percutaneous Pars Fracture Repair Episode 4: Lessons Learned
Uploaded: 2026-10-01T10:31:00Z
Channel: Arthrex
Description: In this episode, leading spine surgeons share their experiences and the key educational tips and pearls they’ve learned while incorporating the fully threaded spine compression screw for percutaneous pars fracture repair into their practices. Joining host Christopher Adams, MD, are in-studio guests Michael A. Gallizzi, MD (Vail, CO), and Raymond J. Gardocki, MD (Nashville, TN).

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<p>In this episode, leading spine surgeons share their experiences and the key educational tips and pearls they’ve learned while incorporating the fully threaded spine compression screw for percutaneous pars fracture repair into their practices. Joining host Christopher Adams, MD, are in-studio guests Michael A. Gallizzi, MD (Vail, CO), and Raymond J. Gardocki, MD (Nashville, TN).</p>

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VID1-009104-en-US | A | BreakThrough™ With Christopher Adams, MD—Percutaneous Pars Fracture Repair Episode 4: Lessons Learned

Christopher Adams

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Michael Gallizzi

Raymond J. Gardocki

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BreakThrough™ With Christopher Adams, MD—Percutaneous Pars Fracture Repair Episode 4: Lessons Learned

Speaker  Welcome to BreakThrough. Today we're going to be discussing fully threaded compression screws for the treatment of pars fractures with Michael Galassi from Vail, Colorado, in Ray Gerdisch from Nashville, Tennessee. Gentlemen, thank you for joining us today. Speaker  Thanks, Chris. Speaker  Thanks for having us. Speaker  So, Ray, let's start with you. With your vast experience treating pars fractures, what are the crucial surgical steps of the pars fracture repair utilizing fully threaded compression screws? Speaker  Well, Chris really starts with preoperative imaging. You want to identify the defect, know the stage and know what trajectory you're trying to hit. Positioning the patient on the table is essential to be able to achieve the proper trajectory. And really, once you place the guidewire perpendicular to the defect, it's pretty much drill tap screw. Speaker  Yeah, I agree with that. You know, a lot of times patients are referred to me with advanced imaging already done or their non-operative treatment already completed. Typically I like to see at least three months of that non-operative try and then an attempt to get back return to play. If they can't do that, that's when we have the discussion. And like Ray said, the preoperative imaging is very important. Knowing the chronicity of the fracture, how acute or old it is, will depend on how we approach it. But also getting that guidewire perfect is essential to making this percutaneous procedure go well. Speaker  Thanks for describing those crucial steps. So, Mike, can you share where percutaneous pars fracture repair fits into your treatment algorithm? Speaker  Yeah, absolutely. So before this wasn't really an option and we had to do like an open repair. And when you think about opening up a young adolescent athlete doing an open surgery to get these screws in, that was very detrimental to the soft tissue ligament structures all the way around. And then they carry that lifetime risk. But with percutaneous repair, we're actually changing their lifetime risk of having a spondylolisthesis by fixing it acutely in a minimally invasive fashion. And by being able to do this percutaneously, we can reduce that fracture and have a high union rate that gives them a better chance for good spine health the rest of their life. Speaker  Makes sense now, Ray, what have you learned from patient selection for the percutaneous technique, and how does that differ from patient selection using conventional surgical approaches? Speaker  Well, because we can do this with less collateral damage high precision and a very high union rate. Really the better candidate is somebody who's early along in the disease process. You know, the morbidity of the approach from an open repair was high enough that you really wanted to give a patient every chance to be asymptomatic before you treated them. The problem with treating them conservatively and shooting for asymptomatic status is they have a very high rate of nonunion, and then that increases their long term risk of spondylolisthesis later. So we have the ability to get these earlier when there's edema in the pedicle, not a big fracture GAP no degeneration or listhesis and decrease that lifetime risk of lumbar fusion. Speaker  Good point. Points. Thank you for sharing that overview. Now, Mike, what is your rehab protocol for patients who have undergone a percutaneous pars fracture repair? Speaker  Yeah. So my rehab protocol is pretty conservative in terms of it is a fracture and I want it to heal. So just my typical post-operative protocol is bracing them post-operatively three months. And then during that three months, we slowly ramp up their physical activity until they're able to walk on a treadmill, increase their elliptical, ride a bike. But then as soon as they hit that three months, I'm really comfortable letting them get back into their sports specific rehab protocol. So core strength and really getting after whatever sport they want to do. Speaker  And sometimes we'll include vitamin D supplementation, bone growth stimulators, anything we can do to get that fracture to heal natively, we want to do. But when it doesn't, getting a reliable fixation is a great option. Speaker  Makes perfect sense. So before we close, can you both leave us with some final thoughts on how the percutaneous technique has improved patient outcomes for pars fracture repairs? Speaker  Yeah, for for me, it's getting athletes back faster to their sport. If you see it and they fail, fix it early. Speaker  Being able to achieve reliable outcomes with consistent recovery and long term results is really the key to doing this. You know, being able to minimize the collateral damage and the hope of being able to reduce the lifetime risk of fusion. It really is a paradigm shift. Speaker  That's great. Ray. Mike, thank you for sharing those lessons learned. 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 Innovative solutions, technique, play by play making the case, and the patient experience. Thank you for joining us.

BreakThrough™ With Christopher Adams, MD—Percutaneous Pars Fracture Repair Episode 4: Lessons Learned

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