Name: Chronic Pars Fracture Repair With Endoscopic Debridement and Fixation
Uploaded: 2026-11-03T12:15:00Z
Duration: 5 min 42 s
Channel: Arthrex
Description: Saqib Hasan, MD (San Francisco, CA), presents on percutaneously repairing chronic pars fractures with endoscopic debridement and fixation.

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<p>Saqib Hasan, MD (San Francisco, CA), presents on percutaneously repairing chronic pars fractures with endoscopic debridement and fixation.</p>

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VID1-008591-en-US | A | Chronic Pars Fracture Repair With Endoscopic Debridement and Fixation

Saqib Hasan, MD

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Chronic Pars Fracture Repair With Endoscopic Debridement and Fixation

Speaker  Hello, I'm Doctor Saqib Hasan, a spine surgeon at Golden State Orthopedics and Spine with a focus on minimally invasive spine surgery. Pars fractures represent a unique challenge, especially in young athletes. These fractures most often occur from repetitive hyperextension in sports such as gymnastics and football. While conservative treatment remains first line, some athletes face career altering setbacks if healing does not occur. Endoscopic pars repair with debridement and fixation preserves anatomy while respecting bone biology, offering a bridge between prolonged conservative care and more invasive open fusion patients typically present with activity related low back pain, worsened by extension when six months of optimized conservative care fails and imaging demonstrates a chronic pars defect with nonunion surgical repair becomes an option, particularly in high level athletes who risk losing critical development opportunities. Pars pathology exists on a spectrum from stress reaction to complete fracture, with gapping and potential progression of Spondylolisthesis diagnosis blends physical exam with targeting imaging and metabolic assessment with bone scan or Spect CT. Acute hot lesions trend towards healing with Rest. While chronic cold lesions with sclerosis are less likely to unite without surgery. In this case, we have a patient with CT confirmed chronic nonunion with persistent symptoms despite conservative management. The goals are to refresh, fracture surfaces and stabilize with compression. Endoscopic debridement allows direct visualization and removal of fibrous tissue, exposing bleeding bones to encourage healing. Fixation is achieved with a cannulated headless compression screw, a concept adapted from Scaphoid and Jones fracture repair. This provides stable compression across the pars with minimal morbidity. Positioning is critical. I prefer the Wilson frame. Many patients with Isthmic spondylolisthesis have high pelvic incidence and therefore marked lumbar lordosis in a Jackson frame. Speaker  This hyperlordosis makes safe screw trajectory difficult. The Wilson frame reduces lordosis, improves visualization, and facilitates a perpendicular pars trajectory. Alternatively, a bump can be used at the operative level to induce kyphosis. Incisions can be localized under fluoroscopy or with navigation. With navigation, I use a universal drill guide. A key pearl is pre-op CT templating to measure PA's width and length. Most often, a 4 to 5 millimeter headless compression screw provides secure fixation while maintaining a low profile trajectory. Planning can also be performed with biplanar fluoroscopy. Ideally, you want a screw to have a medial to lateral trajectory on the AP plane. With bisection of the pedicle on the lateral view, you want to ensure the trajectory is in line with the pars through the proximal tip of the pedicle. Whether using navigation or biplanar fluoroscopy, it's critical to ensure the incision is sufficiently distal and adjacent to the midline to allow for safe drilling. For optimal placement, be sure to dissect past the fascia to ensure the drill guide is not being held up by soft tissue. Advance the guidewire through a soft tissue protector and drill sleeve from the lamina perpendicular to the fracture site into the pedicle, stopping just before the top of the pedicle, always lateral to the medial pedicular line for length. Use the markings on the drill guide to determine screw length. Again, the diameter of the screw can be determined by measuring off of a preoperative CT scan or by using navigation software if using intraoperative navigation. Prior to proceeding with the instrumentation, I find the best workflow for chronic pars fracture is to start with the endoscopic visualization and debridement to allow for instrumentation to be completely under direct visualization using intraoperative navigation or fluoroscopy. Speaker  It's fairly easy to locate the pars fracture. We use a standard workflow that involves locating the fracture site on the AP and lateral fluoroscopy with a needle, and then using sequential dilation, followed by placement of a working channel and endoscope. The soft tissue overlying the fracture is debrided, followed by debridement of the fibrous nonunion within the fracture site. This step is critical in order to adhere to the biologic principles of bone healing. Once you have completed debridement of the fibrous nonunion, ensure you debride sclerotic ends until bleeding bone is seen. Prior to starting the instrumentation. If an assistant is not available, you can use a scope holder to park the endoscope directly over the fracture site in order to allow full visualization of the instrumentation. You can watch the guidewire and screw traverse the defect in real time using both fluoroscopic and endoscopic confirmation. Augment with demineralized bone matrix plus bone marrow aspirate to support bony union. Headless compression screws provide stable fixation while preserving motion segments with biologic augmentation. Our goal is durable union and pain resolution and a timely return to sport. Systematic reviews show 76 to 100% return to sport following direct repair in adolescents. For the postoperative protocol, we typically brace for six weeks and restrict extension for three months, and we typically begin PT at about three months. Return to sports typically falls between 6 and 12 months, depending on healing. Ct follow up confirms union, though chronic cases may require longer follow up.

Chronic Pars Fracture Repair With Endoscopic Debridement and Fixation

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