Name: BreakThrough™ With Christopher Adams, MD—Percutaneous Pars Fracture Repair Episode 3: Making the Case
Uploaded: 2026-10-01T10:34:00Z
Channel: Arthrex
Description: In this episode, leading spine surgeons discuss key patient considerations when using the fully threaded spine compression screw for percutaneous pars fracture repair and highlight their clinical experience through case presentations. Joining host Christopher Adams, MD, are in-studio guests Saqib Hasan, MD (San Francisco, CA), and Christopher A. Yeung, MD (Phoenix, AZ).

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<p>In this episode, leading spine surgeons discuss key patient considerations when using the fully threaded spine compression screw for percutaneous pars fracture repair and highlight their clinical experience through case presentations. Joining host Christopher Adams, MD, are in-studio guests Saqib Hasan, MD (San Francisco, CA), and Christopher A. Yeung, MD (Phoenix, AZ).</p>

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VID1-009105-en-US | A | BreakThrough™ With Christopher Adams, MD—Percutaneous Pars Fracture Repair Episode 3: Making the Case

Christopher Adams

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Christopher A. Yeung, MD

Saqib Hasan, MD

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BreakThrough™ With Christopher Adams, MD—Percutaneous Pars Fracture Repair Episode 3: Making the Case

Speaker  Welcome to BreakThrough. Today we're going to be making the case for using fully threaded compression screws for the treatment of pars fractures with sakalihasan from San Francisco, California, and Chris Young from Phoenix, Arizona. Thank you for joining us. Speaker  Thanks, Chris. Thanks, Chris. Speaker  Now, to start off, Chris, can you tell us about a recent case where you've seen the benefits of a percutaneous technique utilizing the fully threaded compression screw for a pars fracture repair? Speaker  Yes. I'd be happy to share a case. I mean, it's really changed the way I approach this pathology. Hello. So this is a 19 year old professional baseball player who is in the minor leagues. He has a one month history of low back pain and he is unable to pitch. Interestingly in his history, he had a similar episode when he was 15 years of age. This was treated with conservative treatment. On physical exam he has pain with range of motion. He has tenderness over his left paraspinal area and he has a positive Storch test. Otherwise he's neurologically intact. So of course we got an MRI, and on the MRI it showed an acute pars fracture with edema and high signal change in the left L3 pars. We got a CT scan and you can see on the left he had an acute progressive or early fracture at L3. But he also had a chronic fracture on the right L3. And this is consistent with his history. So this is just showing the CT scans. The sagittal going from left to right and the axial. So you can look at the entire spine. So our diagnosis was an acute left L3 pars fracture and a chronic right L3 pars fracture. So I recommended surgery for him. He needed to get back to sport quickly and reliably. So we recommended a navigated percutaneous pars fracture repair with a fully threaded compression screw. Speaker  And this is showing the steps of the actual surgery. So we use a jamshidi needle and place this into the parse and approximate the trajectory. Then we use it as a drill guide and place a k-wire across the pars. Once that's in place, we drill over this and then we place the pars screw. Here you can see us placing the pars screw on the left L3 and placing the jamshidi needle on the right L3. So how did he do so when he presented, he had four out of ten pain post-operatively as early as two weeks he had zero out of ten pain, and he remained zero out of ten through his entire post-operative course, which he's now over a year. At three months, we got a CT scan and this confirmed perfect healing of the fracture, and he was cleared to return to play at three months. So here is the post-operative CT scan again going from left to right on the sagittal. And this shows excellent placement of all the screws. There is no fracture anymore. The fracture is all healed and he was cleared to play at three months. Here's a post-operative CT scan of the axial views again showing healed fractures and well-placed compression screws. This case illustrates that you can treat this with an acute fracture and get athletes back to return, to play very quickly and consistently. Speaker  Chris. That was a great case with an impressive outcome. Now you specialize in spinal endoscopy. Can you share how you incorporate endoscopy into your pars fracture repairs? Speaker  Yeah. Chris. Well, you know, chronic pars fractures can be very cumbersome to treat. And I have a really innovative case to show how you can really leverage the endoscope to really get value out of the endoscope and improve outcomes. Speaker  That would be great. Speaker  So I'm going to present a case of a 17 year old male gymnast who had a greater than one year history of low back pain. The patient was unable to participate in sports, and he was a very athletic male. So he had a tremendous impact on his quality of life in terms of treatment. The patient had tried activity restriction as well as physical therapy with no improvement. On exam, the patient had pain with lumbar extension as well as a positive stork test, and he was neurovascularly intact distally. So as we look at the X-rays, we can see there's chronic bilateral L5 pars fractures. When we look at the Cat scan, we can see that there's fracture gapping with sclerotic bony edges at the fracture site. As you can see, we got a bone scan which demonstrated the pars fracture was metabolically inactive. So our diagnosis is a chronic bilateral L5 pars fracture. And our treatment plan is going to be endoscopic assisted and navigation guided percutaneous pars fixation with fully threaded compression screws. So let's jump right into it. Now I like to use navigation because navigation has two purposes. Not only does it allow us to localize the trajectory for the pars fixation, but it also allows us to localize the actual pars fracture in a very streamlined manner. Speaker  Now I like to start with the endoscopic visualization because I think it has some added benefits. Number one, it allows us to quickly access the pars fracture site after sequential dilation and debris, all fibrous tissue which is critical to achieving bony union. It also has the added benefit of allowing us to visualize the screw and drill trajectory to make sure we're not skiving, and it adds an extra level of confidence in knowing that we are in the right position. Once we have the endoscope in place, we can see all this fibrous tissue that's in the fracture site. Now, you can imagine if we don't remove this fibrous tissue, this pars fracture is going to have a tough time healing once you remove the scar tissue. I like to use a high speed drill to then allow us to get bony bleeding to then facilitate bony union. And you can see nicely on the video that we can visualize the fracture line very well. Once we are confident with our fracture debridement, we can then move on to the actual instrumentation. Now I like to actually have my endoscope parked at the fracture site, visualizing both fracture ends to ensure that one, the guide wire, as well as the drill, are placed in the correct trajectory. Speaker  As you can see here, we are drilling through the fracture site and we can see we're currently in the fracture site. This combined with navigation, allows us to ensure that we are doing a very safe and controlled procedure. Once we have our guide wire in the correct position, we can then place our fully threaded compression screw across the fracture site. We can actually visualize the screw traversing the fracture site. Once we're happy with our final position of our screw, and we know that we have achieved the optimal trajectory and placement of the screw, we can then augment the repair with bone graft. As you can see here, and I like to turn my irrigation off because it allows me to place the bone graft without worrying about migration. And it's critical that we really fill all the crevices of the fracture with bone graft to encourage a nice bony healing environment. So these are the final X-rays which demonstrate that we have excellent position of the hardware. And as you can see, the patient's preoperative Vas score dropped from 8 to 0 as well as their ODI dropped from 22 to 0 as well. That indicates that the patient is no longer disabled from this fracture site. And he was able to return to play within six months. Speaker  Socket, thanks for showing us that innovative case utilizing the endoscope to assist in your pars fracture repair. So Chris, what are your thoughts on utilizing the endoscope to assist during a pars fracture repair? Speaker  Yeah, I've used it multiple times. So I think it's beneficial in the case where the pars fracture is more difficult to heal. So on imaging you'll see widened fracture gaps very sclerotic margins. And it may have low metabolic activity on MRI or Spect scan. So the endoscope allows you to directly visualize the fracture, debride it, and then apply biologics directly in the fracture site, all to help it heal. So I think it's very useful because this can accomplish that in a minimally invasive fashion. Speaker  That's really incredible. Gentlemen, thank you again for sharing your experiences and making the case for pars fracture repairs with fully threaded compression screws. Speaker  Thanks for. Speaker  Having us. Thanks, Chris. 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, lessons learned, and the patient experience. Thank you for joining us.

BreakThrough™ With Christopher Adams, MD—Percutaneous Pars Fracture Repair Episode 3: Making the Case

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