Recent advancements in surgical techniques are offering new hope for adolescent athletes diagnosed with spondylolysis, a stress fracture in the spine. A case series presented at the North American Spine Society Annual Meeting in suggests that robotic-assisted pars repair allows a significant number of these athletes to return to their sport, sometimes even at the same or a higher level of competition.
For years, the initial approach to spondylolysis involved nonoperative treatment, such as rest and physical therapy. However, this isn’t always effective. Traditionally, when conservative measures failed, surgical intervention often meant spinal fusion – a more invasive procedure. Robotic-assisted pars repair is emerging as a potentially less invasive alternative, aiming to prevent the need for future spinal fusion.
Spondylolysis commonly affects adolescents, with approximately 7 percent experiencing a pars fracture. This number can climb as high as 50 percent among teenagers participating in high-risk sports like gymnastics, football, and soccer. A pars fracture, also known as spondylolysis, is a break in the pars interarticularis, a small, thin section of bone that connects the vertebrae in the spine. While some fractures heal with rest – typically six to eight weeks away from sports – around one in five adolescents experience a nonunion, meaning the fracture doesn’t heal.
This nonunion can lead to persistent back pain, and resuming activity often triggers a return of symptoms. In some cases, athletes have been advised to discontinue their sport altogether. “Nonunion can cause persistent back pain and, in certain cases, even require lumbar fusion later in life if the fracture results in a vertebral slip, where the vertebrae slip out of place,” explained Austin Kaidi, MD, an orthopedic surgery resident at Hospital for Special Surgery, as reported in November .
Spine surgeons at Hospital for Special Surgery (HSS) have been investigating the benefits of robotic-assisted pars repair. Their findings, presented at the 40th Annual Meeting of the North American Spine Society, showed that minimally invasive robotic-assisted pars repair enabled most patients to return to sports in as little as six weeks.
The recent case series, as highlighted by Dr. Sheeraz Qureshi, co-chief of spine service at HSS, involved nine adolescent patients with symptomatic spondylolysis. The patients underwent pars repair using a single screw technique. At one-year follow-up, CT scans revealed evidence of fusion in three of the nine patients. Five patients were able to return to their sport at the same or a higher level, while only one continued to experience back pain and was unable to return to athletic activity.
Dr. Qureshi noted a shift in approach at HSS, with robotic-assisted pars repair being increasingly offered to patients. He emphasized that this isn’t a first-line treatment, but rather an option considered when initial non-surgical approaches aren’t successful. “It does not mean we jump the first nonsurgical treatment because some people do get better with that, but we have now increasingly been doing this,” he stated.
A critical question remains: will robotic-assisted pars repair prevent progression to spondylolisthesis, a condition where one vertebra slips forward over the one below it? Researchers are focusing on long-term tracking of patients to determine if this approach can avert the need for future spinal fusion. Dr. Qureshi expressed hope that future research will demonstrate that robotic-assisted pars repair not only addresses the current fracture but also prevents the development of spondylolisthesis. “If we find out that [robotic-assisted pars repair] prevents the development of spondylolisthesis then at that point it may be a fracture where you do not even try the nonoperative treatment,” he said. “If you find it, you fix it, because you are not only fixing the problem today, but you are preventing a future problem.”
The robotic-assisted approach involves carefully planning the placement of surgical screws, a technique pioneered approximately seven years ago by Dr. Qureshi at HSS. This precision is intended to improve outcomes and potentially reduce the risk of complications.
While the initial results are promising, further research is needed to fully understand the long-term benefits and potential risks of robotic-assisted pars repair for adolescent athletes with spondylolysis.
