25 year old Major League Baseball Player presented with low back pain. Upon review of CT scans, he was discovered to have a pars fracture and require surgery.
Pars/Pedicle Fractures in a Professional Major League Baseball Player
25 year old Right handed starter brought up from minorsAfter 1st major league start began having back painPitch mechanics changed, back pain increasedNo radiculopathyExhaustive core rehabilitationMRI no disc herniations or advanced degenerationCT Spect positive L3 and L5CT scan
Indications for Surgery:
Pars interarticularis fracture, L5-S1 on the left.Pedicles pars fracture, L5-S1 on the right.Pars interarticularis fracture, L3 on the left.Pedicle fracture, L3 on the right.Left-sided low back pain due to the above diagnosis.He has multiple comorbidities including flat feet, hypersensibility ofthe elbows.Semi-professional baseball player.Failed conservative therapy.
Spine Surgery Strategy:
L2 no fracture
L3 R pedicle L Pars fracture
L4 no fracture
L5 Bilateral Pars fracture; No Spondylolisthesis L5
1. Interlaminar laminotomy medial facetectomy, lateral recess release, L5-S1, for removal of a pars interarticularis healing callus with nerve root entrapment, L5-S1 bilaterally.
2. Segmental spinal instrumentation L5 for repair of pars interarticularis fracture, L5-S1 on the left.
3. Open reduction and internal fixation pedicle fracture and pars interarticularis fracture, L5 on the right.
4. Posterior fusion L5-S1 with combination of locally harvested autogenous bone and RH BMP for open reduction and internal fixation L5 bilaterally.
5. Intraoperative SSEPs.
6. Intraoperative fluoro management.