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Innovations in Pars Fracture Care

Pars fracture is a common degenerative condition that affects the spine's vertebral discs and joints, leading to pain and reduced mobility. The Center for the Functional Restoration of the Spine specializes in comprehensive treatment plans to alleviate symptoms and improve the quality of life for individuals with spinal spondylosis.


drawn comparison of spine with Spondylolysis

Spondylolysis is a defect that can lead to stress fractures in the posterior element of the spine called the pars interarticularis, the thin piece of bone that connects the upper and lower segments of the facet joints. Facet joints link the vertebrae directly above and below to form a working unit that permits spine movement.

The term is derived from the Greek words spondylos, which means spine or vertebra, and lysis, which means a break or loosening. If the stress fracture weakens the bone so much that it cannot maintain its proper position, the vertebra can start to shift out of place, a condition called spondylolisthesis.

Spondylolysis is a common source of lower back pain in adolescents, particularly those involved in athletic activities that place a lot of stress on the lower back or cause constant overstretching (hyperextending) of the spine, such as gymnastics, weightlifting, and football. It is seen more often in males than in females. Spondylolysis is seldom seen in patients under the age of five and is found in 5% of people over the age of seven. It is a common cause of back pain in children, and the most likely cause of back pain in patients under age 26, but rarely the only cause of complaints after age 40.* The defect may also be present in adults with no prior injury history or sports participation.

The exact cause of spondylolysis is unknown. Some theories point to genetics as a factor, suggesting that those with thinner bones are more susceptible to breakage. Others propose that repetitive trauma to the lower back weakens the pars interarticularis. Spondylolysis may also be associated with conditions that cause spine instability, such as lumbar disc degeneration or narrowing of the area where the nerve roots exit the spinal column (the neural foramina).


In some cases, this stress fracture weakens the bone to the extent that it is unable to maintain its proper position in the spine, causing the vertebra to shift or slip out of place, a condition known as spondylolisthesis. 

In cases of spondylolisthesis, the fractured pars interarticularis becomes separated, resulting in the affected vertebra shifting or slipping forward on the vertebra directly beneath it. In younger individuals, this displacement frequently happens during periods of rapid growth, such as during adolescence.

Medical professionals often categorize spondylolisthesis as either low-grade or high-grade, depending on the degree of slippage:

  • A high-grade slip occurs when more than 50% of the width of the fractured vertebra shifts forward on the vertebra below it
  • Patients with high-grade slips are at a higher risk of experiencing significant pain and nerve damage and may require surgery to alleviate their symptoms and prevent further deterioration

Living with spondylolisthesis can be challenging, but CFRS aims to provide compassionate care and effective interventions to enhance your quality of life.

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Many people with spondylolysis may be asymptomatic, meaning they experience no obvious pain or discomfort. Signs the condition may be present include the following:

  • Pain that spreads across the lower back; often feels like muscle strain
  • Pain worsens with physical activity, particularly during hyperextension
  • Hyperlordosis (increased inward curvature) of the lower back
  • Tightening of the hamstring muscles (those in the back of the leg)
  • Neurogenic/radiating pain (burning/shooting pain down the leg)

Patients diagnosed with spondylolisthesis may experience muscle spasms that can contribute to various additional signs and symptoms, such as:

  • Stiffness in the back
  • Challenges with standing and walking
  • Tingling, numbness, or weakness in one or both legs

These symptoms arise from the spinal nerve root compression as it exits the spinal canal near the fracture site.


    To determine if spondylolysis or spondylolisthesis is the cause of your symptoms, your doctor may recommend a diagnostic test such as an X-ray, computed tomography (CT) scan, or magnetic resonance imaging (MRI) in addition to a physical exam. The diagnosis is confirmed by the discovery of a fracture in the pars interarticularis, called a pars defect.

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    Treatment Options

    Your doctor will be able to discuss with you what your diagnosis means in terms of treatment options. For most people without any signs of nerve compression or other neurologic impairment, the first line of treatment consists of non-surgical therapies such as medication, rest, and physical therapy. Bracing and epidural spinal injections also may be recommended.

    Spine surgery is typically considered only after conservative therapies fail to relieve symptoms over a significant period adequately or if evidence of nerve involvement, such as numbness or tingling, muscle weakness, or bowel or bladder impairment, develops.

    Surgical procedures that may be recommended for the treatment of spondylolysis and spondylolisthesis include:

    • Spinal decompression: a procedure in which bone is removed to eliminate nerve pressure
    • Spinal fusion: a procedure in which bone graft material is placed between vertebrae to join – or fuse together – the vertebrae to restore spinal stability

    The procedures are typically performed together as part of the same surgery, the overall goal of which is to remove the source of irritation and inflammation and restore the spine's stability. However, the benefits of spine surgery must be weighed against the risks. Discuss with your surgeon the risks and benefits of surgery, and the potential results of operative versus non-operative treatment.

    * Borenstein DG, Wiesel SW, Boden SD. Low Back Pain: Medical Diagnosis and Comprehensive Management. Philadelphia, PA:W.B. Saunder's Co.;1995.

    Spondylosis Specialist

    Spondylolysis, a stress fracture in the lower back, often develops in adolescents, but symptoms may not appear until later in life as the condition gradually worsens. Steve Paragioudakis, MD, and Marc Menkowitz, MD, of the Center for the Functional Restoration of the Spine in Shrewsbury, Toms River, and Edison, New Jersey, specialize in spondylolysis and spondylolisthesis. They create individualized treatment plans to relieve the pain and strengthen your back, recommending surgery only when necessary for severe cases. Call or schedule an appointment online today to get help with lower back pain.

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    Spondylosis Q & A

    What is spondylolysis?

    How are spondylolysis and spondylolisthesis different from each other?

    What symptoms develop if I have spondylolysis?

    How do spine specialists diagnose spondylolysis?

    How do spine specialists treat spondylolysis?

    What is spondylolysis?

    Spondylolysis, also called a pars defect or pars fracture, is a stress fracture occurring in the lower back. You’re more likely to develop spondylolysis when you perform repetitive movements that make you bend backward. This bending stresses a specific part of the vertebrae called the pars interarticularis. Pars fractures typically begin in children and adolescents who participate in sports such as football, weightlifting, karate, and gymnastics. A pars fracture that starts in adolescence may not cause symptoms until adulthood.

    How are spondylolysis and spondylolisthesis different from each other?

    Spondylosis and spondylolisthesis are distinct conditions that affect the spine. Spondylosis refers to degenerative changes in the spine, such as the development of bone spurs and the breakdown of intervertebral discs. On the other hand, spondylolisthesis involves the forward displacement of a vertebra in the spine, often due to a stress fracture in the pars interarticularis, a small bone bridge connecting the facet joints at the back of the spine.

    What symptoms develop if I have spondylolysis?

    You may not have any symptoms at first, but they can develop over the years as the stress fracture worsens. Then you may experience:

    • Lower back pain that feels like a muscle strain
    • Pain that’s worse when you’re active
    • Increased inward curvature in your lower back
    • Pain or tingling that radiates down your legs
    • Tight hamstring muscles
    • Muscle spasms

    In severe cases, spondylolysis weakens the bone so much that the vertebra can slip out of place. This condition, called spondylolisthesis, occurs in about 15% of patients who have untreated spondylolysis.

    How do spine specialists diagnose spondylolysis?

    Your provider at the Center for the Functional Restoration of the Spine orders diagnostic testing after reviewing your medical history and symptoms and performing a physical examination. Depending on your exam results, you may need an X-ray, CT scan, or MRI to verify spondylolysis and rule out other causes of your symptoms.

    How do spine specialists treat spondylolysis?

    Your treatment begins with non-surgical therapies such as medication, rest, and physical therapy. You may also need bracing to immobilize your back and give the fracture time to heal. When over-the-counter medications don’t help your pain, your provider may recommend a spinal epidural injection. This injection contains steroids that alleviate your pain by reducing inflammation. If your symptoms still don’t improve after several months of conservative treatment, you may need to consider surgery. Spondylolysis often improves with spinal decompression that takes the pressure off the nerves. This decompression is then followed by a fusion to restore spinal stability. You follow the same treatment plan should your vertebra slip and cause spondylolisthesis. However, you’re more likely to need surgery once a pars fracture progresses to this point. The experienced team at the Center for the Functional Restoration of the Spine offers exceptional treatment for spondylolysis. To schedule an appointment, call or use the online booking feature today.

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