Endoscopic and percutaneous minimally invasive repair of pars interarticularis defects: a systematic review of clinical outcomes.
Rohan Phadke, Samer Salman, Rahul Kumar et al.
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In 30 seconds
This PRISMA-guided systematic review assessed clinical outcomes after endoscopic or percutaneous direct repair of pars interarticularis defects in patients with symptomatic lumbar spondylolysis. Five studies comprising 47 patients (94 pars defects) met inclusion criteria. Computed tomography-confirmed union was achieved in a pooled weighted mean of 84.4% (range, 77-100%) at 6-12 months. Studies also reported improvements in pain and function, with 91.4% achieving good or excellent Macnab outcomes and 93.6% returning to preinjury activity or sport. The authors describe these techniques as a motion-preserving option for selected patients.
Key findings
- CT-confirmed pars union was achieved in a pooled weighted mean of 84.4% (range, 77-100%) at 6-12 months.
- Across studies, mean VAS reduction was 5.5 points, and all studies reported significant pain and functional improvement.
- Good or excellent Macnab outcomes were reported in 91.4%; 93.6% returned to preinjury activity or sport.
- The complication rate was 6.4%, with no major neurologic, vascular, or infectious complications reported.
Why it matters
Direct pars repair aims to preserve spinal motion, and this review suggests that minimally invasive approaches can achieve union alongside reported improvements in pain, function, and activity. These outcomes may inform consideration of repair for selected patients with symptomatic lumbar spondylolysis. However, the evidence comes from a small set of studies with varied techniques and outcome reporting, so the pooled results should be interpreted cautiously.
What to keep in mind
Only five studies and 47 patients were included. Surgical techniques and outcome reporting were heterogeneous; the authors call for prospective studies with standardized outcomes and longer follow-up.