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Pars Interarticularis Injury Follow-up

  • Author: Gerard A Malanga, MD; Chief Editor: Craig C Young, MD  more...
 
Updated: Oct 20, 2015
 

Return to Play

Return-to-play protocol depends on the individual's progress and the stage of the pars injury. Herring and Standaert recommended that the athlete progressively return to the sport if he/she is asymptomatic after 4-6 weeks with a mature corticated fracture on CT scan.[44] According to the investigators, if the CT scan shows an earlier stage lesion with either a stress reaction or minimal separation with noncorticated or cystic margins, the potential for true bone healing exists, and they recommend a more extensive rest protocol of 12 weeks, with no participation in sports and no extensive physical activity beyond that associated with normal daily activities. After a gradual rehabilitation program and no symptoms, the athlete can progressively return to the sport.[44]

Congeni et al recommended that after 8 weeks from the diagnosis, the athlete can return to play if he/she has been pain free during therapy, at rest, with hyperextension, and with the specific athletic activity.[47] Omey et al recommend that with early spondylolytic lesions, a rigid brace be applied for 6-9 months before returning to the sport.[78] The athlete must be pain free when playing the sport with the brace applied before discontinuing its use.

In general, there is no official time guideline for return to play in the literature; however, the general consensus for return to play is for the athlete to be asymptomatic at rest, with activity, with hyperextension, and when playing the specific sport.

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Prevention

See Maintenance Phase, Physical Therapy.

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Prognosis

In general, early lesions have a greater chance for true bony healing. Early lesions usually yield good to excellent results. The chronic lesions have a decreased chance for true bony healing; however, even without complete bony union, the symptoms can resolve with proper therapy, rest, and sport-specific techniques.[1]

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Education

Overall, patient education in the prevention of low back injuries is important. Maintaining proper flexibility and spinal stabilization with a home exercise program are also strongly advised. Teaching proper technique in the specific sport can also prevent recurrence of back injury. Seasonal athletes should be encouraged to cross-train year round or undergo preconditioning before participation in the sport.

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Contributor Information and Disclosures
Author

Gerard A Malanga, MD Founder and Partner, New Jersey Sports Medicine, LLC and New Jersey Regenerative Institute; Director of Research, Atlantic Health; Clinical Professor, Department of Physical Medicine and Rehabilitation, University of Medicine and Dentistry of New Jersey-New Jersey Medical School; Fellow, American College of Sports Medicine

Gerard A Malanga, MD is a member of the following medical societies: Alpha Omega Alpha, American Institute of Ultrasound in Medicine, North American Spine Society, International Spine Intervention Society, American Academy of Physical Medicine and Rehabilitation, American College of Sports Medicine

Disclosure: Received honoraria from Cephalon for speaking and teaching; Received honoraria from Endo for speaking and teaching; Received honoraria from Genzyme for speaking and teaching; Received honoraria from Prostakan for speaking and teaching; Received consulting fee from Pfizer for speaking and teaching.

Coauthor(s)

Nancy Kim, MD Staff Physician, Department of Physical Medicine and Rehabilitation, University of Medicine and Dentistry of New Jersey

Nancy Kim, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, Association of Academic Physiatrists

Disclosure: Nothing to disclose.

Chris Perez, MD Staff Physician, Department of Physical Medicine and Rehabilitation, University of Medicine and Dentistry of New Jersey

Chris Perez, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Medical Association

Disclosure: Nothing to disclose.

David L Tung, MD, MPH Medical Director, PainCare Ambulatory Surgical Center

David L Tung, MD, MPH is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, North American Spine Society, International Spine Intervention Society, North American Neuromodulation Society

Disclosure: Received honoraria from Purdue Pharmaceutical for speaking and teaching; Received honoraria from Endo Pharmaceutical for speaking and teaching.

Michael Goldin, MD Department of Physical Medicine and Rehabilitation, Washington Township Medical Foundation

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Henry T Goitz, MD Academic Chair and Associate Director, Detroit Medical Center Sports Medicine Institute; Director, Education, Research, and Injury Prevention Center; Co-Director, Orthopaedic Sports Medicine Fellowship

Henry T Goitz, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine

Disclosure: Nothing to disclose.

Chief Editor

Craig C Young, MD Professor, Departments of Orthopedic Surgery and Community and Family Medicine, Medical Director of Sports Medicine, Medical College of Wisconsin

Craig C Young, MD is a member of the following medical societies: American Academy of Family Physicians, American College of Sports Medicine, American Medical Society for Sports Medicine, Phi Beta Kappa

Disclosure: Nothing to disclose.

Additional Contributors

Andrew L Sherman, MD, MS Associate Professor of Clinical Rehabilitation Medicine, Vice Chairman, Chief of Spine and Musculoskeletal Services, Program Director, SCI Fellowship and PMR Residency Programs, Department of Rehabilitation Medicine, University of Miami, Leonard A Miller School of Medicine

Andrew L Sherman, MD, MS is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, American Medical Association, Association of Academic Physiatrists

Disclosure: Nothing to disclose.

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Table 1. Outline of the Treatment Strategy Based on Results of Plain Radiographs and SPECT Scanning in the Evaluation of Defects of the Pars Interarticularis in Patients Clinically Suspected of Having Symptomatic Pars Interarticularis Lesions
Plain Radiograph SPECT Scan Interpretation Management
Negative Negative Pathology other than pars defect should be suspected Further investigation of cause of back pain should be performed (eg, MRI)
Negative Positive Early pars interarticularis fracture Conservative management in form of rest, +/– bracing
Positive Healing Spondylolysis Conservative management in the form of rest and bracing
Positive Negative Pseudoarthrosis or old unhealed fracture Consider surgical intervention for stabilization to prevent spondylolisthesis and to relieve pain. Consider further investigation to rule out alternative pathology.
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