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Pars Interarticularis Injury

Abstract
Injury of the pars interarticularis is among the most common causes of low back pain, especially in adolescent athletes. Sometimes these lesions develop in an asymptomatic manner, and they are detected in adulthood when the injury becomes chronic and symptomatic.[1]  The spectrum of pathologies in the pars interarticularis ranges from bone stress, pars fracture (spondylolysis) to isthmic spondylolisthesis, which represents an anterior vertebral slippage. Bone stress is considered the earliest sign of disease. Repetitive bone stress causes bone remodeling and may result in spondylolysis, a non-displaced fracture of the pars interarticularis.[2] Also, radiographically visualized spondylolysis is associated with spondylolisthesis about 25% of cases.[3][4] Spondylolisthesis, a related condition to spondylolysis, is defined by the forward displacement of the upper vertebra relative to the caudal vertebra. In 1976 Wiltse et al.[5] classified spondylolisthesis into five types:  Type I or dysplastic: is attributed to congenital dysplasia of the superior articular process of the sacrum. Type II or isthmic: is due to a lesion in the pars interarticularis; these subclassify as: (a) Lytic, when a fatigue pars fracture is present. (b) Pars elongation due to multiple healed stress fractures. (c) Acute pars fracture. Type III or degenerative: originates from facet instability without a pars fracture.  Type IV or traumatic: the displacement is due to an acute posterior arch fracture other than pars.  Type V or pathological: is due to posterior vertebral arch bone disease.[5]. Type VI or iatrogenic: it is a potential sequel to spinal surgery. For this activity, the focus will be on type II or isthmic spondylolisthesis. Spondylolisthesis was classified by Meyerding et al. [6] in five subtypes according to the magnitude of slippage on plain lateral lumbar radiograph measured in accordance to the inferior vertebra.  Grade I,  less than 25% of displacement,  Grade II, between 25 and 50%,  Grade III, between 50 and 75%,  Grade IV, between 75 and 100% and  Grade V or spondyloptosis, when there is no contact between the vertebrae endplates. The commonly used Grade V, representing more than a 100% slip or spondyloptosis, is not part of the original grading system. The majority of pars lesions or spondylolysis occur at L5 (85 to 95%), with L4 being the second most commonly affected vertebra (5 to 15%). The other lumbar levels are less often affected.[3][7][8][9][10] The defect is unilateral in 22% of the cases.

Publisher

StatPearls Publishing
Treasure Island (FL)

Language

eng

PubMed ID

31424775

Citation

Pereira Duarte M, Camino Willhuber GO: Pars Interarticularis Injury.StatPearls. StatPearls Publishing, 2019, Treasure Island (FL).
Pereira Duarte M, Camino Willhuber GO. Pars Interarticularis Injury. StatPearls. Treasure Island (FL): StatPearls Publishing; 2019.
Pereira Duarte M & Camino Willhuber GO. (2019). Pars Interarticularis Injury. In StatPearls. Treasure Island (FL): StatPearls Publishing;
Pereira Duarte M, Camino Willhuber GO. StatPearls. Treasure Island (FL): StatPearls Publishing; 2019.
* Article titles in AMA citation format should be in sentence-case
TY - CHAP T1 - Pars Interarticularis Injury BT - StatPearls A1 - Pereira Duarte,Matias, AU - Camino Willhuber,Gaston O., Y1 - 2019/01// PY - 2019/8/20/pubmed PY - 2019/8/20/medline PY - 2019/8/20/entrez N2 - Injury of the pars interarticularis is among the most common causes of low back pain, especially in adolescent athletes. Sometimes these lesions develop in an asymptomatic manner, and they are detected in adulthood when the injury becomes chronic and symptomatic.[1]  The spectrum of pathologies in the pars interarticularis ranges from bone stress, pars fracture (spondylolysis) to isthmic spondylolisthesis, which represents an anterior vertebral slippage. Bone stress is considered the earliest sign of disease. Repetitive bone stress causes bone remodeling and may result in spondylolysis, a non-displaced fracture of the pars interarticularis.[2] Also, radiographically visualized spondylolysis is associated with spondylolisthesis about 25% of cases.[3][4] Spondylolisthesis, a related condition to spondylolysis, is defined by the forward displacement of the upper vertebra relative to the caudal vertebra. In 1976 Wiltse et al.[5] classified spondylolisthesis into five types:  Type I or dysplastic: is attributed to congenital dysplasia of the superior articular process of the sacrum. Type II or isthmic: is due to a lesion in the pars interarticularis; these subclassify as: (a) Lytic, when a fatigue pars fracture is present. (b) Pars elongation due to multiple healed stress fractures. (c) Acute pars fracture. Type III or degenerative: originates from facet instability without a pars fracture.  Type IV or traumatic: the displacement is due to an acute posterior arch fracture other than pars.  Type V or pathological: is due to posterior vertebral arch bone disease.[5]. Type VI or iatrogenic: it is a potential sequel to spinal surgery. For this activity, the focus will be on type II or isthmic spondylolisthesis. Spondylolisthesis was classified by Meyerding et al. [6] in five subtypes according to the magnitude of slippage on plain lateral lumbar radiograph measured in accordance to the inferior vertebra.  Grade I,  less than 25% of displacement,  Grade II, between 25 and 50%,  Grade III, between 50 and 75%,  Grade IV, between 75 and 100% and  Grade V or spondyloptosis, when there is no contact between the vertebrae endplates. The commonly used Grade V, representing more than a 100% slip or spondyloptosis, is not part of the original grading system. The majority of pars lesions or spondylolysis occur at L5 (85 to 95%), with L4 being the second most commonly affected vertebra (5 to 15%). The other lumbar levels are less often affected.[3][7][8][9][10] The defect is unilateral in 22% of the cases. PB - StatPearls Publishing CY - Treasure Island (FL) UR - https://www.unboundmedicine.com/medline/citation/31424775/StatPearls:_Pars_Interarticularis_Injury L2 - https://www.ncbi.nlm.nih.gov/books/NBK545191 DB - PRIME DP - Unbound Medicine ER -