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,

1. Pars/Pedicle Fractures in a Professional
Major League Baseball Player
Robert S Pashman, MD
Scoliosis and Spinal Deformity Surgery
www.eSpine.com

2. Patient History
25 year old Right handed starter brought up from minors
After 1st major league start began having back pain
Pitch mechanics changed, back pain increased
No radiculopathy
Exhaustive core rehabilitation
MRI no disc herniations or advanced degeneration
CT Spect positive L3 and L5
CT scan

3. Lumbar Scout Views:
No Spondylolisthesis

4. L2: No Fracture
L2
L2

5. L3: Right Pedicle Fracture
Left Pars Fracture
RL
L3
L3

6. L4: No Fracture
L4
L4

7. L5: Right Pars Fracture, Left Pars Fracture
RL
L5
L5

8. 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 of
the elbows.
Semi-professional baseball player.
Failed conservative therapy.

9. Spine Surgery Strategy?
L5
• L2 no fracture
• L3 R pedicle L Pars fracture
• L4 no fracture
• L5 Bilateral Pars fracture
• No Spondylolisthesis

10. Surgical Strategy
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 SSEP's.
6. Intraoperative fluoro management.

11. Post-Op Films