Do you need spondylolysis surgery? The answer is probably not. However, let’s review what your options are including new procedures that promote healing without surgery.
What is Spondylolysis?
What Are the Main Types of Spondylolysis?
There are two types you should know about:
- Congenital-The patient is born without a bony connection at the pars interarticularis. There is often a fibrous connection where the bone should be.
- Traumatic-The patient often has one side congenital and one which is weakened or normal. An accident or trauma happens and the more normal side breaks due to the inherent weakness of the whole segment.
Spondylolysis surgery is usually used to treat the traumatic type of spondylolysis. However, this is only reserved for cases that don’t heal on their own.
Can a Spondylolysis Heal?
Most athletes who sustain a traumatic spondylolisthesis can expect these injuries to heal with physical therapy and bracing, usually within a few months (1). However, some patients develop what’s called a pseudoarthrosis, where a false joint develops because the site couldn’t mend by itself (2). This is what that looks like on a CT Scan:
The dashed ovals point to the fracture line. Of the three types shown, once the fracture site gets to the terminal phase, it’s much less likely to heal.
Do You Need Surgery to Treat Spondylolysis?
Can Spondylolysis Be Healed without Surgery?
For terminal cases where the fracture line has matured and not healed on its own, there is a new way to avoid spondylolysis surgery that may help. Take this case of a young man who was a collegiate wrestler. He had his own bone marrow stem cells injected into the fracture using x-ray guidance. There was no surgery and no hardware implanted.
Below are his CT Scans from before and after the procedure. The spondylolisthesis site was in that terminal stage and 3 months later it was on it’s way to healing (white dashed circle). The other side was a congenital break, which does not heal with this technique. The goal there was merely trying to toughen up the fibrous connection by injecting it as well.
What Happens in this New Technique?
In this procedure, two micro-trocars (thick needles) are placed under precise x-ray guidance as shown below:
The patient is placed in a back brace for 2 months while the fracture heals. The bone marrow stem cells promote fracture healing and bone formation so that the patient gets left with their own bone at the site rather than a screw or hardware.
Can this Be Done at My Local Stem Cell Clinic?
We have seen an explosion in clinics offering “stem cell” therapy. Most of this is performed in alternative health clinics by nurses or by sports medicine physicians. This procedure requires significant interventional spine skills and real-time x-ray imaging using c-arm fluoroscopy. Hence, this is not something that can be replicated in that type of setting.
The upshot? Healing an end stage non-healing pars fracture without spondylolysis surgery is possible. The goal is to promote healing using the power of your own cells. The part of this procedure that takes significant expertise is placing the cells in the right spot.
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References:
(1) Panteliadis P, Nagra NS, Edwards KL, Behrbalk E, Boszczyk B. Athletic Population with Spondylolysis: Review of Outcomes following Surgical Repair or Conservative Management. Global Spine J. 2016;6(6):615–625. doi: 10.1055/s-0036-1586743
(2) Sairyo K., Sakai T., Takata Y., Yamashita K., Tezuka F., Manabe H. (2020) Spondylolysis and Spondylolisthesis in Athletes. In: Hsu W., Jenkins T. (eds) Spinal Conditions in the Athlete. Springer, Cham
(3) Drazin, D., Shirzadi, A., Jeswani, S., Ching, H., Rosner, J., Rasouli, A., Kim, T., Pashman, R., & Johnson, J. (2011). Direct surgical repair of spondylolysis in athletes: indications, techniques, and outcomes, Neurosurgical Focus FOC, 31(5), E9. Retrieved Mar 9, 2020, from https://thejns.org/focus/view/journals/neurosurg-focus/31/5/2011.9.focus11180.xml
