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?
Before we learn about spondylolysis surgery, we need to learn about the medical problem of spondylolysis and it’s cousin spondylolisthesis. This is a medical term derived from Latin. “Spondy” means “spine” and “lysis” means “cracked”. The pars interarticularis is more Latin that means “the part between the joints”. In this case, it’s the bone between the facet joints. This is where the spine “cracks” in spondylolysis. If this stays this way for years, one part of the spine can start slipping forward on the other which is called spondylolisthesis. This is Latin for “slipped spine”.
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?
If the pars fracture won’t heal, then there are a few spondylolysis surgeries that can be performed (click on the image above to see a bigger version) (3). All use various types of hardware. The most common is a buck screw that goes through the pedicle and through the pars fracture. The pedicle screw and hook tries to use the level above to hold the unstable level together. The U-rod technique as shown uses a semi-circular rod to keep the one vertebra from moving forward on the other. Scott wiring uses wire to hold the two vertebrae together.
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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
This blog post provides general information to help the reader better understand regenerative medicine, musculoskeletal health, and related subjects. All content provided in this blog, website, or any linked materials, including text, graphics, images, patient profiles, outcomes, and information, are not intended and should not be considered or used as a substitute for medical advice, diagnosis, or treatment. Please always consult with a professional and certified healthcare provider to discuss if a treatment is right for you.
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Chris Centeno, MD is a specialist in regenerative medicine and the new field of Interventional Orthopedics. Centeno pioneered orthopedic stem cell procedures in 2005 and is responsible for a large amount of the published research on stem cell use for orthopedic applications.
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Regenerative procedures are commonly used to treat musculoskelatal trauma, overuse injuries, and degenerative issues, including failed surgeries.
Shoulder
Many Shoulder and Rotator Cuff injuries are good candidates for regenerative treatments. Before considering shoulder arthroscopy or shoulder replacement, consider an evaluation of your condition with a regenerative treatment specialist.
Many spine injuries and degenerative conditions are good candidates for regenerative treatments and there are a number of studies showing promising results in treating a wide range of spine problems. Spine surgery should be a last resort for anyone, due to the cascade of negative effects it can have on the areas surrounding the surgery. And epidural steroid injections are problematic due to their long-term negative impact on bone density.
Knees are the target of many common sports injuries. Sadly, they are also the target of a number of surgeries that research has frequently shown to be ineffective or minimally effective. Knee arthritis can also be a common cause for aging athletes to abandon the sports and activities they love. Regenerative procedures can be used to treat a wide range of knee injuries and conditions. They can even be used to reduce pain and delay knee replacement for more severe arthritis.
Many spine injuries and degenerative conditions are good candidates for regenerative treatments and there are a number of studies showing promising results in treating a wide range of spine problems. Spine surgery should be a last resort for anyone, due to the cascade of negative effects it can have on the areas surrounding the surgery. And epidural steroid injections are problematic due to their long-term negative impact on bone density.
Hand and wrist injuries and arthritis, carpal tunnel syndrome, and conditions relating to overuse of the thumb, are good candidates for regenerative treatments. Before considering surgery, consider an evaluation of your condition with a regenerative treatment specialist.
Hand and Wrist Arthritis
Carpal Tunnel Syndrome
Trigger Finger
Thumb Arthritis (Basal Joint, CMC, Gamer’s Thumb, Texting Thumb)
Hip injuries and degenerative conditions become more common with age. Do to the nature of the joint, it’s not quite as easy to injure as a knee, but it can take a beating and pain often develops over time. Whether a hip condition is acute or degenerative, regenerative procedures can help reduce pain and may help heal injured tissue, without the complications of invasive surgical hip procedures.
Foot and ankle injuries are common in athletes. These injuries can often benefit from non-surgical regenerative treatments. Before considering surgery, consider an evaluation of your condition with a regenerative treatment specialist.
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