Search Our Scientific Publications & Authors

Emerg Radiol 2022 May 11. Epub 2022 May 11.

Department of Diagnostic & Interventional Imaging, McGovern Medical School, University of Texas Medical Center at Houston, 6411 Fannin St, Houston, TX, 77030, USA.

Purpose: Traumatic spondylolisthesis of the axis (TSA) with bilateral pars interarticularis fracture (a pattern also known as Hangman's fractures) accounts for 4-5% of all cervical fractures. Various classification systems have been described to assist therapeutic decision-making. The goal is to reassess the utility of these classifications for treatment strategy and evaluate additional imaging associations. Read More

Neurol India 2022 Mar-Apr;70(2):510-514

Department of Spine Surgery Bumin Hospital, Busan, South Korea.

Background And Introduction: Minimally invasive spine surgery (MISS) is a set of techniques and procedures that reduces the local tissue injury while achieving the same results through traditional open surgery. The techniques for the treatment of lumbar disc herniation and degenerative canal stenosis have evolved from tubular discectomy to endoscopic discectomy. This helps in preserving spine function. Read More

Spine J 2022 Apr 30. Epub 2022 Apr 30.

Department of Orthopaedic Surgery, University of California, 101 The City Dr S, Pavilion 3. Building 29A, Orange, CA 92868, USA.

Background: Spondylolysis is a defect of the pars interarticularis of vertebrae, most commonly seen at L5 and L4. The etiology of spondylolysis and isthmic spondylolisthesis is generally considered to be a result of repetitive mechanical stress to the weak portion of the vertebrae. A higher incidence of spondylolysis is observed in young athletes. Read More

J Clin Med 2021 Sep 3;10(17). Epub 2021 Sep 3.

Department of Orthopaedic Surgery, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea.

Spine surgeons often confuse C2 pedicle fractures (PFs) with pars interarticularis fractures. In addition, little information is available about the characteristics and treatment strategies for C2 PFs. We sought to investigate the characteristics of C2 PFs and to propose an appropriate treatment strategy. Read More

J Clin Orthop Trauma 2021 Oct 30;21:101535. Epub 2021 Jul 30.

Professor of Orthopaedics, Jagannath Gupta Institute of Medical Sciences, Kolkata.

Lumbar pars interarticularis (PI) injury or spondylolysis occurs only in humans. This represents a stress fracture of the PI. Excessive loading in repetitive hyperextension is a significant risk factor and occurs most commonly at L5 followed by L4. Read More

World Neurosurg 2021 11 6;155:54-63. Epub 2021 Aug 6.

Spine Unit, Department of Orthopedic and Traumatology, Clínica Alemana, Santiago, Chile; Department of Orthopedic and Traumatology, School of Medicine, University del Desarrollo, Santiago, Chile.

Background: Spondylolysis is a defect in the pars interarticularis of the vertebra that occurs frequently in high-performance young athletes. Although nonsurgical management is the mainstay of treatment, surgery is an option for patients with persistent symptoms despite multiple cycles of nonsurgical treatment. Performing a minimally invasive technique reduces complications, postsurgery pain, and hospitalization time and leads to a quick recovery. Read More

Bone Joint J 2021 Aug;103-B(8):1351-1357

Department of Orthopaedic Surgery, University of Texas Southwestern, Dallas, Texas, USA.

Aims: Some patients presenting with hip pain and instability and underlying acetabular dysplasia (AD) do not experience resolution of symptoms after surgical management. Hip-spine syndrome is a possible underlying cause. We hypothesized that there is a higher frequency of radiological spine anomalies in patients with AD. Read More

JBJS Rev 2021 07 28;9(7). Epub 2021 Jul 28.

San Francisco Orthopaedic Residency Program, St. Mary's Medical Center, San Francisco, California.

Background: Traditional pedicle screws are currently the gold standard to achieve stable 3-column fixation of the degenerative lumbar spine. However, there are cases in which pedicle screw fixation may not be ideal. Due to their starting point lateral to the pars interarticularis, pedicle screws require a relatively wide dissection along with a medialized trajectory directed toward the centrally located neural elements and prevertebral vasculature. Read More

Clin Sports Med 2021 Jul;40(3):471-490

Department of Orthopaedic Surgery, University of Virginia, PO Box 800159, Charlottesville, VA 22908, USA. Electronic address:

Repetitive stress on the lumbosacral spine during sporting activity places the athletic patient at risk of developing symptomatic pars defect. Clinical history, physical examination, and diagnostic imaging are important to distinguish spondylolysis from other causes of lower back pain. Early pars stress reaction can be identified with advanced imaging, before the development of cortical fracture or vertebral slip progression to spondylolisthesis. Read More

JBJS Case Connect 2021 04 7;11(2). Epub 2021 Apr 7.

Department of Radiodiagnosis, Maulana Azad Medical College and Associated Lok Nayak Hospital, New Delhi, India.

Case: Multilevel lumbar spondylolistheses have been reported, but only secondary to degenerative processes. We describe a case where grade 4 anterolisthesis occurred (L3,4,5 over S1) because of multiple level traumatic pedicle avulsion rather than facetal/pars interarticularis/posterior ligamentous complex disruption in a 42-year-old man who presented with paraparesis after a fall from height. Decompression was performed at the L5 level, and pedicle screw fixation was performed at L3, L5, and S1 levels. Read More

Eur Spine J 2021 06 18;30(6):1556-1565. Epub 2021 Mar 18.

Dept. Spine Surgery, London Bridge Hospital, St Olaf House, 27 Tooley street, London, SE1 2PR, UK.

Purpose: Odontoid process fractures can extend rostral into the C2 arch. We investigated the clinical impact of a concurrent fracture of the pars interarticularis on odontoid failure. To overcome the surgical challenges related to the morphology of these fractures, we describe a novel surgical strategy using atlantoaxial joint distraction arthrodesis. Read More

Arch Orthop Trauma Surg 2021 Mar 7. Epub 2021 Mar 7.

Department of Spine Surgery, Zentralklinik Bad Berka, Robert-Koch-Allee 9, 99437, Bad Berka, Germany.

Purpose: In this work, a modification of the percutaneous surgical approach for removing the lumbar foraminal disc prolapse is introduced.

Material And Methods: A prospective study was performed. The indication for surgery was foraminal disc prolapse presenting with acute motor or persistent sensory radiculopathy. Read More

World Neurosurg 2021 02 8;146:e1301-e1306. Epub 2020 Dec 8.

Department of Neurosurgery, Kanuni Sultan Süleyman Education and Research Hospital, University of Health Sciences, Istanbul, Turkey. Electronic address:

Background: Spondylolysis refers to a defect of the vertebral pars interarticularis. Percutaneous direct pars repair using a minimally invasive technique was performed in a group of young patients to maintain their spinal segment movement and to restore their normal anatomy. The aim of this study was to present the clinical, functional, and radiologic outcomes of pars defects that were repaired percutaneously via the minimally invasive technique. Read More

Sports Med Open 2020 Nov 25;6(1):57. Epub 2020 Nov 25.

Game Insight Group, Tennis Australia, Melbourne, Australia.

Background: Lumbar spine abnormalities, in particular stress fractures to the pars interarticularis, are common in elite junior tennis players, though the difference in prevalence between males and females remains unclear. Further, facet joint orientation appears to be a possible option for recognizing which players might go on to present with a pars stress fracture. Given the link between pars stress fractures and low back pain in tennis players, it appears logical to explore the link between facet joint angle and pars abnormalities. Read More

J Neurosci Rural Pract 2020 Oct 29;11(4):663-666. Epub 2020 Oct 29.

Department of Neurosurgery SMS Medical College, Jaipur, Rajasthan, India.

Traumatic spondylolisthesis of axis or hangman's fracture is the second most common C2 vertebra injury. We present a report of a young man presenting with a history of fall from height with C2 to C3 spondylolisthesis without any evidence of injury to pars interarticularis but with associated injury to capsular ligament of facet joint along with posterior spinous ligamentous injury. The patient underwent intraoperative reduction in listhesis with posterior screw fixation. Read More

Bone 2021 02 3;143:115626. Epub 2020 Sep 3.

Cricket Australia, 60 Jolimont St, Jolimont, Victoria 3002, Australia; La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne 3086, Australia.

Objectives: 1) Quantify the intensity of bone marrow oedema (BMO) present in the lumbar vertebrae of asymptomatic elite adult fast bowlers; 2) relate the intensity of BMO to bowling workload and lumbar bone stress injury (LBSI), and; 3) evaluate the utility of MRI screening to reduce the risk of LBSI.

Methods: Thirty-eight elite Australian fast bowlers (21.6 ± 3. Read More

World Neurosurg 2020 11 11;143:339-345. Epub 2020 Aug 11.

Department of Spine Surgery, Ganga Medical Centre and Hospitals Pvt Ltd, Coimbatore, India.

Background: The term "pediculolysis" encompasses rare, chronic pedicular changes characterized by pedicle hypertrophy, sclerosis, and pseudoarthrosis, which develop secondary to recurrent microfractures from repeated stress injuries. These stress injuries to pedicles can be insufficiency fractures, commonly reported in elderly patients with associated osteoporosis, or fatigue fractures, which occur in young adolescents involved in heavy sports. These pedicular lesions have been reported in association with defects in other components of the neural arch, including the pars interarticularis and lamina. Read More

J Sci Med Sport 2021 Feb 9;24(2):112-115. Epub 2020 Jul 9.

Lifecare Prahran Sports Medicine, Australia.

Objectives: Review magnetic resonance imaging (MRI) of elite adult fast bowlers with a history of lumbar spine stress fracture for evidence of bone healing. The findings will determine whether bone healing can occur in this population, and whether MRI may be used as a tool to assess bone healing and inform clinical decision making.

Design: Retrospective cohort. Read More

Clin Imaging 2020 Oct 1;66:1-6. Epub 2020 Apr 1.

Department of Radiology and Medical Imaging, University of Virginia Health System, 1215 Lee Street, Charlottesville, VA 22908, USA. Electronic address:

We report a case of symptomatic Oppenheimer ossicle in an 18-year-old male who presented with back pain. L5 pars interarticularis defect was suspected on initial lumbar spine radiographs. A subsequent technetium99m-methylene diphosphonate (Tc99m-MDP) bone scintigraphy with single-photon emission computed tomography/computed tomography (SPECT/CT) revealed focal radiotracer uptake in an Oppenheimer ossicle in L2 vertebra. Read More

J Med Invest 2020 ;67(1.2):62-66

Department of Orthopedics, Tokushima University, Tokushima, Japan.

INTRODUCTION : The pathology of lumbar spondylolysis is generally thought to begin with a stress fracture in adolescence. Stress fractures of the lower extremities occur in watershed areas with a poor vascular supply because of an inability to respond to stress and heal. This pathology has not been well researched in the lumbar spine. Read More

JBJS Essent Surg Tech 2020 Jan-Mar;10(1). Epub 2020 Mar 23.

Johns Hopkins University, Baltimore, Maryland.

Spondylolysis, defined as injury to the pars interarticularis, is the most common identifiable cause of back pain in children. Historically, treatment has primarily been nonoperative, including physical therapy, activity modification, and occasionally bracing. In instances in which the condition is refractory to nonoperative management, however, surgical treatment may be an efficacious alternative. Read More

BMC Neurol 2020 Apr 29;20(1):162. Epub 2020 Apr 29.

Department of Anesthesia, Stanford University, Palo Alto, CA, USA.

Background: Spinal cerebrospinal fluid (CSF) leak can lead to intracranial hypotension and is an important differential diagnosis to consider in patients with sudden-onset chronic daily headaches. Pars interarticularis (PI) fracture is a potential rare cause of suspected spinal CSF leak.

Methods: This is a retrospective case series of 6 patients with suspected spinal CSF leak evaluated between January 2016 and September 2019. Read More

World Neurosurg 2020 07 26;139:370-372. Epub 2020 Apr 26.

Department of Neurosurgery, King Edward Memorial Hospital and Seth Gordhandas Sunderdas Medical College, Parel, Mumbai, India; Department of Neurosurgery, Lilavati Hospital and Research Centre, Bandra East, Mumbai, India. Electronic address:

Background: We report a rare case of Hangman's fracture in a male child with osteopetrosis.

Case Description: A 7-year-old boy was earlier diagnosed to have 'osteopetrosis'. He presented with neck pain, restriction of neck movements and quadriparesis following a fall while playing at home. Read More

Int J Sports Phys Ther 2020 Apr;15(2):287-300

Division of Sports Medicine, Nationwide Children's Hospital, Columbus, Ohio, United States.

Low back pain in adolescent athletes is quite common, and an isthmic spondylolysis is the most common identifiable cause. Spondylolysis, a bone stress injury of the pars interarticularis, typically presents as focal low back pain which worsens with activity, particularly with back extension movements. Research on spondylolysis has focused on diagnosis, radiographic healing, the effects of bracing, and rest from activity. Read More

World Neurosurg 2020 06 23;138:449-453. Epub 2020 Mar 23.

Department of Neurological Surgery, Loyola University Chicago, Maywood, Illinois, USA. Electronic address:

Background: Surgical intervention for type II odontoid fractures is a common treatment strategy when conservative management is not appropriate, such as in significantly displaced fractures. However, displaced fractures may not be easily reduced with instrumentation alone. We present a novel technique, using a "bucket-handle" construct to manually reduce a dorsally displaced type II odontoid fracture, in a patient with failure of previously placed dorsal instrumentation. Read More

Neurospine 2020 Sep 2;17(3):659-665. Epub 2020 Feb 2.

Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.

Objective: Conventional techniques for atlantoaxial fixation and fusion typically pass cables or wires underneath C1 lamina to secure the bone graft between the posterior elements of C1-2, which leads to complications such as cerebrospinal fluid (CSF) leak and neurological injury. With the evolution of fixation hardware, we propose a novel C1-2 fixation technique that avoids the morbidity and complications associated with sublaminar cables and wires.

Methods: This technique entails wedging and anchoring a structural iliac crest graft between C1 and C2 for interlaminar arthrodesis and securing it using a 0-Prolene suture at the time of C1 lateral mass and C2 pars interarticularis screw fixation. Read More

Spine Surg Relat Res 2019 Apr 25;3(2):146-150. Epub 2018 Aug 25.

Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan.

Introduction: In past biomechanical studies, repetitive motion of lumbar extension, rotation, or a combination of both, frequently seen in batting or pitching practice in baseball, shooting practice in soccer, and spiking practice in volleyball, have been considered important risk factors of lumbar spondylolysis. However, clinically, these have been identified in many athletes performing on a running track or on the field, which requires none of the practices described above. The purpose of this study was to verify how much impact running has on the pathologic mechanism of lumbar spondylolysis. Read More

J Neurosurg Sci 2019 Jun;63(3):318-329

Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL, USA -

Introduction: The repair of symptomatic isthmic pars interarticularis fractures can result in excellent outcomes. A variety of operative interventions exist with conventional techniques requiring larger exposures. Recently described, less invasive techniques tend to minimize disruption of adjacent soft tissues, decrease postoperative pain, increase patient satisfaction, and improve return to work status and/or competitive sports. Read More

Oper Neurosurg (Hagerstown) 2020 Jan;18(1):E8

Department of Neurosurgery, Nanoori Incheon Hospital, Incheon, Republic of Korea.

The conventional surgical approach to far lateral lumbar disk herniations is a paraspinal Wiltse approach. During the Wiltse approach, it is sometimes necessary to resect some of the facet or pars interarticularis to achieve an adequate exposure. The endoscopic transforaminal route can be of benefit in far lateral disk herniations due to direct access to the epidural space through Kambin's triangle, without the need for any bony removal or nerve retraction. Read More