Motion-Preserving Robotic Repair of Bilateral L5 Pars Fractures
A 16-year-old competitive soccer player with persistent back pain and bilateral L5 pars fractures underwent minimally invasive, robotic-assisted direct repair — stabilizing the fractures without fusing the motion segment.
Persistent pain in a young athlete — and a diagnosis that took months to find
After an injury on the soccer field, the patient continued to have lower back pain despite initial treatment for a presumed sprain. Months later, MRI demonstrated stress injury at L5 and CT defined bilateral pars defects.
For a young athlete whose sport depends on spinal motion, the treatment decision involved more than stabilizing the fractures. It also meant considering how to preserve the native motion segment whenever safely possible.
Defining the injury before repair
MRI, CT and three-dimensional reconstruction provided complementary views of the stress injury, bilateral bony defects and anatomy used for surgical planning.
Stress Injury at L5
MRI demonstrates signal change and edema associated with the pars stress injury.
Bilateral Pars Defects
CT provides a detailed view of the bony defects in the pars interarticularis.
Surgical Planning
Three-dimensional reconstruction clarifies the fractures and surrounding anatomy before repair.
Why direct repair instead of fusion?
Direct pars repair stabilizes the fracture itself while preserving the L5–S1 motion segment. For a growing competitive athlete, preserving motion was an important treatment objective.
Robotic guidance through a minimally invasive corridor
Dr. Farah Musharbash performed a minimally invasive, robotic-assisted bilateral L5 pars repair using small titanium fixation through a 2-centimeter incision. Robotic navigation supported precise implant planning and placement while limiting surgical exposure.
The bilateral repair was completed in less than an hour, and the patient went home the same day.
Direct fixation of the pars fractures
Postoperative AP and lateral imaging demonstrate the fixation used to directly stabilize the bilateral defects.
AP View
Postoperative imaging demonstrates the implanted fixation following direct pars repair.
Lateral View
Lateral imaging shows the fixation used to directly stabilize the pars fractures.
Within days of surgery, the patient reported relief from the pain that had persisted for months. He began walking immediately and started intensive physical therapy three weeks after surgery.
At eight weeks he was cleared for non-contact drills. At the three-month follow-up, CT confirmed bony healing, and he was cleared to return to play. He later returned to full-game competition pain-free.
From pars defect to healing
Follow-up CT demonstrates healing across the previously visible pars defects after direct repair.
Bilateral Pars Defects
Healing Across the Repair
Small incisions. Same-day discharge.
The operation was performed through a small incision, and the patient returned home the same day. These postoperative images show the limited surgical footprint following robotic-assisted direct repair.
Repairing the fracture without sacrificing the motion segment
Pars fractures in young athletes require a treatment strategy that considers both healing and the long-term demands placed on the spine. Direct repair can offer a motion-preserving alternative to fusion in appropriately selected patients.
Back on the field after pediatric pars repair
This clinical case is Nathan’s story. After months of unresolved back pain, the 16-year-old competitive soccer player underwent motion-preserving direct pars repair and returned to competitive play after imaging confirmed bony healing.
Read Nathan’s Patient Story →
Farah Musharbash, MD
Dr. Farah Musharbash is an orthopedic spine surgeon with expertise in minimally invasive, endoscopic and robotic spine surgery, including motion-preserving treatment for pediatric and young adult pars fractures.
Persistent back pain should not be ignored.
If a young athlete has ongoing lower back pain, a pars stress injury or fracture may require more specific imaging and evaluation. Our spine team can review the diagnosis and help explain treatment options.
Request an Appointment With Dr. Musharbash