Current Issue - May 2022 - Vol 25 Issue 3


  1. 2022;25;265-282Does Direct Surgical Repair Benefit Pars Interarticularis Fracture? A Systematic Review and Meta-analysis
    Systematic Review
    Sung Huang Laurent Tsai, MD, MPH, Chia-Wei Chang, MD, Wei-Cheng Chen, MD, Tung-Yi Lin, MD, Ying-Chih Wang, MD, Chak-Bor Wong, MD, Yagiz Ugur Yolcu, MD, Mohammed Ali Alvi, MBBS, Mohamad Bydon, MD, and Tsai-Sheng Fu, MD.

BACKGROUND: Promising results have been shown in previous studies from direct pars interarticularis repair. These include Scott wiring, Buck repair, pedicle screw repair, and Morscher techniques. In addition, several minimally invasive techniques have been reported to show high union rates, low rates of implant failure and wound complications, shorter length of stay, a lower postoperative pain score with faster recovery, and minimal blood loss

OBJECTIVES: To compare the evidence on techniques for direct pars interarticularis repair.

STUDY DESIGN: Systematic review and meta-analysis.

SETTING: Review article.

METHODS: We conducted a comprehensive search of databases to identify studies assessing outcomes of direct pars interarticularis defect repair. Two authors independently screened electronic search results, performed study selection, and extracted data for meta-analysis. Sensitivity and subgroup analyses were performed to assess risk of bias.

RESULTS: Forty studies were included in the final analysis. Union rate was higher in the pedicle screw repair group (effect size [ES] 95%; 95% CI, 86% to 100%), followed by the Buck repair group (ES 93%; 95% CI, 86% to 98%), Scott wiring (ES 85%; 95% CI, 63% to 99%), and Morscher method group (ES 63%; 95% CI, 2% to 100%). Positive functional outcome was higher for the Morscher method (ES 91%; 95% CI, 86% to 96%), followed by the Buck repair group (ES 85%; 95% CI, 68% to 97%), pedicle screw repair (ES 84%; 95% CI, 59% to 99%) and Scott repair group (ES 80%; 95% CI, 60% to 95%). Complication rates were highest among the Scott repair group (ES 12%; 95% CI, 4% to 22%) and Morscher method group (ES 12%; 95% CI, 0% to 34%).

LIMITATIONS: Heterogeneity of the included studies were noted. However, we performed sensitivity analyses from the available data to address this issue.

CONCLUSION: Our results indicate that pedicle screw repair and Buck repair may be associated with a higher union rate and lower complication rates compared to the Scott repair and Morscher method. Ultimately, the choice of technique should be based on the surgeon’s preference and experience.

KEY WORDS: Pars interarticularis, pars fracture, direct repair, Buck repair, pedicle screw repair, Morscher method, Scott repair, minimally invasive pars repair, review