Endoscopic and percutaneous minimally invasive repair of pars interarticularis defects: a systematic review of clinical outcomes
5 affiliations
- 1School of Medicine, Baylor College of Medicine, Houston, TX, USA. [email protected]
- 2School of Medicine, Baylor College of Medicine, Houston, TX, USA
- 3T.H. Chan School of Medicine, UMass Chan Medical School, Worcester, MA, USA
- 4School of Medicine, University of Texas at Southwestern, Dallas, TX, USA
- 5Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
Abstract
PURPOSE: Direct pars interarticularis repair preserves motion and avoids adjacent segment degeneration associated with fusion. Endoscopic and percutaneous minimally invasive techniques aim to reduce tissue disruption and accelerate recovery, but their outcomes have not been systematically reviewed to evaluate pooled safety, efficacy, and clinical outcomes of these techniques. METHODS: A systematic review was conducted according to PRISMA guidelines, searching PubMed, Embase, and Scopus from inception through January 2026 using ("pars interarticularis" OR "spondylolysis") AND ("endoscopic" OR "percutaneous" OR "minimally invasive") AND ("repair" OR "fixation" OR "surgery"). English-language human studies reporting clinical outcomes were included. Extracted outcomes included radiographic data, pain and functional scores (VAS, ODI, SF-36), return to activity, complications, and reoperations. RESULTS: Of 140 identified studies, 5 met the inclusion criteria, comprising 47 patients (94 pars defects). Techniques included microendoscopic-assisted, irrigation endoscopic-assisted, tubular retractor-based, and fully percutaneous repair. Computed tomography-confirmed pars union was achieved in a pooled weighted mean of 84.4% (range, 77-100%) at 6-12 months. All studies reported significant pain and functional improvement, with a mean reduction in VAS of 5.5 points. Overall, 91.4% achieved good or excellent Macnab outcomes, and 93.6% returned to preinjury activity or sport. The complication rate was 6.4%, with no major neurologic, vascular, or infectious complications. Heterogeneity existed in surgical techniques and outcome reporting. CONCLUSIONS: Endoscopic and percutaneous minimally invasive direct pars repair is a safe, effective motion-preserving option for selected patients with symptomatic lumbar spondylolysis, though further prospective studies with standardized outcomes and longer follow-up are needed.
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BibTeX
@article{phadke2026endoscopic,
title = {{Endoscopic and percutaneous minimally invasive repair of pars interarticularis defects: a systematic review of clinical outcomes}},
author = {Rohan A. Phadke and Samer Salman and Rahul Kumar and Vineet K. Paidisetty and Brandon Matthews and Rohit Srinivas and Swapna Vaja and Nathan J. Lee},
journal = {Spine Deformity},
year = {2026},
month = may,
doi = {10.1007/s43390-026-01435-6},
url = {https://doi.org/10.1007/s43390-026-01435-6},
note = {CC BY},
}
RIS
TY - JOUR
TI - Endoscopic and percutaneous minimally invasive repair of pars interarticularis defects: a systematic review of clinical outcomes
AU - Rohan A. Phadke
AU - Samer Salman
AU - Rahul Kumar
AU - Vineet K. Paidisetty
AU - Brandon Matthews
AU - Rohit Srinivas
AU - Swapna Vaja
AU - Nathan J. Lee
PY - 2026
DA - 2026/05/20
JO - Spine Deformity
DO - 10.1007/s43390-026-01435-6
UR - https://doi.org/10.1007/s43390-026-01435-6
AB - PURPOSE: Direct pars interarticularis repair preserves motion and avoids adjacent segment degeneration associated with fusion. Endoscopic and percutaneous minimally invasive techniques aim to reduce tissue disruption and accelerate recovery, but their outcomes have not been systematically reviewed to evaluate pooled safety, efficacy, and clinical outcomes of these techniques. METHODS: A systematic review was conducted according to PRISMA guidelines, searching PubMed, Embase, and Scopus from inception through January 2026 using ("pars interarticularis" OR "spondylolysis") AND ("endoscopic" OR "percutaneous" OR "minimally invasive") AND ("repair" OR "fixation" OR "surgery"). English-language human studies reporting clinical outcomes were included. Extracted outcomes included radiographic data, pain and functional scores (VAS, ODI, SF-36), return to activity, complications, and reoperations. RESULTS: Of 140 identified studies, 5 met the inclusion criteria, comprising 47 patients (94 pars defects). Techniques included microendoscopic-assisted, irrigation endoscopic-assisted, tubular retractor-based, and fully percutaneous repair. Computed tomography-confirmed pars union was achieved in a pooled weighted mean of 84.4% (range, 77-100%) at 6-12 months. All studies reported significant pain and functional improvement, with a mean reduction in VAS of 5.5 points. Overall, 91.4% achieved good or excellent Macnab outcomes, and 93.6% returned to preinjury activity or sport. The complication rate was 6.4%, with no major neurologic, vascular, or infectious complications. Heterogeneity existed in surgical techniques and outcome reporting. CONCLUSIONS: Endoscopic and percutaneous minimally invasive direct pars repair is a safe, effective motion-preserving option for selected patients with symptomatic lumbar spondylolysis, though further prospective studies with standardized outcomes and longer follow-up are needed.
SN - 2212-134X
SN - 2212-1358
ER -