08/18/2025
Impressive repair of unstable L5 pars fractures in a 32 year old where the fractures extended into the facets, especially on the left where L5 nerve root was compressed due to a combination of disc bulge, fracture edge, facet arthrosis, instability, and 7mm of spondylolisthesis with 4-7mm fracture gaps. At 3 months post-op, the patient chose to repeat these procedures to further reinforce healing of all structures, and 3D CT confirmed new partial bridging and ossification on the lateral margins on both sides of the fracture! There has since been further bridging, partial ossification bilaterally on lateral margins with continued integration and remodeling of connective tissue patches medially, and diminished marrow edema stress reaction throughout. Both right and left sides have portions that re-bridged and re-fused. Interestingly, the spondylolisthesis on both static and dynamic flexion/extension imaging has reduced from 7mm down to 4mm and the dynamic translation has completely resolved down to 0mm showing complete stabilization per independent unbiased radiologist reports. The primary concern thus remains the facet joint cartilage damage, but the facet cartilage and contour appear much improved and patient also reports no more nerve/back pain since treatment except minor facet pain if overlifting, and this should continue to remodel and repair even further over time.
The Stem Cell + PRF autograft patching approach recapitulates the natural mechanisms of fracture repair utilizing bone marrow stem cells with sticky scaffolding. This is done minimally-invasively with 3D image-guidance to bridge, repair, reinforce, and rebuild tissue.
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