Robotic-assisted bilateral lumbar pars fracture endoscopic debridement and direct repair as treatment for lumbar radiculopathy: A case report.

Background: Management of lumbar spondylolysis in the athletic population can be successful with conservative means, however surgical intervention may be required for fractures presenting with radiculopathy. Direct repair with intralaminar screws is a commonly used technique which has been described previously with various rates of success. Technological advancements now allow minimally invasive direct pars repair with robotic assistance as a viable option. Robotic assistance for instrumentation and stabilization of the fracture can also be combined with endoscopic spine techniques, to debride the fracture site, to effectively treat this issue. Methods: A 16-year-old giant slalom skier presented with low back pain and associated bilateral L5 radiculopathy to our facility. Using MRI and CT, they were diagnosed with bilateral L5 pars interarticularis fractures with bony edema and with subtle hypermobile retrolisthesis in combination with bilateral foraminal stenosis at the L5-S1 disc space. Due to patient's active sports participation and continued symptoms despite rest, physical therapy, chiropractic therapy, and bracing, the patient decided to undergo elective, outpatient, bilateral robotic-assisted percutaneous endoscopic debridement of the pars fractures through 7-mm skin incisions, and bilateral percutaneous intralaminar fixation of the pars fractures with pedicle screws through 1.5-cm skin incisions. Results: In the immediate postoperative period, the patient reported complete resolution of mechanical low back pain and associated bilateral radiculopathy. The patient had resolution of incisional low back pain by 6 weeks postoperatively and demonstrated stable healing with no evidence of hardware failure radiographically through their 6-month postoperative x-rays. This 16-year-old was able to return to prior level of sport and competition at 3-months postoperatively. Conclusions: This novel minimally invasive robotic-assisted percutaneous approach for lumbar spondylolysis fracture debridement and direct repair is a suitable option for nonhealing pars fracture with radiculopathy in high performing active adolescent patients.