Spine Surgery at University of Miami Health System

Healing Pars Fractures in Young Athletes

Dr. Allan Levi is a spine surgeon at UHealth, the University of Miami Health System. To learn more about the treatment of pars fractures or to make an appointment, call 305-243-6946 or visit the University of Miami's health news blog.


Nick Mucerino was a high school hockey player with dreams of the big leagues when he started experiencing lower back pain that grew progressively worse over time. “I knew something was very wrong,” he says.

Nick’s doctors initially misunderstood the injury, believing it was a muscle tear or pull. He tried intensive physical therapy and back bracing, but neither method helped with the pain. When Nick started having back spasms so severe he couldn’t get out of bed, he turned to Dr. Allan Levi, a spine surgeon at UHealth, University of Miami Health System. Dr. Levi diagnosed Nick with an injury to the vertebrae at the lower back of the spine called a pars fracture.

It’s an area that in the young athletes is a point of weakness,” says Dr. Levi. “With repetitive straining, twisting, they can fracture either one or both of the pars in the vertebrae.”

Nick was one of the first patients treated using a spine surgery technique Dr. Levi pioneered at UHealth. “The technique we developed is a way to place a screw across the fracture site without opening the back,” says Dr. Levi. “It’s the most minimally invasive treatment you can offer.” 

This type of injury can be devastating to a young athlete. Nick remembers how it felt to be incapacitated. “You sit in bed for three months. It’s like, ‘just let me do something,’” he says. But Nick’s fears about his future were allayed by Dr. Levi’s confidence in the treatment plan. “I don’t think I was in there for more than 15 minutes before he diagnosed it, told me what his recommendation was, and that I would play again,” says Nick.

Dr. Levi uses an intraoperative CT scan to place the screws across the fracture and another small incision to add bone to the site to encourage the bone to fuse. As an alternative to open back surgery, Dr. Levi’s method has three main benefits: quicker recovery, less blood loss, and less need for pain medication. 

Within a few months after the procedure, Nick was playing hockey again. He called the feeling of returning to the ice, “euphoria.” It’s been seven years since the procedure, and Nick’s life is more active than ever. “I’ve traveled the world. I’ve white water rafted in the Alps. I’ve gone zip lining, ATVing,” says Nick. “No limitations now.”

A research paper published by Dr. Levi on the successful treatment of patients including Nick gained traction through the internet, and young patients from around the world began seeking his advice. “We have seen football players, baseball players, lacrosse players, cheerleaders, ballerinas, everyone can potentially be prone to this type of injury,” he says.

Dr. Levi and his team at UHealth continue to treat pars fractures with a minimally invasive approach, which also shows promise outside of sports, including for young people in the military. “Ninety percent of our patients show healing of the bone on the CT following the procedure and have returned to the activities they once enjoyed,” says Dr. Levi. “I am optimistic.”



Focusing on You: Innovations in Modern Medicine is a series of healthcare-related stories airing regularly on WPLG Local 10. For more stories like this one, visit YouTube channels for UHealth, the University of Miami Health System.