Figure 2: Intraoperative picture showing the METRx tube directed at the pars defect (left side of picture, which is towards the patient’s head) and the guidewire for the screw (right side of the picture). In this case, a single midline cephalad incision was used to access both pars defects with the METRx tube, and a single midline caudal incision used the pass the guidewires and screws. Alternatively, two paired para-sagittal incisions can be used to access each pars defect and a single incision used to pass the guide wires and screws.