RU-2861553-C1 - METHOD FOR SURGICAL TREATMENT OF IRREDUCIBLE HIGH-GRADE SPONDYLOLISTHESIS

RU2861553C1RU 2861553 C1RU2861553 C1RU 2861553C1RU-2861553-C1

Abstract

FIELD: medicine. SUBSTANCE: invention relates to traumatology and orthopaedics, and can be used for surgical treatment of irreducible high-grade spondylolisthesis. Posterior internal fixation of the fifth lumbar vertebra L 5 is performed by transpedicular insertion of screws into the displaced vertebra L 5 and transdisc insertion of screws through the body of the sacral vertebra S 1 , through the disc L 5 -S 1 into the cranioventral part of the body of the displaced vertebra L 5 . Pairwise fixation of the transpedicular and transdisc screws is performed with rods. Under EOT control, a transsacral transdisc channel is formed from a point located laterally and below the superior articular process of the S 1 vertebra, through the body of the S 1 vertebra and the L 5 -S 1 disc into the body of the L 5 vertebra so that it ends blindly in the bone of the L 5 vertebral body. The transsacral transdisc channel is expanded with a cannulated tap, and a transpedicular screw with a diameter of 7.5 mm and a length of 50 to 70 mm is inserted into the formed transsacral transdisc channel. Then the transpedicular screw is removed. An allogeneic bone straw, the transverse dimension of which is from 1×1 mm to 3×2 mm and the length is equal to the length of the formed transsacral transdisc channel, is placed in the transsacral transdisc channel. A transpedicular screw with a diameter of 5.5 mm is screwed into the transsacral transdisc channel filled with the allogeneic bone straw, and then unscrewed, then with a diameter of 6.5 mm, and then the final transpedicular screw with a diameter of 7.5 mm is screwed in. The heads of the transpedicular screws inserted through the pedicles of L 5 and the heads of the transpedicular screws inserted through the body of S 1 , through the disc L 5 -S 1 into the body of L 5 , are connected by rods. EFFECT: formation of a reliable bone block between the vertebrae without the risk of pseudoarthrosis and screw loosening due to the fact that the only inlet into the transsacral transdisc channel is hermetically sealed by the head of the transpedicular screw, creating complete isolation of the disc cavity from the surrounding tissues. 2 cl, 9 dwg, 1 ex

Inventors

Markin Sergei Petrovich
KIRILOVA IRINA ANATOLEVNA
Cherdantseva Liliia Aleksandrovna
SOROKIN ARTEM NIKOLAEVICH

Dates

Publication Date: 20260505
Application Date: 20251021

Claims (2)

1. A method for the surgical treatment of irreducible high-grade spondylolisthesis, including posterior internal fixation of the fifth lumbar vertebra L5 by transpedicular insertion of screws into the displaced vertebra L5 and transdiscal insertion of screws through the body of the sacral vertebra S1 , through the disc L5 - S1 into the cranioventral part of the body of the displaced vertebra L5 ; paired fixation of transpedicular and transdiscal screws with rods, characterized in that, under image intensifier control, from a point located lateral to and below the superior articular process of the S1 vertebra, a transsacral transdiscal canal is formed through the body of the S1 vertebra and the L5 - S1 disc into the body of the L5 vertebra in such a way that it ends blindly in the bone of the body of the L5 vertebra, the transsacral transdiscal canal is expanded with a cannulated tap, and a transpedicular screw with a diameter of 7.5 mm and a length of 50 to 70 mm is installed into the formed transsacral transdiscal canal, then the transpedicular screw is removed, then an allogeneic bone straw is placed into the transsacral transdiscal canal, the transverse size of which is from 1×1 mm to 3×2 mm, and the length is equal to the length of the formed transsacral transdiscal canal, then into the transsacral transdiscal canal filled allogenic bone straw, screw in and then unscrew a transpedicular screw with a diameter of 5.5 mm, then a diameter of 6.5 mm, then screw in the final transpedicular screw with a diameter of 7.5 mm, then the heads of the transpedicular screws passed through the pedicles of L5 , and the heads of the transpedicular screws passed through the body of S1 , through the disc of L5 - S1 into the body of L5 , are connected with rods.
2. The method according to paragraph 1, characterized in that the allogenic bone straw is installed in an amount of 2 to 6 pieces.

Description

The invention relates to medicine, namely to traumatology and orthopedics, and can be used in the surgical treatment of irreducible high-grade spondylolisthesis. A known method for treating high-grade spondylolisthesis is posterior transfixation of the lumbosacral spine with transpedicular screws (Francois J, Lauweryns P, Fabry G, Treatment of high-grade spondylolisthesis by posterior lumbosacral transfixation with transdiscal screws: surgical technique and preliminary results in four cases, 2005, Acta Orthop Belg 71:334–341). This method involves placing the patient prone on a Jackson table, which allows for easy fluoroscopic control in both the lateral and frontal planes. After a standard midline incision, subperiosteal exposure of the posterior elements is performed from the fourth lumbar to the second sacral vertebrae. Transpedicular screws (6.25 mm in diameter) are inserted into the pedicle of the L4 vertebra in the usual manner. Transpedicular screws are not inserted at the level of the L5 vertebra. The key step of the procedure is the placement of both sacral screws. The technique for placing pedicle screws in S1 begins with the use of a pedicle awl. It is recommended to direct the awl parallel to the orientation of the pedicle screws in L4 in the lateral plane, as this will direct the trajectory of the screw to the superior endplate of S1 . Fluoroscopic guidance is essential at this stage. The pedicle awl is then inserted through the superior endplate of S1 , through the lumbosacral disc space, into the anterior and inferior aspect of the L5 vertebral body. The pedicle awl guides the surgeon to the required screw length. When using the pedicle awl, it is necessary to achieve a convergence of approximately 30° so that the screw tip enters the L5 vertebral body. Now a pedicle screw (7 mm in diameter) of the appropriate length can be safely inserted through the pedicle of S1 into the L5 vertebral body. These screws provide excellent penetration through the S1 and L5 endplates. After decortication of the transverse processes of L4 and L5 , the sacral ala, and the facet joints of L4, L5 , and L5, S1 , a standard posterolateral fusion is performed using autogenous bone graft. These autogenous bone grafts can be obtained from the posterior iliac crest. The lumbosacral fascia and skin are carefully sutured, leaving a single subfascial drain, which is removed on the second postoperative day. The disadvantages of this method include insufficiently reliable fixation, as screws are not inserted into the L5 vertebra. Consequently, one element in the chain of moving elements is not included in the overall stabilization system. This also exposes the structure to increased loads, leading to micromotion in the segment and screw loosening, ultimately worsening the conditions for achieving a bone block, leading to the impossibility of vertebral fusion. Furthermore, a conventional posterolateral fusion is performed rather than an interbody fusion. Since 80% of all loads fall on the anterior column, the posterior interbody fusion performed is located outside the primary load zone and is not always able to withstand the development of motion at the operated level. Furthermore, all high-grade spondylolistheses are highly dysplastic, meaning their posterior structures—the arches and transverse processes—are underdeveloped. Consequently, the contact area between the autograft and these structures is small, making it difficult to achieve a high-quality posterior fusion. This increases the risk of metal structure failure (fracture or loosening) and pseudoarthrosis. The closest to the proposed solution is a method for the surgical treatment of highly dysplastic spondylolisthesis (patent RU 2713518, IPC A61B 17/56, A61F 2/46, published 02/05/2020), in which posterior internal fixation of the fifth lumbar vertebra L 5 is carried out by transpedicular insertion of screws into the displaced vertebra L 5 and transdiscal insertion of screws through the body of the sacral vertebra S 1 , through the disc L 5 -S 1 into the cranioventral part of the body of the displaced vertebra L 5, paired fixation of the transpedicular and transdiscal screws with rods, transacral interbody fusion L 5 -S 1, which is carried out as follows: a section of the lamina of the arch of the vertebra S 1 is resected, the left dural sac at the level of S 1 -S 2 is displaced medially, the posterior wall of the body of S is perforated 1 vertebra in the space between the S 1 root and the dural sac, under EOP control, a channel is formed through the body of the S 1 vertebra and the L 5 -S 1 disc into the body of the L 5 vertebra, the channel is made in such a way that it ends blindly in the bone of the body of the L 5 vertebra, then the channel is expanded with a cannulated tap, a hollow tube of the device for introducing osteoinductive material with an external thread along the entire length is screwed into the formed channel, not reaching 4-7 mm to the bottom of t