METHOD FOR SURGICAL MANAGEMENT OF SPONDYLOLISTHESIS AT LUMBOSACRAL LEVEL Russian patent published in 2025 - IPC A61B17/70 A61F2/44 

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to neurosurgery, and can be used for surgical management of spondylolisthesis at the lumbosacral level. Patient is positioned on his/her stomach. Affected vertebral level is determined and marked under X-ray control. Spinous process of the underlying vertebra is palpated and marked. Self-adhesive radiopaque navigation markers are placed on the skin around the areas of the proposed incisions. Linear incision of soft tissues up to 1.5 cm above the spinous process of the underlying vertebra and a subperiosteal dissection of the spinous process are performed. Reference frame of the navigation system is installed on this spinous process. Computed tomography of the lumbosacral spine is performed. Radiopaque markers, a reference frame and surgical instruments are recorded in the navigation system. Using the navigation station, determining the optimal direction of insertion of the stabilizing screws so that each screw passes through the pedicle of the vertebral arch, in the axial plane the angle between the axis of the screw and the middle line of vertebra is 18 to 35 degrees, and the distal end of the screw is located one third from the ventral edge of the vertebral body, in the sagittal plane the distal end of the screw is located from the edge of the vertebral body lying on the side of the intervertebral disc by at least a screw diameter. Two paramedian soft tissue incisions up to 1.5 cm long are marked. On the side opposite to localization of pain, soft tissues are incised and skeletonized vertebral arches of the involved level, and under control of navigation station screws are installed through pedicles of vertebral arches along the specified trajectory and depth. On the side of pain localization, soft tissues are incised, skeletonized vertebral arches of the involved level, facetectomy, flavectomy, decompression of emergent and passing nerve roots. Intervertebral disc is opened, a discectomy is performed with the help of a conchotome and a curette, a curettage of a nucleus pulposus and cartilaginous marginal plates is performed. Optimal position of the implant of the intervertebral disc is determined so that in the axial plane the implant is aligned with the midline of the vertebra, in the sagittal plane the implant does not extend beyond the anterior and posterior edges of the vertebral body. Up to 2 ml of osteogenic material promoting formation of spondylodesis is introduced into the cavity of the intervertebral disc. Intervertebral disc implant is filled with osteogenic material to 1 ml. An intervertebral disk implant and stabilizing screws are installed along the specified trajectory and depth. Spondylolisthesis is reduced by widening the intervertebral space by placing an implant of an intervertebral disc with height of 2 mm more than the height of the intervertebral disc and pulling up the displaced vertebra by means of transpedicular screws placed on the displaced vertebra. Intraoperative computed tomography is performed to control the position of the implant and screws. Haemostasis is performed. Heads of nuts on transpedicular screws and rods are removed; reference frame is removed. Wounds are tightly sutured in layers with application of intradermal sutures; navigation markers are removed.

EFFECT: method provides reduced injuries and radiation exposure, as well as improves stabilization of vertebrae due to the order of screws installation taking into account the described landmarks and angles of introduction and provides convergence of screws in the vertebral arches.

5 cl, 11 dwg