Minimally Invasive Reconstruction of Vertebral Arch in Spondylolisthesis in Children and Adolescents

Syundyukov А.R., Nikolayev N.S., Kuzmina V.А., Aleksandrov S.А., Kornyakov P.N., Emelyanov V.Yu.

Key words: spondylolisthesis; isthmic spondylolisthesis; spondylodesis; vertebral arch reconstruction.

2021, volume 13, issue 5, page 62.

DOI: https://doi.org/10.17691/stm2021.13.5.08

Full text

html pdf

1251

1257

Abstract
References
How to cite

The aim of the study was to assess the effectiveness of the minimally invasive technique used to reconstruct the vertebral arch with a pedicle screw hook system in grade I isthmic spondylolisthesis in comparison with the traditional technique of segment stabilization with interbody fusion.

Materials and Methods. The study included 26 patients aged from 11 to 17 years. The follow-up period lasted from 1 to 7 years. Two groups were formed: in group 1 (n=6), segments L₅–S₁ were stabilized using the traditional technique; in group 2 (n=20), the arch of the L₅ vertebra was reconstructed by means of minimally invasive surgery. The pain syndrome was assessed in each study group using the visual analogue scale (VAS) and Macnab criteria before and after surgery; blood loss, duration of surgery in minutes, and hospitalization in days were also measured.

Results. According to the Macnab scale, the two presented techniques did not show any statistically significant differences; however, when the arch synthesis technique was employed the spinal motion segment remained intact. Furthermore, in group 2, the volume of blood loss was smaller (44.0±19.6 compared to 300.0±130.4 ml, p<0.0001), the duration of the operation was 176.0±41.6 compared to 349.2±93.2 min, p<0.0001, and hospital stay was 6.9±1.6 compared to 10.0±2.1 days, p=0.0025 in the control group.

Conclusion. The technique of vertebral arch reconstruction by a minimally invasive access gives the possibility to stabilize the spinal motion segment and to preserve biomechanics and movements in the spine. This technique allows for shorter inpatient stays for patients as well as earlier recovery and rehabilitation due to reduced surgery time and blood loss.

Nakayama T., Ehara S. Spondylolytic spondylolisthesis: various imaging features and natural courses. Jpn J Radiol 2015; 33(1): 3–12, https://doi.org/10.1007/s11604-014-0371-4.
Ward C.V., Latimer B., Alander D.H., Parker J., Ronan J.A., Holden A.D., Sanders C. Radiographic assessment of lumbar facet distance spacing and spondylolysis. Spine (Phila Pa 1976) 2007; 32(2): E85–E88, https://doi.org/10.1097/01.brs.0000252200.66545.43.
Kalichman L., Hunter D.J. Diagnosis and conservative management of degenerative lumbar spondylolisthesis. Eur Spine J 2008; 17(3): 327–335, https://doi.org/10.1007/s00586-007-0543-3.
Foreman P., Griessenauer C.J., Watanabe K., Conklin M., Shoja M.M., Rozzelle C.J., Loukas M., Tubbs R.S. L5 spondylolysis/spondylolisthesis: a comprehensive review with an anatomic focus. Childs Nerv Syst 2013; 29(2): 209–216, https://doi.org/10.1007/s00381-012-1942-2.
Guigui P., Ferrero E. Surgical treatment of degenerative spondylolisthesis. Orthop Traumatol Surg Res 2017; 103(1S): S11–S20, https://doi.org/10.1016/j.otsr.2016.06.022.
Rivollier M., Marlier B., Kleiber J.C., Eap C., Litre C.F. Surgical treatment of high-grade spondylolisthesis: technique and results. J Orthop 2020; 22: 383–389, https://doi.org/10.1016/j.jor.2020.08.015.
Kavalerskiy G.M., Makirov S.K., Chenskiy A.D., Boev M.V., Cherepanov V.G., Ternovoy K.S., Lisitskiy I.Yu., Amin F.I., Korkunov A.L., Sergeev O.A. Surgical treatment for multilevel degenerative affection of lumbosacral spine in patients older than 60 years. Vestnik Nacional?nogo mediko-hirurgiceskogo centra im. N.I. Pirogova 2010; 51: 51–58.
Kiseliov А.М., Kiseliov А.А., Krotenkov P.V. Transcorporal ventrosacral microendoscopic spondylosyndesis of the lumbosacral spinein patients with spondylolisthesis. Al?manah kliniceskoj mediciny 2011; 24: 8–13.
Buck J.E. Direct repair of the defect in spondylolisthesis. Preliminary report. J Bone Joint Surg Br 1970; 52(3): 432–437.
Nicol R.O., Scott J.H. Lytic spondylolysis. Repair by wiring. Spine (Phila Pa 1976) 1986; 11(10): 1027–1030, https://doi.org/10.1097/00007632-198612000-00011.
Morscher E., Gerber B., Fasel J. Surgical treatment of spondylolisthesis by bone grafting and direct stabilization of spondylolysis by means of a hook screw. Arch Orthop Trauma Surg 1984; 103(3): 175–178, https://doi.org/10.1007/bf00435550.
Lu V.M., Kerezoudis P., Gilder H.E., McCutcheon B.A., Phan K., Bydon M. Minimally Invasive surgery versus open surgery spinal fusion for spondylolisthesis: a systematic review and meta-analysis. Spine (Phila Pa 1976) 2017; 42(3): E177–E185, https://doi.org/10.1097/brs.0000000000001731.
Hyun S.J., Rhim S.C., Kim Y.J., Kim Y.B. A mid-term follow-up result of spinopelvic fixation using iliac screws for lumbosacral fusion. J Korean Neurosurg Soc 2010; 48(4): 347–353, https://doi.org/10.3340/jkns.2010.48.4.347.
Kunze K.N., Lilly D.T., Khan J.M., Louie P.K., Ferguson J., Basques B.A., Nolte M.T., Dewald C.J. High-grade spondylolisthesis in adults: current concepts in evaluation and management. Int J Spine Surg 2020; 14(3): 327–340, https://doi.org/10.14444/7044.
Mac-Thiong J.M., Labelle H. A proposal for a surgical classification of pediatric lumbosacral spondylolisthesis based on current literature. Eur Spine J 2006; 15(10): 1425–1435, https://doi.org/10.1007/s00586-006-0101-4.
Shin M.H., Ryu K.S., Rathi N.K., Park C.K. Direct pars repair surgery using two different surgical methods: pedicle screw with universal hook system and direct pars screw fixation in symptomatic lumbar spondylosis patients. J Korean Neurosurg Soc 2012; 51(1): 14–19, https://doi.org/10.3340/jkns.2012.51.1.14.
Macnab I. Chapter 14. Pain and disability in degenerative disc disease. Clin Neurosurg 1973; 20: 193–196, https://doi.org/10.1093/neurosurgery/20.cn_suppl_1.193.
Hyun S.J., Han S., Kim Y.B., Kim Y.J., Kang G.B., Cheong J.Y. Predictive formula of ideal lumbar lordosis and lower lumbar lordosis determined by individual pelvic incidence in asymptomatic elderly population. Eur Spine J 2019; 28(9): 1906–1913, https://doi.org/10.1007/s00586-019-05955-w.
Bavrina A.P. Modern rules for the use of descriptive statistics methods in biomedical research. Medicinskij al'manah 2020; 2: 95–104.
Roberti F., Arsenault K. Direct pars defect tubular decompression and TLIF for the treatment of low-grade adult isthmic spondylolisthesis: surgical challenges and nuances of a muscle-sparing minimally invasive approach. Minim Invasive Surg 2020; 2020: 5346805, https://doi.org/10.1155/2020/5346805.
Mohi Eldin M. Minimal access direct spondylolysis repair using a pedicle screw-rod system: a case series. J Med Case Rep 2012; 6: 396, https://doi.org/10.1186/1752-1947-6-396.
Fan Y., Zhu L. Decompression alone versus fusion and Coflex in the treatment of lumbar degenerative disease: a network meta-analysis. Medicine (Baltimore) 2020; 99(11): e19457, https://doi.org/10.1097/md.0000000000019457.
Sriphirom P., Siramanakul C., Chaipanha P., Saepoo C. Clinical outcomes of interlaminar percutaneous endoscopic decompression for degenerative lumbar spondylolisthesis with spinal stenosis. Brain Sci 2021; 11(1): 83, https://doi.org/10.3390/brainsci11010083.
Ahmad S., Hamad A., Bhalla A., Turner S., Balain B., Jaffray D. The outcome of decompression alone for lumbar spinal stenosis with degenerative spondylolisthesis. Eur Spine J 2017; 26(2): 414–419, https://doi.org/10.1007/s00586-016-4637-7.
Noggle J.C., Sciubba D.M., Samdani A.F., Anderson D.G., Betz R.R., Asghar J. Minimally invasive direct repair of lumbar spondylolysis with a pedicle screw and hook construct. Neurosurg Focus 2008; 25(2): E15, https://doi.org/10.3171/foc/2008/25/8/e15.

Syundyukov А.R., Nikolayev N.S., Kuzmina V.А., Aleksandrov S.А., Kornyakov P.N., Emelyanov V.Yu. Minimally Invasive Reconstruction of Vertebral Arch in Spondylolisthesis in Children and Adolescents. Sovremennye tehnologii v medicine 2021; 13(5): 62, https://doi.org/10.17691/stm2021.13.5.08