Feasibility of Rialto Sacroiliac Fusion Implant for Trans-Sacral Fixation of High Grade L5 Listhesis Treatment, a Series of Cases

Resumo

Introdução: Utilizando a técnica original de Bohlman com pequenas modificações (ao invés de enxerto de fíbula utilizou-se implante de Rialto e realizando fixação posterior L4-S2) tratamos cirurgicamente duas jovens com listese L5 de alto grau e um caso de pseudoartrose pós-operatória após fixação lombossacra com sucesso. A técnica cirúrgica detalhada e estagiada é descrita, além da descrição de suas falácias e o que deve ser evitado. Métodos: Os pacientes foram acompanhados durante 2 anos e 9 meses e 2 anos e 7 meses, sendo que o seguimento do terceiro paciente é mais curto, por se tratar de um caso recente. Resultados: Duas jovens do sexo feminino, 18 anos, portadoras de listese ístmica L5, foram submetidas à fixação L4-S2 e fusão transssacral, trans-discal com implante de Rialto pela técnica de Bohlman com redução parcial da listese. Ambas tiveram resolução da dor e mantiveram boa evolução clínica, uma em 1 ano e 9 meses e outra em 1 ano e 7 meses de seguimento. O terceiro caso, homem de 79 anos, foi uma pseudoartrose pós-operatória L5-S1 resolvida com o uso do mesmo tipo de implante trans-sacral, associado a parafusos S2 sacroilíaco (S2 SAI). Conclusão: A fusão circunferencial é uma artrodese robusta com baixo risco de pseudoartrose, recomendando-se fusão sem redução em pacientes com pelve equilibrada, equilíbrio sagital global aceitável e poucos sintomas neurológicos. A redução parcial pode ser obtida durante a fixação após a remoção dos elementos ósseos posteriores da vértebra L5. A fixação in situ pode ser aumentada com implante de Rialto transsacral.

Palavras-chave

Técnica de Bohlman; Implante Rialto; Espondilolistese; Lombar

Abstract

Introduction: Using the original Bohlman technique with small modifications (instead of fibula graft used Rialto implant and performing posterior fixation L4-S2) we treated surgically two young females with high grade L5 listhesis and a case of postoperative pseudarthrosis after lumbosacral fixation with success. The detailed, staged surgical technique is described, also with description of pitfalls and their avoidance. Methods: The patients were followed up during 2 year and 9 months and 2 year and 7 months, the third patient´s follow up is shorter, because this is a recent case. Results: Two young females of 18 years old with isthmic listhesis L5 were submitted to fixation L4-S2 and trans-sacral, trans-dical fusion with Rialto implant by Bohlman technique with partial reduction of listhesis. Both had resolution of the pain and has maintained a good clinical outcome at 1 year and 9 months and another one at 1 year and 7 months follow up. The third case, 79 years old male, was a postoperative pseudarthrosis L5-S1 solved with the use of the same type of trans-sacral implant, associated with S2 sacroiliac (S2 SAI) screws. Conclusion: Circumferential fusion is a robust arthrodesis with a low risk of pseudarthrosis, fusion without reduction is advised in patients with a balanced pelvis, acceptable global sagittal balance, few neurological symptoms. Partial reduction may be achieved during the fixation after posterior osseous elements removal of L5 vertebra. In-situ fixation can be augmented with trans-sacral Rialto implant.

Keywords

Bohlman technique; Rialto implant; Spondylolisthesis; Lumbar

References

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Feasibility of Rialto Sacroiliac Fusion Implant for Trans-Sacral Fixation of High Grade L5 Listhesis Treatment, a Series of Cases

Utilidade do Implante Rialto para Fixação Trans-Sacral da Listese de Alto Grau L5, a Série de Casos

Resumo

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Abstract

Keywords

References

JBNC Brazilian Journal of Neurosurgery

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