Method for surgical filling of post-resection cavities of benign spinal tumors in children
A method combining precise surgical techniques and allografts with imaging oversight addresses the shortcomings of existing spinal tumor treatments, ensuring effective bone grafting and improved patient quality of life.
Patent Information
- Authority / Receiving Office
- RU · RU
- Patent Type
- Patents
- Current Assignee / Owner
- FEDERALNOE GOSUDARSTVENNOE BYUDZHETNOE UCHREZHDENIE NATSIONALNYJ MEDITSINSKIJ ISSLEDOVATELSKIJ TSENTR TRAVMATOLOGII I ORTOPEDII IMENI N N PRIOROVA MINISTSTVA ZDRAVOOKHRANENIYA ROSSIJSKOJ FEDERATSII FGBU NMITS TO IM N N PRIOROVA MINZDRAVA ROSSII
- Filing Date
- 2025-05-28
- Publication Date
- 2026-07-07
Abstract
Description
[0001] The invention relates to the field of medicine, namely to traumatology and orthopedics, to a method for surgical filling of post-resection cavities of benign spinal tumors in children and can be used in the treatment of patients in trauma, orthopedic, surgical and other hospitals.
[0002] A known method for filling a bone cavity consists of replacing it, characterized in that the cavity is filled with a spongy allograft in the form of crumbs and its surface is treated with low-temperature plasma until a homogeneous filling is formed (see Russian Federation Patent No. 2318464, MPKA61B 18 / 04. 10.03.2008).
[0003] However, this method has the following disadvantages when used:
[0004] - insufficient results of surgical treatment of patients with benign tumors of the spine,
[0005] - low quality of bone grafting and formation of supporting bone block in the late period in the tumor resection area,
[0006] - large volume of surgical intervention,
[0007] - slight improvement in the patient's quality of life.
[0008] A method of vertebroplasty for vertebral body fractures is known, which consists in repositioning the fractured vertebral body with a transpedicular device and vertebroplasty of the vertebrae with bone cement, characterized in that a temporary external transpedicular repositioning structure and full-size transpedicular screws are used, which are inserted into healthy vertebrae adjacent to the damaged one through small skin incisions, and short transpedicular screws are additionally inserted into the arch of the damaged vertebra from 2 sides, having an immersion part that does not exceed the length of the pedicles of the arch of the damaged vertebra, and the fracture is finally fixed by puncture introduction and straightened vertebral body of bone cement or biocomposite material, with subsequent removal of the external repositioning transpedicular device, (see Russian Federation Patent No. 2462206, IPC A61B 17 / 56, (27.09.2012).
[0009] However, this method has the following disadvantages when used:
[0010] - insufficient results of surgical treatment of patients with benign tumors of the spine,
[0011] - low quality of bone grafting and formation of supporting bone block in the late period in the tumor resection area,
[0012] - large volume of surgical intervention,
[0013] - slight improvement in the patient's quality of life.
[0014] The objective of the invention is to create a method for surgical filling of post-resection cavities of benign spinal tumors in children.
[0015] The technical result is reliable provision of surgical treatment for patients with benign spinal tumors, reliable restoration of the patient's functional and motor capabilities, high-quality bone grafting and the formation of a supporting bone block in the late period in the tumor resection area, a reduction in the scope of surgical intervention, as well as a significant improvement in the patient's quality of life.
[0016] The technical result in the implementation of the invention is achieved in that a method is proposed for surgical filling of post-resection cavities of benign tumors of the spine in children, characterized in that before performing surgical treatment, a spatial visualization of the affected spine is determined by the method of multi-layer spiral computed tomography, then the state of the surrounding soft tissues, vascular and nerve structures that are not visualized when performing multi-layer spiral computed tomography is assessed by the method of magnetic resonance imaging, after anesthesia, with the patient in the prone position, an incision is made in the skin and subcutaneous fat above the spinous processes, access is made to the posterior parts of the spine, hemostasis is performed, the benign tumor is separated from healthy tissue and removed, hemostasis is performed,then, a resection of the vertebral body is performed by resection of the articular processes or by performing a laminectomy in the absence of damage to the posterior supporting column, then the neural structures are isolated, the cyst membranes in the vertebral body are removed by scraping with spoons, curettes or cleaning with a high-speed bur, the soft tissue component of the cyst is removed and an assessment is made of the possibility of preserving the bone structures, tumor bone structures are removed to healthy bone tissue, then, using a tube and an impactor, the post-resection cavities of the vertebrae are filled with an allograft in the form of powder or bone "chips", while granules of a complex alloplastic drug based on hydroxyapatite containing 60 mass. % collagen, or granules of an osteoplastic biological material based on bone tissue, or autologous bone chips are used as an allograft,After each dosed introduction of the allograft column, using a spatula or bone awl, it is evenly distributed along the walls of the cavity until it is completely filled; after performing bone grafting, the spinal canal is revised and the remaining allograft on the surface of the dural membrane is removed, drainage is performed; immediately after surgery, the surgical area is examined using multi-layer spiral computed tomography to assess the adequacy of filling in the vertebral body area and the distribution of the bone allograft in the surgical area; 1 month after surgery, computed tomography is performed to determine the uniformity of distribution of the bone allograft in the post-resection cavity; 3 months after surgery, a repeat CT scan is performed to determine the same parameters; the patient is recommended to undergo follow-up examinations at the following times from the moment of surgical treatment: 6 months, 12 months,18 months and 24 months,
[0017] The method is as follows. Preoperatively, spatial imaging of the affected spine is determined using multislice spiral computed tomography. Magnetic resonance imaging is used to assess the condition of surrounding soft tissues, vascular, and neural structures not visualized by multislice spiral computed tomography.
[0018] After anesthesia, with the patient in the prone position, an incision is made in the skin and subcutaneous fat above the spinous processes. The posterior spine is accessed. Hemostasis is achieved. The benign tumor is separated from healthy tissue and removed.
[0019] Next, a vertebral body resection is performed by resecting the articular processes or performing a laminectomy if the posterior column is not affected. Next, the neural structures are isolated, and the cyst membranes in the vertebral body are removed by scraping with spoons, curettes, or by cleaning with a high-speed burr. The soft tissue component of the cyst is removed, and the possibility of preserving the bone structure is assessed. The tumorous bone structures are removed down to healthy bone tissue.
[0020] Then, using a tube and impactor, the post-resection cavities of the vertebrae are filled with an allograft in the form of powder or bone chips. The allograft used is granules of a complex alloplastic preparation based on hydroxyapatite containing 60% collagen, or granules of a bone-based osteoplastic biological material, or autologous bone chips.
[0021] After each dosed injection of the allograft column, use a spatula or bone awl to evenly distribute it along the cavity walls until it is completely filled. After bone grafting, the spinal canal is inspected and any remaining allograft on the surface of the dural membrane is removed. Drainage is performed.
[0022] Immediately after surgery, a multi-layer spiral computed tomography scan of the surgical site is performed to assess the adequacy of filling in the vertebral body area and the distribution of bone allograft in the surgical site.
[0023] One month after surgery, a CT scan is performed to determine the uniformity of bone allograft distribution in the post-resection cavity. A repeat CT scan is performed three months after surgery to determine the same parameters. The patient is recommended to have follow-up examinations at the following intervals after surgery: 6 months, 12 months, 18 months, and 24 months.
[0024] Among the essential features characterizing the proposed method of surgical filling of post-resection cavities of benign spinal tumors in children, the following are distinctive:
[0025] - determination of spatial visualization of the affected spine before performing surgical treatment using multi-layer spiral computed tomography,
[0026] - magnetic resonance imaging is used to assess the condition of surrounding soft tissues, vascular and nerve structures that are not visualized when performing multi-layer spiral computed tomography,
[0027] - after anesthesia, with the patient in the prone position, an incision is made in the skin and subcutaneous fat tissue above the spinous processes,
[0028] - access to the posterior spine, perform hemostasis,
[0029] - performing separation of a benign tumor from healthy tissue and its removal,
[0030] - performing resection of the vertebral body by resection of the articular processes or performing a laminectomy in the absence of damage to the posterior supporting column,
[0031] - isolation of neural structures, removal of the cyst membrane in the vertebral body by scraping with spoons, curettes or cleaning with a high-speed bur,
[0032] - removal of the soft tissue component of the cyst and assessment of the possibility of preserving bone structures,
[0033] - removal of tumor bone structures to healthy bone tissue,
[0034] - filling of post-resection cavities of vertebrae with an allograft in the form of powder or bone “chips” using a tube and impactor,
[0035] - use of granules of a complex alloplastic preparation based on hydroxyapatite containing 60% collagen by weight, or granules of bone-plastic biological material based on bone tissue or autogenous bone chips as an allograft,
[0036] - after each dosed introduction of the allograft column, using a spatula or bone awl, it is evenly distributed along the walls of the cavity until it is completely filled,
[0037] - performing a revision of the spinal canal and removal of the remnants of the allograft on the surface of the dural membrane after bone grafting,
[0038] - performing immediately after surgery a multi-layer spiral computed tomography study of the surgical area to assess the adequacy of filling in the vertebral body area and the distribution of bone allograft in the surgical area,
[0039] - performing a computed tomography scan 1 month after surgery and determining the uniformity of distribution of the bone allograft in the post-resection cavity,
[0040] - performing a repeat CT scan 3 months after the operation to determine the same parameters,
[0041] - The patient is recommended to have follow-up examinations at the following times from the date of surgical treatment: 6 months, 12 months, 18 months and 24 months.
[0042] Experimental and clinical studies of the proposed method for surgical filling of post-resection cavities of benign spinal tumors in children have demonstrated its high efficacy. The proposed method for surgical filling of post-resection cavities of benign spinal tumors in children enabled surgical treatment of patients with benign spinal tumors, reliably restored the patient's functional and motor capabilities, ensured high-quality bone grafting and the formation of a supporting bone block in the late period in the tumor resection area, reduced the extent of surgical intervention, and significantly improved the patient's quality of life.
[0043] The implementation of the proposed method of surgical filling of post-resection cavities of benign spinal tumors in children is illustrated by the following clinical examples.
[0044] Example 1. Patient N., 17 years old, was admitted to the 11th traumatology and orthopedic department of the Federal State Budgetary Institution “N.N. Priorov National Medical Research Center of Traumatology and Orthopedics” with the diagnosis: “Aneurysmal bone cyst of the 17th vertebra.”
[0045] Objective status: General condition is satisfactory. Skin and visible mucous membranes are of normal color. Temperature is 36.6°C. Breathing in the lungs is rhythmic, vesicular, conducted equally in symmetrical areas of the chest, there are no wheezing. Respiratory rate: 17 per minute. Pulse: 75 beats per minute, of satisfactory volume and tension. Blood pressure is 120 / 80 mmHg. Heart sounds are clear, rhythmic. The abdomen is symmetrical, soft, painless. The spleen is not enlarged. The percussion symptom is negative on both sides. Physiological functions are normal.
[0046] The patient underwent surgical filling of post-resection cavities of benign spinal tumors in children.
[0047] Preoperatively, multislice spiral computed tomography (MSCT) was used to determine spatial visualization of the affected spine. Magnetic resonance imaging (MRI) was used to assess the condition of surrounding soft tissues, vascular, and neural structures not visualized by MCT.
[0048] After anesthesia, with the patient in the prone position, an incision was made in the skin and subcutaneous fat above the spinous processes. Access to the posterior spine was achieved. Hemostasis was achieved. The benign tumor was separated from healthy tissue and removed.
[0049] Then, a vertebral body resection was performed by resecting the articular processes. Next, the neural structures were isolated, and the cyst membranes in the vertebral body were removed using spoon scraping. The soft tissue component of the cyst was removed, and the possibility of preserving the bone structure was assessed. The tumor-containing bone structures were removed down to healthy bone tissue.
[0050] Then, using a tube and an impactor, the post-resection cavities of the vertebrae were filled with an allograft in the form of a powder. In this case, granules of a complex alloplastic preparation based on hydroxyapatite containing 60% collagen were used as an allograft.
[0051] After each dosed injection of the allograft column, a spatula was used to evenly distribute it along the cavity walls until it was completely filled. After bone grafting, the spinal canal was explored and any remaining allograft on the surface of the dural membrane was removed. Drainage was performed.
[0052] Immediately after surgery, a multi-layer spiral computed tomography scan of the surgical site was performed to assess the adequacy of filling in the vertebral body area and the distribution of bone allograft in the surgical site.
[0053] One month after surgery, a CT scan was performed to determine the uniformity of bone allograft distribution in the post-resection cavity. A repeat CT scan was performed three months after surgery to determine the same parameters. The patient is recommended to have follow-up examinations at the following intervals after surgery: 6 months, 12 months, 18 months, and 24 months.
[0054] Example 2. Patient T., 10 years old, was admitted to the 11th traumatology and orthopedic department of the Federal State Budgetary Institution “N.N. Priorov National Medical Research Center of Traumatology and Orthopedics” with the diagnosis: “Aneurysmal bone cyst of the Th2 spine”.
[0055] Objective status: General condition is satisfactory. Skin and visible mucous membranes are of normal color. Temperature is 36.6°C. Breathing in the lungs is rhythmic, vesicular, no wheezing. Respiratory rate: 16 per minute. Pulse: 74 beats per minute, satisfactory filling and tension. Blood pressure is 125 / 85 mmHg. Heart sounds are clear, rhythmic. Objective status: General condition is satisfactory.
[0056] The patient underwent surgical filling of post-resection cavities of benign spinal tumors in children.
[0057] Preoperatively, multislice spiral computed tomography (MSCT) was used to determine spatial visualization of the affected spine. Magnetic resonance imaging (MRI) was used to assess the condition of surrounding soft tissues, vascular, and neural structures not visualized by MCT.
[0058] After anesthesia, with the patient in the prone position, an incision was made in the skin and subcutaneous fat above the spinous processes. The posterior spine was accessed. Hemostasis was achieved. The benign tumor was separated from healthy tissue and removed.
[0059] Then, a vertebral body resection was performed using laminectomy if there was no posterior column involvement. Next, the neural structures were isolated, and the cyst membranes in the vertebral body were removed using curettes. The soft tissue component of the cyst was removed, and the possibility of preserving the bone structure was assessed. The tumor-containing bone structures were removed down to healthy bone tissue.
[0060] Then, using a tube and impactor, the post-resection cavities of the vertebrae were filled with an allograft in the form of bone "chips." The allograft used was granules of a bone-based osteoplastic biological material.
[0061] After each dosed injection of the allograft column, a spatula is used to evenly distribute it along the cavity walls until it is completely filled. After bone grafting, the spinal canal is explored and any remaining allograft on the surface of the dural membrane is removed. Drainage is performed.
[0062] Immediately after surgery, a multi-layer spiral computed tomography scan of the surgical site was performed to assess the adequacy of filling in the vertebral body area and the distribution of bone allograft in the surgical site.
[0063] One month after surgery, a CT scan was performed to determine the uniformity of bone allograft distribution in the post-resection cavity. A repeat CT scan was performed three months after surgery to determine the same parameters. The patient is recommended to have follow-up examinations at the following intervals after surgery: 6 months, 12 months, 18 months, and 24 months.
[0064] Example 3. Patient Ya., 15 years old, was admitted to the 11th traumatology and orthopedic department of the Federal State Budgetary Institution “N.N. Priorov National Medical Research Center of Traumatology and Orthopedics” with the diagnosis: “Polyosseous form of fibrous dysplasia with damage to the T3 and T10 vertebrae.”
[0065] Objective status: General condition is satisfactory. Skin and visible mucous membranes are of normal color. Temperature is 36.7°C. Breathing in the lungs is rhythmic, vesicular, no wheezing. Respiratory rate: 17 per minute. Pulse: 73 beats per minute, satisfactory filling and tension. Blood pressure is 125 / 80 mmHg. Heart sounds are clear, rhythmic. Objective status: General condition is satisfactory.
[0066] The patient underwent surgical filling of post-resection cavities of benign spinal tumors in children.
[0067] Preoperatively, multislice spiral computed tomography (MSCT) was used to determine spatial visualization of the affected spine. Magnetic resonance imaging (MRI) was used to assess the condition of surrounding soft tissues, vascular, and neural structures not visualized by MCT.
[0068] After anesthesia, with the patient in the prone position, an incision was made in the skin and subcutaneous fat above the spinous processes. The posterior spine was accessed. Hemostasis was achieved. The benign tumor was separated from healthy tissue and removed.
[0069] Then, a vertebral body resection was performed by resecting the articular processes. Next, the neural structures were isolated, and the cyst membranes in the vertebral body were removed by cleaning with a high-speed burr. The soft tissue component of the cyst was removed, and the possibility of preserving the bone structures was assessed. The tumor-containing bone structures were removed down to healthy bone tissue.
[0070] Then, using a tube and impactor, the post-resection cavities of the vertebrae are filled with powdered allograft. Autologous bone chips were used as the allograft.
[0071] After each dosed injection of the allograft column, it was evenly distributed along the cavity walls until it was completely filled. After bone grafting, the spinal canal was explored and any remaining allograft on the surface of the dural membrane and within the spinal canal was removed. Drainage was performed.
[0072] Immediately after surgery, a multi-layer spiral computed tomography scan of the surgical site was performed to assess the adequacy of filling in the vertebral body area and the distribution of bone allograft in the surgical site.
[0073] One month after surgery, a CT scan was performed to determine the uniformity of bone allograft distribution in the post-resection cavity. A repeat CT scan was performed three months after surgery to determine the same parameters. The patient is recommended to have follow-up examinations at the following intervals after surgery: 6 months, 12 months, 18 months, and 24 months.
[0074] The use of the proposed method of surgical filling of post-resection cavities of benign spinal tumors in children ensured surgical treatment of patients with benign spinal tumors, reliably ensured the restoration of the functional and motor capabilities of the patient, ensured high-quality bone grafting and the formation of a supporting bone block in the late period in the tumor resection area, ensured a reduction in the scope of surgical intervention, as well as a significant improvement in the patient's quality of life.