RU2324437C1 - Method of surgical treatment of lumbar spine in osteochondrosis with segmental instability or in mild spondylolisthesis - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: yellow ligament is unsheathed by posterior approach, dissected at the needed level, then the microsurgical diskectomy, interbody vertebral fixation with the transforming cages and preliminary dissection of disk tissue in the supposed bed between cages are performed. The chondral plates of adjacent vertebras are dissected. Two transforming cages are inserted so as the height of intravertebral space is restored and a wedging of posterior segments is achieved. The interbody space is filled between cages and adjacent bodies with autogenous cancellous tissue in shape of 4 mm diameter cylinders. The anterior margins of graft and cages are retroplaced from the anterior edge of vertebral bodies. The posterior margin of grafts should not contact the posterior edge of vertebral bodies, to avoid the roots compression in graft dislocation or by generated bone tissue. The installation and transformation of the second cage causes the compression effect between the grafts and adjacent closing plates vertebral bodies. The cage installation and filling of the interbody space is performed until the inclination of the articular processes of adjacent vertebras is achieved. Then, a groove is drilled perpendicularly to the articular surface in the adjacent vertebral articular processes, and 3 mm diameter and 1 cm long autograft wedge is rammed inside tightly.

EFFECT: method increases area of spondylosed surfaces; prevents resorption and migration of graft before bone consolidation of adjacent vertebras.

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Description

The invention relates to medicine, namely to neurosurgery, traumatology and orthopedics, and is intended for the treatment of osteochondrosis of the lumbar spine with segmental instability and / or spondylolisthesis of I degree.

Increasing attention is being removed by instability of the lumbar spine. In the last decade, instability with intervertebral osteochondrosis, with spinal injuries, and spondylolysis with spondylolisthesis (IA A. Movshovich, 1994) has been especially carefully studied.

Methods are being developed for eliminating instability by anterior fusion, posterior fusion, and combined anteroposterior fusion. Of the posterior approaches, interbody fusion (RU 2125416, publ. 11/29/1999), interbody and arched joints (RU 2186541, publ. 08/10/2002) is performed using screws. Various methods of using fixation tools have been developed: screws, screws with bone cement (RU 2001111630, publ. 02/20/2003, RU 2004134385, publ. 25.11.2004), means of tightening vertebrae from material with thermomechanical memory (RU 2220683, publ. 10.01.2004 ), implants made of bone, carbon material (RU 2199978, publ. 10.03.2003), biostilate (RU 2175249, publ. 10.27.2001). The main disadvantages of these operations are the difficulty of achieving intervertebral ankylosis, the need for long-term patient compliance with bed rest after surgery.

A known method of surgical treatment of the lumbar spine in case of osteochondrosis with instability and degenerative spondylolisthesis of the first degree, including open surgery through the posterior mini-approach, discectomy, processing the closure plates of adjacent vertebrae before removing the cartilaginous plates and the appearance of bone tissue of the vertebrae, installing two mechanically transformed B-Twin implants, introduction of bone autografts into the intervertebral space. The method is used to achieve lumbar spinal fusion of lumbar localization after discectomy using implants. However, as noted by the developers of the method, complications were identified when using the method, including non-fusion of vertebrae, rejection of implants or bone autografts, bleeding, hematoma, epidural fibrosis (Y. Folman, Sang-Ho Lee et al., Posterior Lumbar Interbody Fusion of Degenerative Disc Disease Using a Minimally Invasive B-Twin Expandable Spinal Spacer, Journal of Spinal Disorders & Techniques, 2003, Philadelphia, vol. 16, No. 5, pp. 455-460).

The objective of the claimed method is the creation of reliable fusion by increasing the area of fusion, the selection of funds that contribute to spinal fusion, which ultimately reduces the time of fusion.

The method is as follows: expose the yellow ligament with posterior access, excise it at the desired level, produce microsurgical discectomy, interbody fixation (in the case of spondylolisthesis after elimination of vertebral displacement) with transforming cages, for example B-Twin, with preliminary removal of disc tissue in the proposed bed between the cages . The cartilaginous closure plates of adjacent vertebrae are removed. Two transforming cages are installed so that the height of the intervertebral space is restored and the posterior sections are wedged. The interbody space between the cages and adjacent bodies is filled with a spongy autobone in the form of cylindrical columns with a diameter of 4 mm, usually in the amount of four. Moreover, the front edge of the grafts and cages are located posterior to the front edge of the vertebral bodies, the rear edge of the grafts should not reach the rear edge of the vertebral bodies in order to prevent compression of the roots when the grafts or bone tissue is displaced. The installation and transformation of the second cage creates a compression effect between autotransplates and adjacent vertebral body end plates. The transformation of the cages and the filling of the interbody space is performed until the inclinations of the articular processes of adjacent vertebrae are eliminated. Then, in the adjacent articular processes of the vertebrae with a drill up to 3 mm in diameter perpendicular to the articular surface, a groove is formed in which the autograft in the form of a wedge with a diameter of 3 mm and a length of 1 cm is tightly clogged. Using the claimed method increases the area of the spondylated surfaces, prevents the resorption and migration of the grafts to bone fusion of adjacent vertebrae, reduces the time of sponodelodes. The choice of autografts in the form of cylindrical columns with a diameter of 4 mm prevents the phenomenon of graft resorption before the organization of the bone block. Transplants less than 4 mm undergo premature resorption, and an increase of more than 4 mm creates technical difficulties in their installation.

We used this technique in the surgical treatment of 32 patients. No complications were noted.

An example implementation of the method. Patient M., 45 years old, was admitted with a diagnosis of intervertebral osteochondrosis, deforming spondylosis of the lumbosacral spine, sequestered herniation of the intervertebral disc L4-L5, segmental instability, right-sided lumbar ischialgia. Surgery according to the claimed method.

In the long term, 6 months after surgical treatment, a good functional and cosmetic result was noted. There is no pain syndrome. According to control x-ray and magnetic resonance imaging in the area of spinal fusion L4-L5 ventral bone block. Spondelodes were reduced from 12 to 6 months. After 48 months, no complaints, good functional result. During control radiography and magnetic resonance imaging, additional data were not obtained, in the area of spinal fusion L4-L5 formed ventral bone block.

In all patients operated on by this method, nonunion of adjacent vertebral bodies was not observed.

Claims (1)

A method of surgical treatment of the lumbar spine in case of osteochondrosis with segmental instability and / or grade I spondylolisthesis, including microsurgical microdisectomy via posterior access, removal of cartilaginous plates of adjacent vertebral bodies, installation of two transformable cages, filling of the interbody space with autobone, which is set so that so that there is a restoration of the height of the interbody gap and wedging of the posterior sections, fill the interbody space m Between cages and adjacent bodies, a spongy autobone in the form of cylindrical columns with a diameter of 4 mm, the front edge of the grafts and cages is located posterior to the front edge of the vertebral bodies, the rear edge of the grafts does not reach the rear edge of the vertebral bodies, the cages are transformed and the interbody space is filled until the compression effect is created between autografts and adjacent end plates of the vertebral bodies, as well as eliminating the inclinations of the articular processes of adjacent vertebrae, and then in adjacent articular perpendicular appendages articular surfaces form a groove diameter of 3 mm, which is tightly clog autograft in a wedge diameter of 3 mm a length of 1 cm.