RU2147843C1 - Method for making intervertebral disk prosthesis at the lumbosacral level - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves making transcutaneous puncture of intervertebral disk with working cannula by partially removing pulpous nucleus using special surgical instrument and introducing prosthesis material into the disk cavity through the working cannula. Material position in the cavity is estimated from X-ray pictures. EFFECT: enhanced effectiveness of treatment; lower risk of traumatic complications in postoperative period. 2 dwg

Description

 The invention relates to medicine, namely to neurosurgery, and can be used in surgical interventions to remove herniated discs at the lumbosacral level, in the presence of instability in the intervertebral disc using endoscopic techniques.

 A known method of prosthetics of the intervertebral disc, we have chosen for the prototype / A. I. Osna. Surgical treatment of lumbar osteochondrosis. M. 1965, from 37 - 39 /.

 The known method is as follows: under general anesthesia, surgical access is performed (laminectomy, hemilaminectomy, partial hemilaminectomy), after mobilization of the dural sac and root, the posterior longitudinal ligament and fibrous ring are dissected, followed by removal of the pulpous nucleus. After removal of the disk material, prosthetic material (bone fragments, collagen sponge, metal structures) is inserted into the cavity of the disk. The operation ends with layered closure of the wound.

The disadvantages of this method:
- violation of the integrity of the musculoskeletal system of the vertebral segment;
- a significant risk of damage to blood vessels, nerve structures during manipulations;
- large invasiveness of soft tissues during the intervention;
- development of the scar adhesions;
- the severity of the operating injury and a significant weakening of the musculoskeletal system, if necessary, prosthetics at several levels;
- mandatory general anesthesia.

 The invention is aimed at creating a method for prosthetics of the intervertebral disc at the lumbosacral level, which can significantly reduce the morbidity of surgical interventions and the development of complications in the postoperative period.

 The essence of the method consists in performing percutaneous puncture of the intervertebral disc of the working cannula, removing part of the pulp nucleus with a special surgical instrument / AES CULAP-Prospekt P-095 12/88: P 20-21 /. And the introduction of a prosthetic material through the working cannula into the cavity of the disc is evaluated by radiographs.

 The inventive method differs from the prototype in that they carry out puncture access to the intervertebral disc and introduce prosthetic material through the working cannula.

 The invention is illustrated by drawings, where in FIG. 1 shows a diagram of the removal of the pulpous nucleus from the cavity of the disk with a special surgical instrument, FIG. 2 shows a diagram of the placement of a prosthetic material (for example, metal construction) in a disk cavity. The figures show the intervertebral disc 1, the working cannula 2, the surgical instrument 3, and the metal structure 4.

 The method is used as follows: after performing a puncture of the intervertebral disk 1 and placing the working cannula 2, a surgical instrument 3 is inserted into the cavity of the disk 1 to remove part of the pulp nucleus. Any prosthetic materials are introduced into the created cavity of the disk 1 (for example, metal construction 4) through the working cannula 2. To assess the position of the prosthetic material in the intervertebral disk, control radiographs are made.

 The inventive method is developed and passed clinical trials at the Russian National Research Institute of Chemical Technology. prof. A.L. Polenova in the treatment of a patient with discogenic lumbosacral radiculitis. We give an example extract from the medical history.

Example: Patient T., medical history N 13300, was treated in a clinic with severe degenerative changes at the L _1-2 level, anterior and posterior protrusion of the hernia of the disc, instability of the vertebral segment at this level. According to the claimed method, the patient underwent percutaneous discectomy at the L _1-2 level on the left under local anesthesia and intravenous administration of sedatives, a part of the degeneratively modified pulp nucleus with a volume of 1.5 cm ^{3 was} removed; high elasticity in the form of a spring ring with an outer diameter of 15 mm. Control radiographs of the position of the metal structure in the intervertebral disc cavity were made. The postoperative period was uneventful.

 Using the proposed method allows for prosthetics of the intervertebral disc at the lumbosacral level under local anesthesia and intravenous administration of sedatives, provides minimal soft tissue trauma, does not violate the integrity of the musculoskeletal system, and does not damage vessels and nerve structures during manipulation in the disk cavity, does not cause the development of scar-adhesions in the epidural space, provides the possibility of prosthetics at several levels simultaneously, does not cause severe operating injury.

Claims (1)

 A method for prosthetics of an intervertebral disc at the lumbosacral level, comprising removing part of the pulpous nucleus and introducing a prosthetic material into the cavity of the disc, characterized in that puncture access to the intervertebral disc is performed and prosthetic material is inserted through the working cannula.

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