RU2186541C2 - Method for stabilizing the mobile vertebral segment in case of surgical correction of spondilolisthesis - Google Patents

Abstract

FIELD: medicine, traumatology, orthopedics. SUBSTANCE: method deals with creating a reliable spondilodesis L₅-S₁ due to introducing the screws with the thread on their working surface through articular processes and arch supports of the first sacral vertebra and area of distant disk L₅-S₁ in anterior- cranial direction at convergence angle of 30 deg. and orientation in sagittal plane towards anterior-superior angle of the fifth lumbar vertebra body. Correction of anterior shift of the fifth lumbar vertebra is conducted due to screwing to provide autotransplant compression in antibody space L₅-S₁ to reach spondilodesis. EFFECT: increased force of fixation. 2 dwg

Description

 The invention relates to medicine, namely to traumatology and orthopedics, and can be used to fix the vertebra, displaced as a result of spondylolisthesis.

 Patients with spondylolisthesis are treated promptly, fixing the affected segment of the spine with a bone autograft or various metal structures (Boychev V., Conforti B., Chokanov K. Operative orthopedics and traumatology. - Sofia, 1961. - P. 775 and 776; Movshovich I.A. Orthopedics .-- Moscow, 1983 .-- S. 331-339). The main disadvantages of these operations are the difficulty in achieving intervertebral ankylosis, technically difficult and dangerous anterior operative access, additional tissue trauma associated with taking a bone graft from the iliac wing or tibia crest, and the need for prolonged bed rest after the intervention.

 A known method of fixing the vertebrae using metal plates located on the back surface of the vertebral column and fastened with screws held transpedicularly above and below the lesion area (Müller M.E., Allgover A., Schneider R., Willinger H. Manual for internal osteosynthesis. - Ad Marginem, Moscow, 1996 .-- S. 670-673).

 This method is taken as a prototype, since it has common features with the claimed: the creation of posterior fusion by implanting a metal structure, the introduction of fixing elements in the projection of the base of the vertebral arch, the possibility of early activation of the patient in the postoperative period.

 The disadvantages of the prototype are the high invasiveness of the operation associated with the massiveness of the metal structure, wide operative access, skeletonization of adjacent vertebrae, and the duration of the intervention. In addition, the high cost of installed clamps limits the possibility of using a prototype operation in a significant part of the population.

 The aim of the invention is to reduce the morbidity of the operation, eliminating the anterior displacement of the vertebral body, increasing the reliability of fixation of the movable vertebral segment, reducing the cost of treatment.

The essence of the invention consists in performing from the rear access a laminectomy of the fifth lumbar vertebra (with subsequent use of bone fragments of the arch and articular processes as an autograft - bone gravel), removing the substance of the L ₅ -S ₁ disc with the replacement of the defect with bone gravel, fixing the movable vertebral segment L ₅ -S ₁ through two titanium nepolnorezbovyh spongy screws to the body of the fifth lumbar vertebra through articular processes S ₁ region and L ₅ -S disk ₁ in direction y perednekranialnom 30 ^o th convergence and orientation of the sagittal plane toward the corner of the anterior vertebral body L _5.

 The method is as follows (Fig. 1 and 2).

The patient is laid on his stomach, face down, his legs are lowered over the edge of the table and bent at the hip and knee joints to reduce lumbar lordosis. The zone L ₅ -S ₁ is located above the radiolucent part of the orthopedic operating table and, under the control of the electron-optical converter (EOP), radiopaque landmarks (long injection needles) are set. The skin incision is carried out along the midline of the lumbosacral region from the spinous process of L ₄ to S ₂ . Fascia of the muscles of the lower back is cut in layers, acute and bluntly skeletonize the spinous process, arch, upper and lower articular processes of the fifth lumbar vertebra. A laminectomy is performed, the removed bone is saved as an autograft. An audit of the dural sac, spinal roots is carried out. The posterior longitudinal ligament is dissected transversely, the fibrous ring of the disk L ₅ -S _{1 is} isolated. The latter is removed. Under the control of the image intensifier, the anterior longitudinal ligament is reached, without destroying the bone block (if any) between the front surfaces of the vertebral bodies L ₅ -S ₁ . The space between the fifth lumbar and first sacral vertebrae is filled with autobone fragments. By manipulating the operating table under the control of the image intensifier, the magnitude of the lumbar lordosis and the displacement of the fifth lumbar vertebra are corrected. Using a guide through the first sacral vertebra into the body of the fifth lumbar vertebra, two spongy, partially threaded titanium screws are drawn. They pass through the articular process and the legs of the arch S _{1 of the} vertebra, the interbody space with the autograft placed, perforating the lower contact plate L ₅ , then into the vertebral body to its front surface. The screws are inserted in the front cranial direction with a convergence angle of 25-30 degrees. Tightening the screws leads to compression of the interbody space filled with the autograft and to the maximum possible elimination of the anterior displacement of the vertebra L ₅ . The wound is sutured in layers, leaving a paravertebral vacuum drainage. The patient is raised on the third day after the intervention. Over the next three months, they recommend wearing a removable plastic corset. Due to the biological inertness of the titanium alloy, the fixing screws are not removed further.

Clinical example. Patient Z-th, born in 1960, was admitted to the Samara Regional Clinical Hospital. Kalinina 01/31/2000 with a diagnosis of "Spondylolisthesis L ₅ vertebra, vertebral radicular pain syndrome."

 After the examination and detailing the nature of the existing disease, the patient underwent surgery according to the proposed method. The postoperative period was uneventful. Examined after 2 months. after surgery. No complaints, no neurological disorders were detected. On the control radiograph there are signs of emerging bone ankylosis between the fifth lumbar and first sacral vertebrae, there is no progression of spondylolisthesis.

 The inventive method was operated on 7 patients, the results are positive.

 The method is less traumatic, technically not complicated and can be recommended in medical practice for the surgical treatment of patients with spondylolisthesis.

Claims (1)

A method for stabilizing the mobile vertebral segment during surgical correction of spondylolisthesis, including posterior internal transpedicular fixation of the fifth lumbar vertebra after removal of the intervertebral disc and its bone autoplasty, characterized in that the screws are threaded on the working surface through the articular processes and legs of the arches of the first sacral vertebra into the body of the fifth of the lumbar vertebra and the region of the distal disc L ₅ -S ₁ in the ancranial direction with an angle of convergence of 30 ^o and orientation in the sagittal plane toward the anteroposterior angle of the body of the fifth lumbar vertebra, perform correction of the anterior displacement of the fifth lumbar vertebra by tightening the screws, providing compression of the autograft in the interbody L ₅ -S ₁ until fusion is achieved.

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