RU2125416C1 - Surgical method for treating the cases of spondylolisthesis of lumbar region of the vertebral column - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves making access from behind the yellow ligament, its resection, microsurgical diskectomy culoplasty between the dislocated and inferior vertebra, transpedicular fixation using Schanz screws and additional fixation with a screw introduced through interdisk space formed after removing disk to create bone block between the dislocated and inferior vertebrae of lumbar region of the vertebral column. EFFECT: accelerated treatment course. 3 dwg

Description

 The invention relates to medicine, specifically to vertebrology, and is intended for surgical treatment of spondylolisthesis of the spine.

 A known method of surgical intervention on the vertebral bodies and on the intervertebral discs is anterior fusion according to V.D. Chaklin (Chaklin V.D. Fundamentals of operative orthopedics and traumatology, M., 1964, 532-534).

 The essence of this method is anterior extraperitoneal access to the vertebral bodies, a wedge-shaped partial resection of two adjacent bodies together with the intervertebral disc, and fusion of the bodies using a bone autograft.

 The disadvantage of this method is the need for a long (up to 1 year) stay of the patient in a plaster bed in the postoperative period and in the subsequent wearing of corsets in order to achieve spinal fusion of the vertebrae (bone block formation). Another disadvantage is that the access to the spine is anterior extraperitoneal - traumatic and fraught with the risk of damage to the great vessels and other anatomical formations.

 There is a method of surgical treatment of spondylolisthesis of the lumbar spine with transpedicular insertion of screws on which the repair and fixing systems are installed (Walter Dick. Internal Fixation of Thoracic and Lumbar Spine Fractures. Toronto-Lewiston N.Y.-Bern-Stuttrart, 1989, 92-99).

 The method is carried out by rear access, which allows reposition of the shifted vertebra and achieve stable fixation of the vertebrae.

 The disadvantage of this method is that they do not provide spinal fusion of the vertebrae.

 The objective of the invention is to develop a method of spondylolisthesis, providing stable fixation of the vertebrae.

 The technical result is the formation of a bone block (arthrodesis) between the bodies of the displaced and the underlying vertebrae of the lumbar spine due to stable fixation and a reduction in the period of vertebral fusion.

The problem is solved as follows. Rear access expose and remove the spinous processes and arches at the level of the shifted and underlying vertebrae. Then a yellow ligament is resected and a microsurgical discectomy between the displaced and the underlying vertebrae is performed. Under the control of an electron-optical converter (EOP), three pairs of Schants screws are inserted at an angle of 30-35 ^o through the legs into the vertebral bodies to the front walls of the vertebrae. On the screws of the Shants, a reponent and fixing system is installed and reposition is performed under the image intensifier tube.

 After fixing, the screws bite off. Then, screws are inserted from two sides into the space between the vertebral bodies, formed after discectomy, through the inter-junctional access (Fig. 1).

The screws are inserted with a smooth surface to the cortical plates (Fig. 2) and rotated 90 ^° (Fig. 3).

 Clinical example.

 Patient G., 15 years old, and / b 10807, was admitted to PNHO GKB N 67 3.07.97. Complaints of pain in the lumbar region, inability to work physically, impaired sensitivity of the type of hyperstension on the back of the thighs in the S 2 - S 3 zone. Sick since 8 years. Constantly turned to the clinic, where he received no practical help. Radiographs of the lumbar spine determine IV-V spondylolisthesis.

 The operation was completed on July 15, 1997. - a skin incision 15 cm long above the line of the spinous processes. The spinous processes and arches are exposed and removed at the level of 3 - 4 - 5 vertebrae.

A microsurgical discectomy was performed between the bodies of 4 to 5 lumbar vertebrae. Then, under the image intensifier tube, three pairs of Shants screws were introduced at an angle of 30-35 ^o through the legs into the bodies of 3 - 4 - 5 lumbar vertebrae.

The Shants screws are equipped with a repair and fixation system and 4 vertebrae are repositioned. Then, through the inter-arterial access of 4 to 5 vertebrae into the space after removal of the disc, the screws from the carbon material are brought with a smooth surface to the cortical plates (Fig. 2) and rotated 90 ^° (Fig. 3).

 Layered seams on the wound leaving drainage. After 12 days, the patient was activated and was discharged for outpatient treatment at the place of residence. After 1.5 months, the patient is able to work, pain in the back and limbs have passed. On the control x-ray after 6 months, fixation is stable in the correct position. No complaints, able-bodied.

 Thus, the use of this method allows the formation of a bone block between the bodies of the displaced and the underlying vertebrae, to achieve reliable fixation of the damaged segment, eliminate pain, reduce the time of vertebral fusion.

Claims (1)

A method of surgical treatment of spondylolisthesis of the lumbar spine, including posterior access to the yellow ligament, its resection, discectomy, reposition of the displaced vertebra, transpedicular fixation with Shants screws, characterized in that the screws are additionally inserted through the inter-arterial access to the space after the discectomy from two sides and the surface is smooth to cortical plates and carry out their rotation by 90 ^o .

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