RU2496439C1 - Method of treating spondylodiscitis - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to surgery. Method is performed by introduction of puncture needles through roots of vertebra arches into its body to focus of affection. Irrigators are introduced along puncture needles, after which low-invasive extrafocal transpedicular fixation of spine is carried out.

EFFECT: method makes it possible to influence focus of affection and creates supportability of spine.

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Description

The invention relates to medicine, namely to surgery, and can be used to treat spondylodiscitis.

The frequency of purulent nonspecific spinal diseases, according to various authors, has no tendency to decrease [1, 2]. It has been established that spinal osteomyelitis is recorded in 2-16% of osteomyelitis of all localizations [3]. The average period of detection of spondylitis is more than two months, and in 30-40% of patients after the disease, a neurological deficit remains [1, 3, 4]. Despite the use of modern antibacterial drugs, the number of adverse outcomes remains high [2, 3].

It is proved that the main way to treat inflammatory diseases of the spine is surgical. With its help, reorganization of the destruction site in the vertebral bodies is achieved, compression of the spinal cord and roots is eliminated, and spinal support is restored [5]. To stabilize the spine, bone autografts are more often used, when used, however, in 16–40% of cases, complications are observed in the form of resorption, fracture, or nonunion with the mother’s bed [6]. The use of implants is also not without drawbacks - galvanic corrosion and cracking of metal implants, insufficient mechanical strength of ceramic, as well as a high risk of relapse of the inflammatory process, hinder their widespread use [7].

The well-known "Method of anterior combined spinal fusion for inflammatory diseases of the spine" [8], which consists in the reclamation of the spine and the rehabilitation of the focus of infection by resection of a pathologically changed vertebral body. A carbon-carbon implant tightly filled with autobone is introduced into the post-resection defect. The spinal reclination is stopped, while the implant is jammed in the plastic zone, filling it as much as possible.

However, this method is not effective enough, since fixing only the front parts of the spine does not allow to create sufficient supportability, thereby the graft can migrate and relapse of the pathological process, in addition, implantation is carried out during an exacerbation of the inflammatory process, which can also contribute to its relapse.

The prototype of this invention is taken "Method for the treatment of initial and limited destructive forms of spondylitis" [9] consisting in x-ray determination of the lesion and the introduction of a trocar into it from the paravertebral line to the right at an angle of 35-45 ° to the vertebral body. Then, the purulent contents of the focus are sucked out with a syringe through the trocar and the irrigator is introduced, the trocar is removed, and the left irrigator is sutured to the skin. The patient is laid on his stomach and extrafocal fixation of the affected spine by the compression apparatus for the spinous processes, through the irrigator to the focus and intravenous administration of antibiotics, which reduces the likelihood of postoperative complications.

However, this method has the following disadvantages: - holding a trocar and introducing an irrigator in this way threatens the spread of the inflammatory process in the paravertebral space; - with the introduction of one irrigator into the lesion, the probability of a relapse of the pathological process remains due to the difficulty of its rehabilitation, since the bone tissue has a complex cellular structure [10]; - fixation for the spinous processes of the vertebrae does not create sufficient supportability of the spine, which can lead to a relapse of the inflammatory process [11].

To increase the effectiveness of treatment of the inflammatory process due to the intensity of exposure to the lesion and reduce the number of relapses, as well as reduce the time of temporary disability of patients with spondylodiscitis, puncture needles are inserted through the roots of the vertebral arches into the lesion, irrigators are injected using puncture needles, then they perform stabilization of the spine by the method of minimally invasive extra focal transpedicular fixation with subsequent rehabilitation of the pathological focus.

The invention is illustrated in the drawing, where Fig. Shows a diagram of a method for the treatment of spondylodiscitis. The numbers denote: 1 - the root of the vertebral arch; 2 - the body of the affected vertebra; 3 - pathological focus; 4 - irrigators; 5 - extra focal transpedicular fixation of the spine.

The method is as follows. In the operating room under general anesthesia, the patient is placed on the operating table in a position on the abdomen. Under x-ray control, for example, using an electron-optical transducer (EOP), we determine the point of introduction of puncture needles. In the thoracic region, the needle insertion point lies at the intersection of the vertical line passing through the middle of the convex part of each articular process and the horizontal line drawn through the upper third of the transverse process. In the lumbar region, the needle insertion point is at the intersection of the vertical line passing through the junction of the articular processes of the upper and lower vertebrae and the horizontal line passing through the middle of the transverse process. In addition, needles are inserted into the bodies of the thoracic and lumbar vertebrae at a certain angle both in the horizontal and in the sagittal plane. The pedicular angle in the horizontal plane varies from 0 ° to 10 ° in the thoracic region and from 10 ° to 30 ° in the lumbar, and the sagittal angle of administration can vary from 0 ° to 10 ° in the cranial or caudal directions, the angle of administration depends on the location of the pathological focus .

After determining the points of introduction of the puncture needles and the required angles, the needles are passed through the roots of the arches (1) by twisting movements into the vertebral body (2) to the lesion site (3). Irrigators (4) are introduced using puncture needles, after which the spine is stabilized by the minimally invasive extra focal transpedicular fixation (5) and the pathological lesion is rehabilitated.

A method of treating spondylodiscitis is illustrated by the following examples.

Example 1. Patient P., 52 years old, was admitted to the hospital with a diagnosis of Chronic idiopathic spondylitis Lv vertebra. From the anamnesis, it was noted that the growing pain syndrome arose about 6 months ago. Repeatedly sought medical help - courses of conservative antibacterial therapy without effect. In a hospital under endotracheal anesthesia, the patient is laid on the operating table in a position on his stomach. Using the X-ray image intensifier, the injection points of the puncture needles were determined - at the intersection of the vertical line passing through the junction of the articular processes of the upper and lower vertebrae and the horizontal line passing through the middle of the transverse process. The pedicular angle in the horizontal plane is 30 °, the sagittal angle is 10 ° in the cranial direction. The needles were carried out through the roots of the arches by twisting movements into the vertebral body to the lesion site. Irrigators were injected along puncture needles and fixed to the skin, after which stabilization of the spine by minimally invasive extra focal transpedicular fixation and rehabilitation of the pathological focus were performed. Further reorganization was carried out through irrigators for 10 days. After removal of irrigators, the patient was discharged for outpatient treatment in satisfactory condition. After 3 weeks from the time of surgical treatment, I started to work. During the follow-up examination of the patient after 1, 3, 6, 12 months, there were no signs of a relapse of the inflammatory process. On the control computed tomography after 1 year there is a lack of signs of recurrence of the inflammatory process, the formation of fusion.

Example 2. Patient I., 41 years old, was admitted to the hospital with a diagnosis of Chronic idiopathic ThXn spondylitis of the vertebra. From the anamnesis it was noted that the growing pain syndrome arose about four months ago. Anti-inflammatory therapy without effect. In a hospital under endotracheal anesthesia, the patient is laid on the operating table in a position on his stomach. Using the image intensifier tube, the injection points of the puncture needles are determined - at the intersection of the vertical line passing through the middle of the convex part of each articular process and the horizontal line drawn through the upper third of the transverse process. The pedicular angle in the horizontal plane is 10 °, the sagittal angle is 10 ° in the caudal direction. The needles were carried out through the roots of the arches by twisting movements into the vertebral body to the lesion site. Irrigators were injected by puncture needles and fixed to the skin, after which stabilization of the spine by minimally invasive extra focal transpedicular fixation and rehabilitation of the pathological focus were performed. Further reorganization was carried out through irrigators for 9 days. After removal of irrigators, the patient was discharged for outpatient treatment in satisfactory condition. After 20 days from the time of surgical treatment, I started to work. During the follow-up examination of the patient after 1, 3, 6, 12 months, there were no signs of a relapse of the inflammatory process. On the control computed tomography after 1 year there is a lack of signs of recurrence of the inflammatory process, the formation of fusion.

The proposed method is used in the treatment of 10 patients with spon-dilodiscitis of the spine. When using the proposed method for the treatment of complications, it was not noted, in all cases a good clinical result was obtained - the pain syndrome was completely stopped and a stable remission of the inflammatory process was achieved (no relapse within 1 year).

Thus, the proposed method for the treatment of spondylodiscitis is effective and can significantly reduce the time period of temporary disability of patients.

Information sources

1. Fadeev B.P. Diagnosis and treatment of purulent spinal epiduritis / B.P. Fadeev, I.Sh. Karabaev. - SPb., 2004.

2. Deardre C. Spinal epidural abscess: A Diagnostic Challenge / C. Deardre // Am. Fam. Phisician. 2002. Vol. 65. P.1341-1346.

3. McHenry M.C. Vertebral osteomyelitis: long-term outcome for 253 patients from 7 Cleveland-area hospitals / M.C. McHenry, K.A. Easley, G.A. Locker // Clin. Infect. Dis. 2002. Vol. 34. P.1342-1350.

4. Tikhodeev S.A. Nonspecific osteomyelitis of the spine / S.A. Tikhodeev, A.A. Vishnevsky. - SPb., 2004.

5. The immediate results of the treatment of purulent nonspecific diseases of the spine / M.Yu. Goncharov and [other] // Surgery of the spine. - 2005. - No. 2. - S. 70-72.

6. Long-term results of bone grafting in patients with tuberculous spondylitis / D.V. Kuklin and [other] // 7 All-Russian. Congr. "Man and his health." - SPb., 2002. - S.184-185.

7. Belyakov M.V. The use of carbon - carbon implants for anterior spinal fusion for inflammatory diseases of the spine: Abstract. diss. (Candidate of Medical Sciences. - SPB. 2006, - 12 p.

8. RF patent No. 2364362, IPC A61B 17/56. The method of anterior combined fusion for inflammatory diseases of the spine / applicant and patentee GOU VPO Amur State Medical Academy. No. 20088112621/14, declared 04/01/2008, publ. 08/20/2009, bull. Number 23. - 6 p.

9. RF patent No. 2195890, IPC A61B 17/56. A method for the treatment of initial and limited destructive forms of spondylitis / applicant and patent holder of the Research Institute of Phthisiopulmonology. No. 200103677/14, claimed 02.17.2000, publ. 01/10/2003.

10. Traumatology: national leadership / ed. G.P. Kotelnikova, S.P. Mironova. - M .: GEOTAR-Media, 2011 .-- 1104 p.

11. Slynko E.I. The use of computer optimization of points and angles of insertion of screws in the transpedicular system of stabilization of the spine / E.I. Slynko // Ukrainian journal of minimally invasive and endoscopic surgery. - 2000. - No. 4. - S.24-28.

12. Manukovsky V.A. Puncture percutaneous vertebroplasty in the treatment of pathology of the spine: a training manual / V.A. Manukovsky. St. Petersburg: Borey Art, 2007 .-- 59 p.

Claims (1)

A method for the treatment of spondylodiscitis, including the introduction of an irrigator and sanitation of the lesion of the vertebra, minimally invasive extra-focal fixation of the spine, characterized in that the introduction of irrigators is carried out through needles held in the vertebral body from both sides through the roots of its arches, and in the thoracic region, the needle injection point lies at the intersection of the vertical a line passing through the middle of the convex part of each articular process, and a horizontal line passing through the upper third of the transverse process, in the lumbar the needle is located at the intersection of the vertical line passing through the junction of the articular processes of the upper and lower vertebrae and the horizontal line passing through the middle of the transverse process, the pedicular angle of needle injection in the horizontal plane varies from 0 to 10 ° in the thoracic region and from 10 to 30 ° in the lumbar, and the sagittal angle of administration varies from 0 to 10 ° in the cranial or caudal direction, stabilization of the spine is carried out by the method of extra focal transpedicular fixation.

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