RU2624675C1 - Method for tethered spinal cord syndrome correction during repeated surgical intervention - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: cut of skin and soft tissues in the Th10 vertebra projection is made, arches and Th10 spinous process are skeletonized. Laminotomy is performed unilaterally. The dura mater is opened, the lower paired dentate ligaments are dissected. After that, the dura mater is sutured, the arches and spinous process are fixed, the wound is sutured layer-by-layer.

EFFECT: method allows to reduce intraoperative complications and postoperative neurological deficit, which is achieved due to additional skeletonization of the arch and process of the Th10 vertebra.

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Description

Technical field

The invention relates to medicine, namely to neurosurgery, and can be used in the surgery of spinal dysraphia, in particular the surgical treatment of secondary fixed spinal cord syndrome.

State of the art

The closest method (prototype) is the method of surgical treatment of fixed spinal cord syndrome with secondary fixation of the spinal cord, described in RF patent No. 2574715, publ. 02/10/2016.

The known method consists in the correction (treatment) of the fixed spinal cord syndrome. At the same time, a laminectomy is performed from the posterior median access to a level above and below the level of fixation. A longitudinal dissection of the dura mater (TMT) is performed. The areas of TMT soldered to the roots of the spinal cord are excised along the roots in the direction from the level of fixation of the root to the TMO to the level of entry of the roots into the radicular sheaths of the TMO. An expanding plasty of the dura mater is performed with a xenograft, which is fixed along the edges of the laminectomy defect.

The disadvantage of this method is the risk of damage to the roots of the spinal cord, the need for repeated refixing operations.

The result of the proposed method is to eliminate the tension of the caudal parts of the spinal cord with its inelastic structure, which contributes to the stabilization and regression of neurological deficit. In addition, the result is a decrease in the risk of damage to the caudal spinal cord during its release (during surgical treatment of spinal dysraphia).

The specified technical result is achieved due to the fact that in the method of correction of fixed spinal cord syndrome during repeated surgery, in which the skin and soft tissues are cut in the projection of the Th10 vertebra, the arches and spinous process Th10 are skeletonized, single-level laminomy is performed, the dura mater is opened, the lowest paired dentate ligaments are dissected, the dura mater is sutured, the arches and spinous process are fixed, the wound is sutured in layers.

Method Disclosure

In an adult, the location of the spinal cone normally varies, correlating with body length. It can be located at the level of the lower third of the 12th thoracic vertebra Th12 or at the level of the disk between the 2 and 3 lumbar vertebrae L2 and L3. At birth, it is usually located between the bodies of the 3 and 4 lumbar vertebrae L3 and L4, and then it moves up (Voronov V.G. Fixed Spinal Cord Syndrome. URL: http://www.neuro.neva.ru/RNOnline_22/Russian /Issues/Articles_1_2002/spb/14.htm, accessed: 04/01/2016).

Fixed spinal cord syndrome is a progressive increase in neurological deficit due to the tension of its caudal sections with an inelastic structure.

Other names for this pathology of the spinal cord are terminal filament tension syndrome, fixed (tense) spinal cord syndrome (FSM), thickened terminal filament syndrome.

It should be noted that spinal cord stretch does not spread above the level of the twelfth myelomer (attachment of the lowest dentate ligaments).

Secondary spinal cord fixation syndrome (SVFS) is characterized by progressive neurological deficiency, pelvic organ dysfunction, bone-articular deformity of the lower extremities due to the fixation of the distal spinal cord, cauda equina and terminal filament after surgery for spinal dysraphia (myelomenegocele, lipeloma) , myeloradiculocele, myelocystocele, etc.), SVFS develops in 10-75% of children after correction of spinal hernias. Surgical treatment of SVFS is the only method to improve or stabilize neurological deficits in patients with increasing dysfunction of the caudal spinal cord. After correction of spinal hernias, every third child needs to undergo a “spinal cord release” operation due to the development of SVFS. This situation is caused by the difficulty in closing the dura mater defect around the neural placode. An operation aimed at eliminating spinal cord fixation is the only method that can improve or stabilize neurological deficit in patients with fixed spinal cord syndrome (Kushel Yu.V., Zemlyansky M.Yu. Secondary fixation of the spinal cord after correction of various forms of spinal dysraphism in children. URL: http://therjn.com/ru-ru/Files/Pdf/2010/2/41.pdf, accessed: 04/01/2016).

In other words, secondary fixed spinal cord syndrome develops in patients after removal of spinal dysraphia. In some cases, repeated multiple repair surgery is performed.

The implementation of the method

The method is implemented as follows. An incision is made of the skin and soft tissues in the projection of the Th10 vertebra. The arches and spinous process of Th10 are skeletonized. Carry out a single-level laminomy. Dissect the dura mater. Under the control of a microscope and with the help of microsurgical instruments, serrated ligaments are cut from two sides. The dura mater is hermetically sutured. The temples and spinous process are fixed. The wound is sutured in layers.

Thus, performing the surgery as described above eliminates spinal cord tension and ensures stabilization and regression of neurological deficit.

Claims (1)

A method for the correction of fixed spinal cord syndrome with repeated surgery, in which an incision is made in the skin and soft tissues in the Th10 projection of the vertebra, the arches and spinous process Th10 are skeletonized, a single-level laminomy is performed, the dura mater is opened, the lowermost dentate ligaments are dissected, and the dura mater is sutured sheath, the arches and spinous process are fixed, the wound is sutured in layers.