Method for preventing cicatricial commissure process development in epidural space after having removed intervertebral disk hernia at the lumbar level

FIELD: medicine.

SUBSTANCE: method involves carrying out hernia removal in intralaminar way. Posterior longitudinal ligament defect is covered with Tacho-Comb plate after having done disk cavity curettage. Subcutaneous fat fragment on feeding pedicle is brought to dorsal surface of radix and dural sac.

EFFECT: enhanced effectiveness of treatment; reduced risk of traumatic complications.

1 dwg

 

The invention relates to medicine, neurosurgery, section of surgery of the intervertebral discs of the lumbar spine.

The recurrence of radicular pain syndrome after removal of herniated intervertebral discs of the lumbar spine according to different authors ranges from 6% to 15% (R.Davis 1994, R.Hoffab t.l., 1993 Label A.T. 1992) operated patients. Of these, 2/3 of patients with radicular pain occur due to scarring, adhesions in the area of the operation.

To prevent the development of scar adhesions in the epidural space with a variety of ways. Such as:

- Meticulous hemostasis during surgery, without the introduction of muscle flaps in the spinal canal (Basumatary, Aigarius. Postoperative recurrence of neurological syndromes of lumbar osteochondrosis and their

surgical treatment // Questions of neurosurgery, No. 6, Moscow, 1983, 30-33 C.).

It should be noted that a careful hemostasis at the end of the operation does not exclude the possible leakage of blood into the epidural space in the early postoperative period.

Active drainage of the wound (Lebedev, A.S. long-term results of surgical treatment of hernias lumbar intervertebral disks and improvements: abstract of thesis. Kida. the honey. Of Sciences, St. Petersburg, 2002, 10 seconds).

Usually, the drainage of stave is by skeletron arches and spinous processes of vertebrae and drains blood, accumulated on the dorsal part of the dural SAC and nerve root. And on the ventral part of the root and dural SAC, the blood continues to accumulate.

- Introduction into the epidural space of solutions steroidal anti-inflammatory drugs (Musikhin NR. Clinic, diagnostics and treatment of discogenic lumbosacral epiduritom: Dis. Kida. the honey. Sciences. - L., 1978 - 11 S.).

Steroid anti-inflammatory drugs affect developed scar adhesions, however, do not prevent its development.

Plastic interlaminar period with intermuscular fat (Lebedev, A.S. long-term results of surgical treatment of hernias of intervertebral disks and ways of their improvement. Abstract of thesis. Kida. the honey. Sciences. - SPb, 2002, 10 seconds).

Here it should be noted that intermuscular fat as such does not exist (Sinelnikov RD Atlas of human anatomy, - M, 1963, Vol. 1).

However, the weight of scar adhesions among the causes of recurrence of radicular pain syndrome continues to be a high of 50% (Cold S.A. Microsurgical treatment of multilevel discogenic lesion of the lumbar spine Questions neurosurgery, No. 3, Moscow, 2001, p.9).

The prototype of the presented invention is a method (Cold S.A. Microsurgical treatment of multilevel discogenic affected the th lumbar

spine Questions neurosurgery, No. 3, Moscow, 2001, pp. 7-9), where for the protection of the root and dural SAC from the development of scar adhesions used microparameter of porous silicone that is a tube with a thin elastic walls, which is installed on the spine. And to protect dural structures used spinal membrane.

Disadvantages of the proposed method in our opinion is the following:

- No impact on the causes of scarring, adhesions (the blood flowing from the cavity remote intervertebral disc and epidural veins). Blood is available, turns into a scar, and there pronounced scar-adhesive changes.

- Dorsal part of the root and dural SAC remain without protection from possible leakage of blood from the muscles, and therefore remain without protection from the appearance of the scar adhesions.

- Select the diameter and length of Microlaboratory causes certain difficulties. If its diameter is greater than the diameter of the root, then the blood can leak to the spine and to be in the space between the spine and micronanoelectron. If the diameter of the tread is less than the diameter of the spine, it can develop ridiculosity. As for the length of the tread, a small length of leaves part of the spine without the protection against the development of scar adhesions, long may cause tension and ischemia of the spine or bedsore on the dural SAC at the place of discharge from his spine.

The invention is aimed at preventing the development of scar adhesions in the area held discectomy for lumbar level.

The method provides effective hemostasis (stopping bleeding from the cavity of the remote drive and from the epidural veins), bonding posterior longitudinal ligament, reliable closing and sealing the cavity remote disk, thus we protect the ventral part of the dural SAC and nerve root from the development of scarring. And we seek to protect the dorsal part of the root and dural SAC from the development of scar adhesions by plastics interlaminar period.

To achieve the above, we used a plate Tahoe komba. Tahoe Comb registered with the Ministry of health of the Russian Federation, approved by the Chairman of the section of the scientific Council of the Ministry of health of Russia in General surgery, academician of the Russian Academy of medical Sciences Wedforum. Protocol №1 dated 12.10.2000, Tahoe Comb is absorbent collagen plate, covered with a layer components of fibrin glue, which is applied adhesive surface on the defect of the posterior longitudinal ligament, which is produced through diskectomy, thereby the contact of the spine and dural the CSOs bag with Tahoe-Combom and not with blood, thus we protect the ventral part of the nerve root and dural SAC from the development of scar adhesions. And to protect root and dural SAC dorsally much farther we produce plastic interlaminar gap by imposing on the root and dural bag fragment of the subcutaneous fat on the supply leg and bring to magdoskova period.

The claimed method differs from the prototype in that:

- Provides reliable protection of the ventral part of the dural SAC and nerve root from the development of scar adhesions, which develops as a result of leakage of blood into the epidural space of the cavity remote drive and from the epidural veins.

Real protection of the dorsal part of the root and dural SAC from blood, which can act on the nerve root and dural SAC of muscle, by closing interlaminar period by using a fragment of the subcutaneous fat on the supply leg.

After the curettage of the cavity of the disk is taken a piece of plate Tahoe komba, superimposed adhesive (yellow) from the surface defect of the posterior longitudinal ligament. Thereby we achieve sealing holes in the posterior longitudinal ligament, reliable closing and sealing the cavity remote intervertebral disc and stop the bleeding from the epidural veins.

The advantages of the Tahoe komba I have are:

- easily trimmed with scissors to the desired size and shape;

- closes and seals the surface of the wound;

is not washed off by blood or saline solution:

- well absorbs on the surface of the fabric.

For plastics interlaminar period is a fragment of the subcutaneous fat on the supply leg, which is held to magdoskova period. This we protect the dorsal part of the root and dural SAC from possible leakage of blood from the muscles.

This ensures reliable prevention of the development of scar adhesions in the epidural space (on the ventral and dorsal surfaces of the dural SAC and nerve root) in the postoperative period.

The invention is illustrated by the drawing, which shows a scheme of the method.

After the curettage of the cavity of an intervertebral disc is cut plate Tahoe-komba (1), which exceed the defect of the posterior longitudinal ligament, through which is produced by curettage, and overlaps the defect (2), for which the root and dural bag (3 and 4) are shifted medially, and then after applying plate Tahoe komba back into place.

- Scissors cut the area of subcutaneous fat (5) of the feed leg and is held to the dorsal surface of the root and dural SAC (3 and 4)./p>

Here is an example extract from a case history No. 3746. Patient, 38 years of age, was treated at LRCH on NHO with 25.02.02, 16.03.02,

Diagnosis: herniated disc L5/L6.

The herniated disc was verified by MRI.

Complaints of pain in the lumbar spine with irradiation in the right lower extremity, and in the right groin area.

From the anamnesis: sick for 10 years, last 2 years the pain narastanie in intensity and began to irrationality in right leg and right groin area.

Objective: the restriction of movement in his right leg because of the pain. Achilov reflex D<S, hypesthesia in the S1 dermatome on the right. Vertebral syndrome: right-sided scoliosis 2 tbsp., block

movements of the spine ago. The symptom of Lasaga position. to the right at an angle of 45.

06.03.02, the patient underwent surgery transparentsea (interlaminar) removal of herniated disc L5/L6 to the right. After performing curettage of the cavity of the disc in order to prevent the development of scar-adhesive process on the defect of the posterior longitudinal ligament stacked plate Tahoe komba 1.5×3 see And on the dorsal surface of the root and dural SAC stacked plot of the subcutaneous fat on the supply leg held up magdoskova period.

After 10 months after the operation the patient underwent MRI scan, data for scar adhesions is not received. The patient in overvoltage condition, pain doesn't bother sensitive disorders no, the symptoms of tension is negative, regression vertebral syndrome.

The way to prevent the development of scar adhesions in the epidural space after removal of herniated intervertebral discs in the lumbar level, including intralaminar hernia repair, characterized in that after curettage of the cavity of the disk defect posterior longitudinal ligament impose a plate Tahoe komba, and on the dorsal surface of the root and dural SAC down a fragment of the subcutaneous fat on the supply leg.



 

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