Method of prosthetics of intervertebral disc nucleus pulposus

FIELD: medicine.

SUBSTANCE: ablation of nucleus pulposus and sequestrectomy are carried out; implant is introduced into enucleated disc. As implant applied is nitinol thread, folded in form of spherical ball, diameter of which is 4-6 mm larger than height of disc cavity. Preliminarily cooled implant is pressed, and after its placement into disc, work spherical shape is given by heating to 40-45°C.

EFFECT: method makes it possible to reduce complications, which is reached due to elasticity of nitinol, providing protection of over- and underlying vertebrae from increased load from implant, with nitinol shape-memory effect ensuring support of given shape of intervertebral disc.

1 ex

 

The invention relates to medicine, namely to neurosurgery, and can be used for prosthetics of nucleus pulposus of intervertebral disc degenerative-dystrophic diseases of the spine in all its departments.

The known method of prosthetics of nucleus pulposus of intervertebral disk hydrogel predetermined shape Hydraflex (James J. YUE, Rudolph Bertagnoil, Paul C. McAfee, Howard S. AN, "Motion Preseveration Surgery of the Spine: Advanced Techniques and Contrversies" 2008. Chapter 52, 407-410). The disadvantage of this method: when the hydration of the implant, after prolonged pressure maintaining range of motion and height of the vertebral-motor segment is provided in part (Zelenkov V. P. Functional reconstruction of the intervertebral disc in the surgical treatment of discogenic lumbodynia. Abstract. Moscow - 2010 page 13).

The known method of prosthetics of nucleus pulposus of intervertebral disk injectable silicone with fixings PNR (James J. YUE, Rudolph Bertagnoil, Paul C. McAfee, Howard S. AN, "Motion Preseveration Surgery of the Spine: Advanced Techniques and Contrversies" 2008. Chapter 57, 435-441). From transsacral access perform a partial discectomy, and then make the installation of clamps, and then using a special needle with silicone fill located in denuclearising of the disc implant. The disadvantages of this method: it is applicable for the prosthesis at the level of LV-SI, LIV-LV; requires the use of specially designed tool�Riya.

A method of intervertebral disc prosthesis with metal of Nickel-titanium in the form of a spiral (shelyakin S. Y. Percutaneous discectomy in the complex treatment of patients with discogenic lumbosacral radiculitis. Dissertation. St. Petersburg, 1996, p. 62). Through the working cannula located in the space in the cavity formed after partial removal of nucleus pulposus, enter snap ring from titanium nickelide. The disadvantage of the method: the use of only the lumbar spine.

The closest to the claimed is a method of prosthetics of nucleus pulposus of the intervertebral disc (James J. YUE, Rudolph Bertagnoil, Paul C. McAfee, Howard S. AN, "Motion Preseveration Surgery of the Spine: Advanced Techniques and Contrversies" 2008. Chapter 59, 452-461), adopted as a prototype. To of nucleus pulposus prosthesis use sphere of cobalt, chromium, molybdenum or PEEK (polyetheretherketone). Posterior perform hemilaminectomy, flavoconia, after mobilizatsii dural SAC and root produce dissection longitudinal ligament and the annulus fibrosus, make a removal of nucleus pulposus. The increase in the interbody space or provide a temporary distractor, or giving the patient a kyphotic position. Next, a set of known fields carry selection of the desired diameter sphere. Using cure�TCI predetermined diameter to produce the final preparation denuclearising part of the disk, in this space is placed a spherical implant.

The disadvantages of the prototype: the scope is limited to the levels LIII-SI; application of the method is contraindicated in osteoporosis and chronic administration of steroids because of the risk of fracture of the vertebral end plate; trauma due to additional intraoperative distraction level for the vertebral-motor segment.

The invention is directed to a method of prosthetics of nucleus pulposus of intervertebral disk, allowing the prosthesis in any of the vertebrae, even in the face osteoporotics modified vertebrae, to reduce intraoperative trauma.

Said technical result of the invention is achieved in that in the known method of prosthetics of nucleus pulposus of intervertebral disk, comprising the removal of nucleus pulposus, sequestrectomy and introduction to denuclearising disc implant, the peculiarity lies in the fact that fix the implant from nitinol strands, folded in the form of a spherical ball whose diameter 4-6 mm greater than the height of the disc cavity, the implant is pre-cooled compress, and after installation give working a spherical shape by heating to 40-45°C.

The method is as follows. Access damage�nomu spinal motion segment at a predetermined level. Produce dicotomia, removal of nucleus pulposus of intervertebral disk, sequestrectomy. In Limbe endplates above and underlying vertebrae in the projection of the remote pulpous nucleus, under the control TUBE, a curette prepare dome-shaped grooves to prevent migration of the installed implant. Measure the height of the cavity formed after removal of nucleus pulposus. To of nucleus pulposus prosthesis using the implant from nitinol filament having a diameter of 0.3-0.4 mm, folded in the form of a spherical ball. The spherical diameter of the implant is selected according to the height of the cavity, increasing by 4-6 mm. It is necessary to continue to provide such a height of the intervertebral disc, in which the bony part of the vertebral bodies will not touch that prevents the formation of a bone block in a given spinal motion segment. Spherical implant is cooled in sterile saline solution with a temperature of +5°...0°C, after which deform (compress) with the clamps so as to reduce the diameter to fit the defect in the fibrous ring, and place it in denuclearising disk. After that, spherical implant, installed between the vertebral bodies, water heated to +40°...+45°C saline solution, under the action of which he restore�infuses working spherical shape. The layers are sutured the wound. Over time around the implant is formed of connective tissue scar ("false joint") that provides sufficient mobility in a given spinal motion segment.

The claimed method was developed and clinically tested in the Polenov research neurosurgical Institute them. Prof. A. L. Polenov on the basis of City hospital №3 in the treatment of 3 patients with degenerative disease of the spine.

Here is an example, an extract from the medical history.

Patient S., 45 years, IB No. 19335. Diagnosis: Dorsopathy. Common degenerative disc disease of the cervical spine. Acquired stenosis of the spinal canal at the level of the cervical spine. Hernia MTD CV-CVI; CVI-CVII with compression of the anterior chamber and the spinal cord and nerve roots C5, C6, C7 from both parties at these levels, compression-ischemic cervical myeloradiculopathy.

Surgery performed: Anterior decompression of the spinal cord at the level of PDS CV-CVI: CVI-CVII. Remove disks CV-CVI and CVI-CVII and marginal bone growths at these levels. Installation of spherical implant nitinol filament instead of the remote disk, CV-CVI and CVI-CVII. The height of the cavity after removal of nucleus pulposus was 8-9 mm, were set spherical implants with a diameter of 12 mm. In the postoperative period, there was regression of pain and radicular syndromes.

The use of the claimed �of p allows the prosthetic nucleus pulpous of the intervertebral disc in all parts of the spine, does not require additional intraoperative distraction that is less traumatic surgery. The superelasticity of the nitinol causes protection upstream and downstream of the vertebrae from the increased load on the vertebral end plate from the side of the implant, which is particularly important in the context of osteoporotics modified bone, and the shape memory effect maintains the predetermined height of the intervertebral disc.

The method of prosthetics of nucleus pulposus of intervertebral disk, comprising the removal of nucleus pulposus, sequestrectomy and introduction to denuclearising disc implant, characterized in that set the implant from nitinol strands, folded in the form of a spherical ball whose diameter 4-6 mm greater than the height of the disc cavity, the implant is pre-cooled compress, and after installation give working a spherical shape by heating to 40-45°C.



 

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