Treatment of spondylolisthesis


(57) Abstract:

The invention relates to medicine, specifically to orthopedics. Approved for treatment of spondylolisthesis. The purpose of the invention: atraumatic lumbar displaced vertebra with restoration of function and elimination of neurological disorders. The invention consists in the fact that carry out longitudinal distraction of the spine and traction of a displaced vertebra in the back with threaded rods and elastic loops attached to the external fixation device (AVF). The second step after the reduction of the vertebra and removal of neurological disorders simultaneously with the removal of AVP carry back corporates vertebrae.

The invention relates to medicine, namely to orthopedics, and is intended for the treatment of spondylolisthesis.

There is a method of treatment of spondylolisthesis by performing a decompressive laminectomy. However, this surgery has a significant drawback, since an unstable form of spondylolisthesis significantly affects the clinical course of the disease. This has forced surgeons to Supplement the operation posterior spinal fusion. These surgical interventions exacerbate netlet reduction of a displaced vertebra.

Closest to the offer is accepted by us as a prototype method setting in spondylolisthesis, based on the principle of direct pressure on the front body of a displaced vertebra. However, surgical intervention is required allocation anterior or anterior-lateral surface of the body is shifted and located below the vertebrae, resection of the intervertebral disc with closing plates, which is of great technical difficulties for the surgeon and lead to severe complications for the patient due to the closely located to major vessels and nerve plexus.

The essence of the invention is expressed in a set of key characteristics, sufficient to achieve provided by the invention the technical result consists in that the dorsal side through the base of the handles in body shifted, up - and underlying vertebrae enter threaded rods, around the lateral parts of the bows hold loops of elastic tissue, the Foundation of the threaded rods and the ends of the hinge is fixed on the elements of external fixation device, then produce a measured distraction of the spine along its axis and traction of a displaced vertebra posterior to, and after that eliminate the des vertebrae.

The method is based on the fact that when using the proposed external fixation device is created dosed stretching rods (distraction) along the longitudinal axis between the displacement and the underlying vertebra and at the same time in the sagittal plane of the traction rod and loops (traction) of a displaced vertebra posterior. Thus, use "Effect Ilizarov", i.e. when creating measured the tensile stresses occur conditions for purposeful managed recovery and morphogenetic processes in the area of injury.

The physiological way, because when dosed stretching restores metabolic and vascular processes, the conditions for reparative regeneration.

When applying our external fixation device dosed extension of the spine as along the longitudinal axis, and in the sagittal direction is carried out over a sufficiently large bone structure (the roots of the arcs with the bodies of the vertebrae and the lateral surface of the bows), which eliminates the possibility of separation of the spinous processes, the pulling out rods with traction backwards, as when using other external fixation devices that do not contain loops.

The proposed method osushestvljali over the spinous processes in the field of a displaced vertebra and skeletonize the rear sections of the vertebrae on both sides until the Foundation of the roots of the bows. In body shifted, up - and underlying vertebrae through the base of the arms enter the threaded rods, and around the lateral parts of the bows hold loops of elastic thread. Remove the studs and thread through the skin. Impose layered sutures, after which the Foundation of the threaded rods and the ends of the hinge is fixed on the elements of the external fixation device and is created in the stress state. On the second day after the operation start dosed traction of the spine as along the longitudinal axis and the sagittal direction 2-3 times a day and continue this pattern until you obtain a favorable clinicopathologically results. Distraction of the spine with the conservation of the stress state in the system depending on the magnitude of listeth and nature of the clinical-neurological disorders requires from 6 to 10 weeks. These terms are already sufficient for you without fear of relapse slippage of the vertebra to dismantle the apparatus and to carry back the interbody corporates.

Clinical example. Patient K., aged 52, history N 3142, was treated at the research centre of Tatarstan "Restorative traumatology and Orthopaedics" with 23.12.92, 18.02.93, about spondeo radicular syndrome. Complaints about persistent pain in the lumbosacral region with irradiation in the lower limbs, more in the right. Progressive weakness in both legs paresis of the right foot. Difficulty walking, sometimes incontinence during walking. First felt pain in the back in 1989 occurred for no apparent reason. Since that time, the pain almost did not stop, especially amplified when lifting weights. In 1991, the pain began to give in feet, by the end of the year there is a weakness in them. In September 1992, developed paresis of the right foot, it became difficult to walk. Objective: analgesia pose crooked torso to the right. Reinforced lumbar lordosis. Moves independently, but gets tired quickly. Knee reflexes quickened. Ankle reflex on the right is missing. Paresis of the right foot. Gipostesia in the area of innervation of L3-5Koreshkov. When natureway periodic incontinence. On spondyliosoma: body L4vertebrae shifted forward by half of its sagittal size. 9/XII-92, the patient had an operation: after exposure of the posterior structures of the lumbar spine put the rods through the roots of the arcs in the body L3-4-5vertebrae and held tight elastic loops through the side sections of these arms. After uchiwa same fixed ends of the loops, and the system created a stress state. On the second day after the operation began producing metered traction of the spine as along the longitudinal axis and the sagittal direction 2-3 times a day until the occurrence of lung pain in the area of a displaced vertebra. On the background stress state in the system of stretching of the spine lasted for 8 weeks. All this time the patient was served by itself. Range of motion in the lower extremities, increased gradually recovered fully, came regression of neurological symptoms. The control spondyliosoma: offset body L4vertebra halved, greatly expanded intervertebral slit L4-5the vertebrae. 3/II-93, due to the regression of neurological symptoms and pain to the patient, the external fixation device dismantled and carried back interbody corporates plates Roy-Camille. The patient was discharged in good condition. Works in a former post of fireman.

Treatment of spondylolisthesis, including the reduction of a displaced vertebra and its stabilization, characterized in that the dorsal side through the base of the arches in the body shifted up - and underlying vertebrae enter R rods and the ends of the hinge is fixed on the elements of external fixation device, then make dosed the distraction of the spine along its axis and traction of a displaced vertebra posterior to, and after eliminating displacement of the vertebra, the second stage removes the external fixation device, performing one-stage rear corporates vertebrae.


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