The method of stabilization of the rolling of the spinal segment during surgical correction of spondylolisthesis

 

(57) Abstract:

The invention relates to medicine, namely to traumatology and orthopedics at the fixation of the vertebra that has shifted in the spondylolisthesis. The invention consists in creating a reliable fusion L5-S1by introducing the screw thread on the working surface through the articular process and the legs of the bows of the first sacral vertebra in the body of the fifth lumbar vertebra and the area of the remote drive L5-S1in irenecaramella direction with an angle of convergence of the 30oand orientation in the sagittal plane toward poradneorgany corner of the body of the fifth lumbar vertebra and the correction of anterior displacement of the fifth lumbar vertebra is performed by tightening the screws, providing compression autograft in Meteleva space L5-S1to achieve fusion, which ensures the rigidity of fixation. 2 Il.

The invention relates to medicine, namely to traumatology and orthopedics, and can be used for fixation of the vertebra that has shifted in the spondylolisthesis.

Patients with spondylolisthesis treated quickly, locking the affected segment pozvonocnika Orthopaedics and traumatology. Sofia, 1961. - S. 775 and 776; Movshovich I. A. Operative Orthopaedics. - Moscow, 1983. - S. 331-339). The main disadvantages of these operations are difficult to achieve intervertebral frets technically difficult and dangerous front-line access, additional trauma to tissues associated with taking a bone graft from the iliac wing bone or ridge of the tibia, the need for long-term compliance with bed rest after surgery.

There is a method of fixing vertebrae with metal plates located on the back surface of the spine and fastened with screws, held transpedicular above and below the area of injury (müller M. E. , Allgower A., Schneider R., Villinger H. Manual of internal fixation. - Ad Marginem, Moscow, 1996. -S. 670-673).

This method is used as a prototype, because it has common features with claimed: create a back fusion by the implantation of the metal, the introduction of locking elements in the projection of the base of the pedicles of the vertebra, the early activation of the patient in the postoperative period.

The disadvantages of the prototype - the greater invasiveness of the surgery associated with massivestars. In addition, the high cost of the set of latches limits the applicability of the prototype operations in large parts of the population.

The aim of the invention is to reduce the morbidity of surgery performed, the removal of a forward displacement of the vertebral body, improving the reliability of fixing of rolling vertebral segment, reducing the cost of treatment.

The invention consists in the execution of the rear access laminectomy fifth lumbar vertebra (with subsequent use of bone fragments arc and articular processes as autograft bone gravel), removing substances disk L5-S1with the replacement of the defect with bone gravel, fixing rolling vertebral segment L5-S1by conducting two spongy titanium nepomereshilosj screws into the body of the fifth lumbar vertebra through the articular processes of the S1and the disk L5-S1in irenecaramella direction with an angle of convergence 30oand orientation in the sagittal plane toward poradneorgany corner of the body L5vertebra.

The method is as follows (Fig. 1 and 2).

Patient is placed the lumbar lordosis. Area L5-S1come over interpretace part of the orthopaedic operating table and under the control of the electro-optical Converter (EOC) set of radiopaque targets (long needles). The skin incision is carried through the midline lumbosacral region from the spinous process of L4to S2. Layers cut through the fascia of the muscles of the lower section of the back, sharp and blunt skeletonize spinous process, the rim, the upper and lower articular processes of the fifth lumbar vertebra. Make laminectomy, remote bone save as autograft. Carry out a revision of the dural SAC, spinal roots. Posterior longitudinal ligament cut transversely, allocate the fibrous ring of the disc L5-S1. The last is removed. Under the control of the image intensifier reach the anterior longitudinal ligament, without destroying the bone block (if it exists) between the front surfaces of the vertebral bodies L5-S1. The space between the fifth lumbar and first sacral vertebrae are filled with fragments of autocast. Manipulating the operating table, under image intensifier control, correct the amount of lumbar lordosis and the displacement of the fifth lumbar vertebra. With POM who's nepomereshilosj titanium screw. They pass through the articular process and the legs of the shackle S1vertebrae interbody space with the laid autograft, perforare lower closing plate L5later in the body of the vertebra to its front surface. The screws enter in irenecaramella direction with a convergence angle of 25-30 degrees. Tightening the screws causes compression of the interbody space, filled with autograft and the most possible to eliminate the anterior displacement of a vertebra L5. The wound is sutured in layers, leaving paravertebral vacuum drains. The patient raised on the third day after the intervention. In the next three months recommend wearing removable plastic corset. In connection with the biological inertness of titanium alloy, the locking screws in the future, do not remove.

Clinical example. Patient C-Aya, born in 1960, he enrolled in the Samara regional clinical hospital. Kalinin 31.01.2000 years with the diagnosis of Spondylolisthesis L5vertebra, vertebral radicular pain syndrome".

After the examination and detail of the existing character of the disease the patient operation was performed on the proposed method. The POI. No complaints, neurological disorders are not identified. The control x-ray signs of emerging bone ankylosis between the fifth lumbar and first sacral vertebrae, the progression of spondylolisthesis no.

The claimed method operated 7 patients, positive results.

The low-impact way, technically not complicated and can be recommended in medical practice for the surgical treatment of patients with spondylolisthesis.

The method of stabilization of the rolling of the spinal segment during surgical correction of spondylolisthesis, including rear internal transpedicular fixation of the fifth lumbar vertebrae after removal of the intervertebral disc and bone autoplasty, characterized in that hold the screw thread on the working surface through the articular process and the legs of the bows of the first sacral vertebra in the body of the fifth lumbar vertebra and the area of the remote drive L5-S1in irenecaramella direction with an angle of convergence of the 30oand orientation in the sagittal plane toward poradneorgany corner of the body of the fifth lumbar vertebra, perform correction of a forward bias fifth pojasnitj the e L5-S1to achieve spinal fusion.

 

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