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Appliance for percutaneous insertion of connection of pedicle screws has two arms of equal length with transverse connection, circular arm and circular support,

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Publication number
DE10027988A1
DE10027988A1 DE2000127988 DE10027988A DE10027988A1 DE 10027988 A1 DE10027988 A1 DE 10027988A1 DE 2000127988 DE2000127988 DE 2000127988 DE 10027988 A DE10027988 A DE 10027988A DE 10027988 A1 DE10027988 A1 DE 10027988A1
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circular
connection
support
percutaneous
lengthwise
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DE2000127988
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DE10027988C2 (en )
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Arkadiusz Kosmala
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Arkadiusz Kosmala
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    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/88Osteosynthesis instruments; Methods or means for implanting or extracting internal or external fixation devices
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/68Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/70Spinal positioners or stabilisers ; Bone stabilisers comprising fluid filler in an implant
    • A61B17/7074Tools specially adapted for spinal fixation operations other than for bone removal or filler handling
    • A61B17/7083Tools for guidance or insertion of tethers, rod-to-anchor connectors, rod-to-rod connectors, or longitudinal elements
    • A61B17/7089Tools for guidance or insertion of tethers, rod-to-anchor connectors, rod-to-rod connectors, or longitudinal elements wherein insertion is along an arcuate path
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/00234Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/68Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/70Spinal positioners or stabilisers ; Bone stabilisers comprising fluid filler in an implant
    • A61B17/7001Screws or hooks combined with longitudinal elements which do not contact vertebrae
    • A61B17/7002Longitudinal elements, e.g. rods
    • A61B17/7011Longitudinal element being non-straight, e.g. curved, angled or branched
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/68Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/70Spinal positioners or stabilisers ; Bone stabilisers comprising fluid filler in an implant
    • A61B17/7001Screws or hooks combined with longitudinal elements which do not contact vertebrae
    • A61B17/7035Screws or hooks, wherein a rod-clamping part and a bone-anchoring part can pivot relative to each other

Abstract

The equilateral triangle is located in a circle with a shared center point. These geometric principles determine the stereotactically guided percutaneous implantation of the lengthwise support connecting the polyaxial pedicle screws without the necessity of prolonged exposure of the spine during an operation. The appliance consists of two arms of equal length with a cross-connection on a plane on which swivels a circular arm of freely selected radius and holding the circular lengthwise support.

Description

Der aktuelle Stand der Technik The current state of the art

Die offene transpedikuläre Instrumentierung der Wirbelsäule ist eine bereits seit Jahrzehnten etablierte Operationsmethode (2-19, 21-28, 32, 34-37, 40-41, 44-47, 49- 55, 57-60). The open transpedicular instrumentation of the spine is an established method of operation for decades (2-19, 21-28, 32, 34-37, 40-41, 44-47, 49- 55, 57-60). Die rasche Entwicklung der wirbelsäulenspezifischen Operationstechnik, der Zugangswege sowie die in den letzten Jahren geradezu explosionsartig gestiegene Zahl der Implantate machen es zwingend erforderlich, auch nach neuen Ideen zu suchen. The rapid development of the spine specific surgical technique, the access roads and the almost explosively increased in recent years number of implants make it imperative to also search for new ideas. Die von allen Seiten geförderte chirurgische minimalinvasive Behandlungsphilosophie wird es in der Zukunft verbieten, die häufig nur zur Unterstützung der endgültigen ventralen Instrumentation durchgeführte dorsale Stabilisierung im Sinne einer dorsalen Zuggurtung mittels der herkömmlichen Muskel- und Bandapparat zerstörenden Zugangsweise durchzuführen. Promoted by all sides surgical minimally invasive treatment philosophy will ban it in the future to carry out the frequently performed as a support for the final ventral instrumentation posterior stabilization in terms of a dorsal tension band by the conventional muscle and ligaments destructive access way. Während die die Bauchmuskulatur schonenden allgemeinchirurgischen endoskopischen Zugänge bereits auf breite Zustimmung gestoßen sind und mit großem Können durchgeführt werden, wurden noch keine etablierten Methoden beschrieben, die eine komplette perkutane Implantation der Pedikelschrauben und der Längsträger standardisieren und optimal ermöglichen. While the abdominal muscles gently general surgical endoscopic approaches are broadly supported and carried out with great skill, no established methods have been described yet that standardize a complete percutaneous implantation of the pedicle screws and the longitudinal support and enable optimal. Die perkutane Schraubenplazierung ist dagegen seit der Einführung 1984 (1, 20, 29, 30-31, 33 38-39, 42-44, 48, 56) eine anerkannte Methode, die jedoch per definitionem eine externe Verbindung der perkutan implantierten Schrauben zum Ziel hat. Percutaneous screw placement, however, is 1984 since the introduction (1, 20, 29, 30-31, 33 38-39, 42-44, 48, 56) a recognized method, but by definition, an external connection of the percutaneously implanted screws goal Has. Sie hatte längst den Eingang in den klinischen Alltag gefunden, konnte sich dennoch nicht weit verbreiten, da sich die Handhabung der extrakorporalen Montage als recht problematisch erwiesen hat. She had long since found their way into clinical practice, yet could not spread far because the handling of extracorporeal assembly has proven to be quite problematic. Die Befürworter dieser Technik hatten allerdings diverse Verfahren entwickelt, die eine anatomisch belegbare und standardisiert sichere Plazierung der Pedikelschrauben ermöglichen (29-30, 39, 43-44, 48, 56). Proponents of this technology, however, had developed various methods that allow an anatomically verifiable and standardized safe placement of pedicle screws (29-30, 39, 43-44, 48, 56). Die Fehlplazierungsrate wurde dadurch minimalisiert und gleicht einer offenen Schraubenimplantation. The misplacement rate was minimized and thus resembles an open coil implantation.

Bei der bereits seit mehreren Jahren beschriebenen Methodik der perkutanen Schraubenimplantation war es bis dato offensichtlich nicht möglich, die Schraubenköpfe im gleichen (perkutanen) Arbeitsgang mit den Stäben zu verbinden. In the described methodology for several years percutaneous screw insertion, it was so far obviously not possible to connect the screw heads in the same (percutaneous) operation with the bars. Erst eine rein perkutane vollständige Wirbelsäuleninstrumentation einschließlich Montage der schraubenverbindenden Längsträger würde einen weiteren Schritt auf dem Gebiet der Minimalisierung des iatrogenen Traumas bedeuten. Only a purely percutaneous complete spinal instrumentation including mounting of the screw connecting the longitudinal support would be a further step in the art of minimizing the iatrogenic trauma. Dieses Problem wird durch die im Patentanspruch aufgeführten Geräteeigenschaften gelöst. This problem is solved by the features listed in claim device properties.

Das Wirkungsprinzip des Gerätes leitet sich aus den einfachen geometrischen Prinzipien ab (Zeichnung 1, 2). The operating principle of the device derives from the simple geometric principles from (drawing 1, 2). Jedes Dreieck hat einen Umkreis, dessen Mittelpunkt innerhalb dieses Dreiecks liegt und alle 3 Ecken schneidet. Each triangle has a radius, whose center lies within this triangle and intersects every 3 corners. Der Mittelpunkt des Umkreises ist der Schnittpunkt der Mittelsenkrechten. The center of the circumscribed circle is the intersection of the perpendicular bisector. In einem gleichschenkligen Dreieck liegt der Mittelpunkt des Umkreises in der Symmetrieachse des Dreiecks (45). In an isosceles triangle, the center of the circumscribed circle is located in the axis of symmetry of the triangle (45). Die sagittale Krümmung der Lendenwirbelsäule beschreibt einen Kreis, bzw. ein Oval. The sagittal curvature of the lumbar spine describes a circle or an oval. Gemessen an den Eintrittspunkten der zwei Pedikelschrauben eines oder mehrerer Bewegungssegmente, werden diese durch den Kreis geschnitten (Zeichnung 2, 3). Measured at the entry points of the two pedicle screws of one or more motion segments, they cut through the circle (Drawing 2, 3). Somit ist der ein Schraubenpaar verbindende Stab geometrisch gesehen bei vorgegebener Krümmung ein Kreisbogen mit einem definierbaren Radius und Mittelpunkt. Thus, a pair of screws connecting rod is geometrically seen at a predetermined curvature, a circular arc having a definable radius and center.

Die perkutan auf den Schraubenköpfen sitzenden Kanülen sind gleich lang. The percutaneously seated on the screw heads cannulas are of equal length. Durch eine Brücke werden sie zu einer Verbindung geschlossen, die geometrisch betrachtet einem gleichschenkligen Dreieck entspricht. By a bridge, they are closed to a compound considered geometrically corresponds to an isosceles triangle. Dieses Dreieck und der Umkreis besitzen somit den gleichen Mittelpunkt, um den auf einem Schwenkstab sitzender und die Pedikelschrauben zu verbindender Längsträger gegebenenfalls bewegt werden kann (im Kreis an einem festen Arm) (Zeichnung 3). This triangle and the radius thus have the same center to the seated on a pivot rod and the pedicle screws may be moved to be connected to the longitudinal carrier optionally (at a fixed arm in a circle) (Drawing 3). Eine vorgegebene Längsträgerkrümmung ist daher die Voraussetzung für eine derartige Implantation. A predetermined longitudinal beam curvature is therefore the prerequisite for such implantation. Diese muss industriell gewährleistet sein, und beträgt etwa 18 cm. This must be industrially secured and is about 18 cm. Folgt die Krümmung (Radius) der Wirbelsäule einem Kreis nicht, ist die Dreieckkonstruktion alleine durch eine entsprechende Schraubenpositionierung und Ankippung der beweglichen polyaxialen Schraubenköpfe zur Aufnahme des kreisförmig vorgebogenen Stabes möglich. does not follow the curvature (radius) of the spinal column a circle, the triangular construction is solely possible by a corresponding screw placement and Ankippung the movable polyaxial screw heads for receiving the circular pre-bent rod.

Das Prinzip der gänzlich perkutanen Wirbelsäuleninstrumentierung stützt sich auf die bereits im Vorfeld erarbeiteten Techniken der perkutanen Schraubenimplantation (1, 20, 29, 30-31, 33 38-39, 42-44, 48, 56) Nach Erfassung der Pedikeleintrittspforte unter dem C-Bogen oder aber unterstützt mit der spinalen Navigation, beginnt die perkutane Instrumentation des Pedikels mit einem Kirschnerdraht. The principle of the completely percutaneous spinal instrumentation is based on the compiled in advance techniques of percutaneous implantation screws (1, 20, 29, 30-31, 33 38-39, 42-44, 48, 56) after detection of the Pedikeleintrittspforte under the C- arch supports or with spinal navigation, percutaneous pedicle instrumentation of starts with a Kirschner wire. Danach folgt der eigentliche Hautschnitt - jeweils etwa 18 mm pro 1 Schraube. Thereafter, the actual incision follows - each about 18 mm per 1 screw. Über den im Pedikel liegenden Kirschnerdraht werden sukzessive Dehnungskanülen bis zum Erreichen eines entsprechend weiten Arbeitskanals eingebracht. Via the in-pedicle Kirschner wire strain cannulas are introduced until a correspondingly large working channel successively. Dieser wird mit einer Platzhaltekanüle festgehalten, die wiederum auch mit einem Fixierarm optional gehalten werden kann. This is held in place with a retaining cannula, which in turn can be maintained optionally also with a fixing arm. Diese Kanüle ist bereits ein Teil des Stabeinführsystems, später "Karussell" genannt. This cannula is already a part of the Stabeinführsystems, later called "Carousel". Der Pedikel wird nun entweder mit dem üblichen lumenhaltigen Bohrer aufgebohrt und dann nach Entfernung des Kirschnerdrahtes mit einer standardmäßigen polyaxialen Schraube versehen. The pedicle is now drilled either with the usual lumen containing drill and then provided after removal of the Kirschner wire with a standard polyaxial screw. Dieser Vorgang wäre auch nach vorausgegangenem Gewindeschneiden (kanülierter Gewindeschneider) möglich. This process would also be possible after prior threading (cannulated taps). Über den Kirschnerdraht wird ebenso eine kanülierte polyaxiale Pedikelschraube eingeführt. a cannulated polyaxial pedicle screw is also introduced over the Kirschner wire. Die erste Option ermöglicht die Benutzung der Standardimplantate, jedoch mit der Gefahr den Schraubenkanal durch eine unkontrollierte Verschiebung der Arbeitskanüle zu verlieren. The first option allows the use of standard implants, but with the risk of losing the screw channel by an uncontrolled movement of the working cannula. Die zweite Möglichkeit bedarf der Spezialimplantate (perforierte polyaxiale Schrauben), jedoch in Kombination mit der spinalen Navigation bietet sie eine relevant kürzere Durchleuchtungszeit. The second option requires special implants (perforated polyaxial screws), but in combination with the spinal navigation it provides a relevant shorter fluoroscopy time. Eine Durchleuchtung ist nur am Anfang zur Positionierung des Kirschnerdrahtes notwendig. A screening is necessary to position the Kirschner wire at the beginning. Liegt dieser korrekt, erfolgen weitere Schritte ohne Notwendigkeit einer ausgiebigen Röntgenkontrolle. Is this correct, followed by further steps without the need for extensive X-ray control.

Wünschenswert ist eine leicht (5-10 Grad) konvergierende oder aber weitgehend parallele Positionierung der einseitigen Schraubenpaare. It is desirable that a convergent or slightly (5-10 degrees) but substantially parallel-sided positioning of the pairs of screws.

Die Schraube wird durch die Arbeitskanüle eingebracht, wobei der Schraubenkopf mit einem Instrument (Zeichnung 4) festgehalten und positioniert wird. The screw is inserted through the working cannula, wherein the screw head is retained with an instrument (drawing 4) and positioned. Das Instrument wird in der Arbeitskanüle durch eine in seiner Wand eingefrästen Führung eingebracht, so dass das Übereinanderliegen der seitlichen Schraubenöffnung und der auf dem Schraubenkopf sitzenden Kanüle, die ebenso im Bereich des Schraubenkopfes eine seitliche Öffnung besitzt, gewährleistet ist. The instrument is introduced into the working cannula through a milled in the wall guide, so that the superposition of the lateral screw hole and seated on the screw head cannula having a lateral opening as in the region of the screw head, is ensured. Diese Vorgänge werden einseitig an der oberen und unteren Schraube durchgeführt. These operations are performed on one side by the upper and lower screw. Auf die nach außen (extrakutan) hin verlängerten Implantate wird das eigentliche Stabeinführinstrument aufgesetzt (Zeichnung 5). the actual Stabeinführinstrument is placed on the outward (extrakutan) towards elongated implants (drawing 5).

Das eigentliche Instrument besteht aus zwei Aufsätzen, die auf die Arbeitskanülen aufgesteckt werden. The actual instrument consists of two towers that are attached to the work needles. Sie sind mit der Brücke verbunden, auf welcher der bewegliche Arm fixiert ist (Zeichnung 5). They are connected to the bridge on which the movable arm is fixed (fig 5). Da der interpedikuläre Abstand nicht konstant ist, ist auch eine stufenlose Verstellung und Arretierung des Kanülenabstandes notwendig. Since the interpedikuläre distance is not constant, also a continuous adjustment and locking of the needle spacing is necessary. Bei Veränderung des interpedikulären Abstandes ändert sich aber auch der Winkel der Kanülen zueinander, da die Ausrichtung der frei beweglichen Schraubenköpfe der Krümmung des festgelegten Radius des Längsträgers zwangsläufig folgen muss. When changing the distance interpedikulären itself but also the angle of the cannula to each other changes, since the orientation of the floating screw heads must follow the curvature of the fixed radius of the longitudinal member inevitably. Damit das geometrische Prinzip eines gleichschenkligen Dreiecks im Umkreis greift, müssen die auf den Schraubenköpfen sitzenden Arbeitskanülen samt der Aufsätzen bewegbar bzw. kippbar sein. Thus, the geometrical principle of an isosceles triangle engages within which is seated on the screw heads work needle with the articles must be moved or tilted. Durch ein Zahnradprinzip sind die auf den Schraubenkanülen steckenden Aufsätze verbunden, was ihre gleichmäßige Ankippung bei Abstand- und Winkelveränderung der Schraubenköpfe bedingt und der Erhaltung der geometrischen Grundsätze des gleichschenkligen Dreiecks dient. By a gear principle, the plug-in terminations on the screw cannulas extensions are connected, which caused and the preservation of the geometrical principles of the isosceles triangle is its uniform Ankippung at Distance and angle change of the screw heads.

Sitzt das Karussell auf den Pedikelschrauben, wird der vorgebogene Stab perkutan in die Schraubenköpfe über den beweglichen Arm hineingeschwenkt und mit der Innenmutter leicht fixiert. Sitting the carousel to the pedicle screws, the pre-bent rod is inserted percutaneously in the screw heads on the movable arm is pivoted in and lightly fixed with the inner nut.

Zur Verringerung des Gewebswiederstandes am Stabanfang muss diese entsprechend angespitzt sein. To reduce the Gewebswiederstandes at the member start it must be pointed accordingly.

Damit eine derartige Instrumentation durchgeführt werden kann, sind vier Hautinzisionen von etwa 18 mm Länge zur Einbringung der Pedikelschrauben, zwei Inzisionen von der Länge etwa 6-7 mm zur perkutanen Implantation der Längsträger nötig. For such instrumentation can be carried out, four skin incision of approximately 18 mm in length for insertion of the pedicle screws, two incisions on the length of about 6-7 mm for the percutaneous implantation of the longitudinal members are necessary. Eine Fasciennaht ist bei dem Hautverschluss nicht zwingend erforderlich. A Fasciennaht is not mandatory in the skin closure required.

Das Gerät lässt sich mit geringfügigen Veränderungen an jede derzeit erhältliche polyaxiale Pedikelschraube/Schraubensystem anwenden. The device can be applied with minor modifications to any currently available polyaxial pedicle screw / screw system.

Vorteile advantages

Erst eine rein perkutane vollständige Stabilisierung einschließlich Montage der schraubenverbindenden Längsträger würde einen weiteren Schritt auf dem Gebiet der Minimalisierung des iatrogenen Traumas bei einer einfachen dorsalen Wirbelsäuleninstrumentation bedeuten. Only a purely percutaneous complete stabilization including the mounting screw connecting the longitudinal support would be a further step in the art of minimizing the iatrogenic trauma in a simple dorsal spinal instrumentation. Sie könnte die Vorzüge und manche Indikationen der offenen und der perkutanen Schraubenimplantation vereinigen und bei weiterer Entwicklung die Behandlungsphilosophie in einem bestimmten Grad verändern. You could combine the advantages and some indications of open and percutaneous screw insertion and change the treatment philosophy on further development in a certain degree. Die Vorteile liegen auf der Hand: Das intraoperative Muskeltrauma ist wesentlich kleiner, da ein echtes Muskelablösen zur Freilegung der Wirbelsäule nicht mehr nötig ist, nach entsprechender Lernkurve bedeutend kürzere Operationszeit. The advantages are obvious: The intraoperative muscle trauma is much smaller, since a real muscle stripping to expose the spine is no longer necessary after appropriate learning curve significantly shorter operation time. Effekte wie zum Beispiel wesentlich kleinere postoperative Narbe oder auch höhere Akzeptanz durch die Patienten durch das wesentlich kleinere Ausmaß des Eingriffs sind medizinisch gesehen von kleinerer Bedeutung. Effects such as much smaller postoperative scar or higher patient acceptance by the much smaller extent of engagement are medically of smaller importance. Die von der periduralen endoskopischen Bandscheibenchirurgie bekannte schnellere postoperative Mobilisation der Patienten im Vergleich zu der klassischen, auch mikroskopischen Operationsmethode, kommen bei offenem Zugang zur Wirbelsäulenimplementierung und der um ein Mehrfaches größeren Zugangslänge hier um so deutlicher zum Tragen. The well-known from the epidural endoscopic disc surgery faster postoperative mobilization of patients compared to the classical, even microscopic surgical technique, come here so clearly into with an open approach to the spine implementation and the larger by a multiple access length.

Es resultiert daraus ein zu vernachlässigender Blutverlust sowie ein minimales Muskeltrauma, da die Muskelfasern nicht durchtrennt sondern auseinandergedrängt werden. It results from a negligible blood loss and minimal muscle trauma because the muscle fibers not severed but are forced apart. Die bloßliegenden Muskelfasern verschließen sofort den Zugangstunnel, Blutungen oder grobe Läsionen des Muskelgewebes sind eher eine Seltenheit. The bare muscle fibers close the access tunnel immediately, bleeding or gross lesions of muscle tissue are more of a rarity. Die traumabedingten postoperativen Schmerzen werden dadurch wesentlich reduziert, die Mobilisation des Patienten erfolgt früher. The trauma-related postoperative pain is substantially reduced, the patient's mobilization comes earlier.

Mögliche Einsetzbarkeit possible deployment

Das Instrument setzt an der Basis der transpedikulären Wirbelsäuleninstrumentation ein und ist demnach keine hochspezifische Entwicklung für besondere Fragestellungen in der Wirbelsäulenchirurgie. The instrument uses at the base of transpedicular spinal instrumentation and is therefore not highly specific development for specific issues in spinal surgery. Auf diese Weise wäre die potentielle Einsetzbarkeit durch den ohnehin weiten Anwenderkreis entsprechend hoch. In this way, the potential applicability of the already wide range of users would be correspondingly high. Theoretisch könnte man damit in der Zukunft die meisten Indikationen für eine dorsale Zuggurtung ohne Notwendigkeit einer Spinalkanalinzision vollkommen ersetzen, da mit den herkömmlichen Implantaten zuzüglich des og Instrumentes eine einfache und viel schonendere Option der dorsalen Stabilisierung gewährleistet wäre. In theory, one could completely replace most indications for posterior tension band without the need for Spinalkanalinzision so in the future, as would be ensured with the conventional implants plus the above-mentioned instrument simple and much gentler option the dorsal stabilization.

Die Integration der zusätzlichen Schrauben (mehr als 2 Schrauben in einer Reihe) in das Instrument scheint auf jeden Fall möglich zu sein, bedarf jedoch einer präziseren Implantation der Schraubenlage in der mit dem Stab zu versorgenden Reihe. The integration of additional screws (more than two screws in a row) in the instrument seems to be definitely possible, but requires a more precise implantation of screws location to be supplied with the row of bars. Die mittleren Schrauben müssen entsprechend tiefer zu liegen kommen; The center screws must come to lie correspondingly lower; die primäre Verwendung der sog. Langkopfschrauben könnte von Vorteil sein. the primary use of the so-called. long head bolts could be beneficial. Damit wären auf diese Weise die leichteren Formen der Spondylolisthesen (Meyerding 1 bis 2) ohne eine nennenswerten Spinalkanalstenose schonend zu versorgen, vorausgesetzt, eine ventrale Abstützung folgt. This would in this way the lighter forms of spondylolisthesis (Meyerding 1 to 2) without a significant spinal stenosis to provide gentle, provided, followed by a ventral support. Eine peridurale endoskopisch unterstützte Dyscektomie mit nachfolgendem Zwischenwirbelraumersatz sind beim rein dorsalen Zugang denkbar. An epidural endoscopic assisted Dyscektomie followed intervertebral space replacement are possible during dorsal access only. Die Instrumentation der Brustwirbelsäule ist monosegmental bis bisegmental möglich. The instrumentation of the thoracic spine is monosegmentally to bisegmental possible. Zu bedenken ist jedoch eine etwas höhere Position der Schraubenköpfe, damit ein Konflikt des Längsträgers mit dem Wirbelsäulenabschnitt zwischen den Pedikelschrauben vermieden wird. but points is a slightly higher position of the screw heads so that a conflict of the side member is avoided with the spine section between the pedicle screws.

Literatur literature

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2) AEBI, M., ETTER, C.: The internal skeletal fixation system: a new treatment of thoracolumbar fraktures and other spinal disorders. 2) Aebi, M., ETTER, C .: The internal skeletal fixation system: a new treatment of thoracolumbar fraktures and other spinal disorders. Clin Orthop 227: 30-42 (1988) Clin Orthop 227: 30-42 (1988)
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4) AEBI, M., MOHLER, M.: Analysis of 75 operated thoracolumbar fraktures and fracture dislocations with and without neurological deficit. 4) Aebi, M., MOHLER, M .: Analysis of 75 operated thoracolumbar fraktures and fracture dislocations with and without neurological deficit. Arch Orthop Trauma Surg 105: 100-112 (1986) Arch Orthop Trauma Surg 105: 100-112 (1986)
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Claims (3)

1. Gerät zur stereotaktisch geführten perkutanen Implantation der Längsverbindung der Pedikelschrauben, dadurch gekennzeichnet , dass durch Einhaltung der bestimmten geometrischen Prinzipien des gleichschenkligen Dreiecks in einem Umkreis mit gemeinsamen Mittelpunkt, die die Gerätekonstruktion charakterisieren, eine stereotaktisch geführte perkutane (geschlossene) Implantation des die polyaxialen Pedikelschrauben verbindenden Längsträgers ohne Notwendigkeit einer langstreckigen operativen Freilegung der Wirbelsäule möglich ist. 1. Apparatus for stereotactically guided percutaneous implantation of the longitudinal connection of the pedicle screws, characterized in that by adhering to the specific geometric principles of the isosceles triangle in a beam with common center which characterize the equipment design, a stereotactic guided percutaneous (closed) implantation of the polyaxial pedicle screws connecting the longitudinal member with no need of a long segment surgical exposure of the spine is possible.
2. Das Gerät nach Patentanspruch 1, dadurch gekennzeichnet, dass das Gerät aus zwei gleich langen Armen, mit einer Querverbindung in einer Ebene zusammengeschlossen, zusammengesetzt ist, auf der ein schwenkbarer, zu einem Kreis von einem frei bestimmbaren Radius gebogener Arm, zur Aufnahme des ebenso kreisförmig gebogenen Längsträgers aufgesetzt ist, der perkutan eingeführt wird. 2. The apparatus according to claim 1, characterized in that the device consists of two arms of equal length, joined together with a cross-connection in a plane which is composed, on the one pivotable to a circle of a freely determinable radius curved arm, for receiving the is placed as well circular arcuate longitudinal carrier which is introduced percutaneously. Die Köpfe der zuvor perkutan in die Wirbelsäule eingebrachten polyaxialen Pedikelschrauben werden dabei in einer Ebene aufgerichtet und können bedingt durch die Gerätemerkmale entlang des Längsträgers bis zu einem Grad gleichmäßig zu- oder auseinander bewegt werden, wodurch eine Kompression und Distraktion der Wirbel erzielt wird. The heads of the above percutaneously introduced into the spine polyaxial pedicle screws are thereby raised in a plane and can be conditioned uniformly to-by device characteristics along the longitudinal support to a degree or moved apart, whereby a compression and distraction of the vertebrae is obtained.
3. Das Gerät nach Patentanspruch 1, dadurch gekennzeichnet, dass - bedingt durch die Gerätekonstruktion - die in einer Ebene erzwungene Position der Schraubenköpfe eine gleichzeitige perkutane Verbindung von mehr als einem Schraubenpaar ermöglicht. 3. The device according to claim 1, characterized in that - due to the equipment design - allows simultaneous percutaneous connection of more than one pair of screws, the forced in a plane position of the screw heads.
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