JPS6337668B2 - - Google Patents

Description

DETAILED DESCRIPTION OF THE INVENTION The present invention relates to medical devices, and more particularly to devices for treating spinal curvature cases, such as implantable spinal curvature correctors.

Implantable corrector for spinal curvature by Cobb
It is used to treat cases of worsening scoliosis with a curve angle of up to 50°. It is also used to treat new and diffuse vertebral fractures associated with kyphoscoliosis, juvenile kyphosis, Calvue's disease, traumatic spondylitis of Kiyummel, kyphotic deformity, and fractures of more than 50° according to Cobb. It can be used in cases of scoliosis deformity of the curved angle.

Clinical statistics in the USSR and abroad show that, on average, about 4 children of different ages
Between 6% and 6% have scoliosis.

Patients with scoliosis are treated by conservative and surgical methods. Currently existing conservative methods, such as therapeutic gymnastics, physical therapy, orthodontic jackets, etc., are not always effective and it is necessary to rely on more effective and reliable surgical treatments.
At least 1 in 1500 children will require surgical treatment. Therefore, many experts in developed countries of the world are engaged in improving the current surgical methods of treating scoliosis and kyphosis and in exploring new, more effective and economical techniques. ing.

In the surgical treatment of scoliosis and kyphosis, various types of metal structures are used to correct and stabilize the curvature of the spinal column, and these metal structures are implanted in whole or in part into the patient's body. . Known devices for stabilizing and correcting the spinal column by applying corrective effort in the longitudinal direction of the spinal column include, for example, the Harrington spreader. (1962, The Journal of Bone and Joint Surgery, Volume 44-A, No. 4, pp. 591-610, P.
(See Earl Harrington's ``Scoliosis Correction and Internal Fixation Procedures Using Spinal Instruments.'') Harrington's spreader has a straight, rigid metal rod, both ends of which are secured to the spinal column by hooks. The upper end has a tapered element. The rod is positioned on the concave side of the spinal column and is secured by a hook that engages the arch or transverse process of the spine above and below the crest of the curvature. A special tool is used to move the upper hook toward the end of the rod to lengthen the spinal column and correct the curvature.

However, this powerful action adds considerable effort to correct spinal curvature, ultimately resulting in fractures of the vertebral structures in the area of engagement, traction on the spinal cord, or pelvic organ damage. This may result in functional impairment and paralysis and paralysis of the lower extremities. Therefore, the use of this straightener is
Failure to completely straighten the spine.

To improve the degree of straightening of the spinal column while minimizing contingencies affecting the bony structure, the rods are fitted with lateral clamps. Further known implantable correctors for spinal curvature include:

(1978 International Orthopedics, Vol. 1, No. 4, pp. 247-265, V.
(See ``New Treatment Techniques for Idiopathic Scoliosis'' by Dr. Cottrell). It has the Harrington rod and lateral tension mentioned above. The rod is placed on one side of the spinous process on its concave side, and the relatively short plate-like transverse brace with a hook that engages the transverse process is placed on the curved apex on the opposite side of the spinous process. located and pulled towards the rod by a threaded connection.

Various types of implantable correctors of spinal curvature, which act in the longitudinal direction of the spinal column, can only be used in children who will not grow any further. It is impractical to use on children who are still growing. This is because as the spinal column is being stretched, its corrective action quickly wears off. Furthermore, since both the convex and concave sides of the spinal column undergo stretching during spinal curvature correction procedures, the above-mentioned implantable orthosis improves the bone structure dimensions of the spine on the convex and concave sides of the spinal column. It is not possible to provide conditions for stronger growth of bone tissue on the concave side of the spinal column so as to stabilize the position of the spinal column obtained by the corrective action of balancing.

Implantable correctors for spinal curvature that are capable of correcting and stabilizing the spinal column by action perpendicular to the longitudinal axis of the spinal column are also known. (See the section on Mr. Earl Lord in the 1969 Russian magazine "Orthopaedics, Traumatology and Prosthodontics" No. 4, pp. 32-33)
This design includes a plate with a hole adapted to receive a hook with a threaded end. These hooks are engaged in the transverse processes or arches of the vertebrae located at the top of the curve on the side opposite to the side on which the plate was positioned. The plate is positioned on the concave side of the spinal column. The threaded end of the hook is then passed through the corresponding hole in the plate. Nuts are attached to these threaded ends and tightened until the spine is pulled towards the plate. As a result, the plate, spine and hook define a rigid structure.

Straight rigid rod or plate-like spinal curvature implantable corrector structures cannot sustain a sufficiently strong corrective action applied to the spinal column during post-surgical treatment. Often, it is necessary to repeat the surgical procedure to properly tighten the spinal column with the hook by tightening the nuts in order to restore the necessary corrective action.

Still other implantable spinal curvature correction devices are known. (1977 Journal of Bone and Joint Surgery, Vol. 59-B,
2, pp. 159-165, J. Regina and E. Fuerreira Alves, "Correction and Internal Fixation for Scoliosis"). It comprises a straight metal rod positioned on the convex side of the vertebral column, which is secured to the base of the spinous process with corresponding holes by pieces of wire at several points along the length of the rod. ing.

This type of rod is not suitable for overcorrecting, i.e. by bending the line of the spinous process in the opposite direction to the initial curvature, on the initially convex and concave sides of the spinal column, respectively. It is unsuitable for creating stimulating conditions to balance the dimensions of the bony structure of the vertebral column by inhibiting and forcing the growth of bone tissue and to eliminate spinal torsion.

The tightening elements in all of the above-mentioned implantable orthoses cause bone atrophy in the area of contact with the metal. Therefore, these orthotics cannot be used as permanent internal fixation devices for the purpose of spinal correction and stabilization;
It must be removed within a relatively short time before treatment is complete. This is osteoplasty
necessitates fixation of the spinal column, i.e.
It is necessary to attach the vertebrae using spondylosyndesis. However, osteoplastic fixation is unable to maintain the degree of correction achieved.

In order to increase the straightening effect of the implanted metal device and to reduce the loss of the degree of correction achieved, the surgeon performs preliminary implantation of the spinal column by performing complex surgical procedures on the soft tissues, spinal column, and thoracic cavity. It relies on movement. These surgical procedures include, for example, crossing the long dorsal muscles, transection of the levator trunk and psoas muscles, resection of the vertebrae and rib bodies, resection of the transverse spinous and articular processes of the vertebrae, These include transection of the annulus fibrosus of the intervertebral disc at several levels and removal of the disc.

However, such complex surgical interventions have proven life-threatening due to their shock-inducing nature and large blood losses. Moreover, it is inadequately effective and repeat surgeries must be performed, as approximately 30 to 45% of the correction obtained by the procedure is partially lost in a relatively short period of time.

Also, for the well-known implant corrector for spinal curvature, Soviet Inventor Certificate No. 450572, filed on January 12, 1973,
Published December 25, 1974, Publication No. 43, it has an arcuate shape and positions its convex side facing the convex side of the spinal column in the longitudinal direction of the spinous process, and this orthosis has a fixation device. It is used to anchor to the spinal column and is partially straightened to create an effort to straighten the spinal column. This orthosis includes a stack of arcuate plates. Four or five plates are positioned on either side of the spinous process, with the plates on each side of the spinous process engaging each other to form a leaf spring. The fixation device includes a wire coil that draws the plate and spinal column together. These wire coils engage the vertebrae by their arches.

This construction of an implantable corrector for spinal curvature requires that the spinal column be stripped of a significant amount of soft tissue on both sides during the performance of the surgery. Moreover, when the orthosis is removed at the completion of treatment, repeated surgeries are required, resulting in considerable traumatic intervention. This results in a large blood loss of approximately 1200 to 2000 ml per surgery;
The surgical time is extended to 2 to 3 hours, and life is at risk. It should also be pointed out that when the spinal column is avulsed on both sides, those avulsed muscles are affected and it is necessary to keep them intact in order to rehabilitate the patient by auxiliary treatments such as exercise therapy and physical therapy. It is important that the Also, exposure of both sides of the spinal column results in complications in the area of surgical wounds quite frequently. For example, hyperplasia, serosis and even paraplegia occur. The highly traumatic nature of the surgery to fix the rods in the spinal column creates psychological disturbances during its performance. Unless spinal curvature in children is over-declared, parents rarely realize that such major surgical intervention is really necessary. This is a situation in which surgical treatment is usually delayed until such time as surgery is absolutely unavoidable, i.e. until the spinal curvature has worsened significantly, so this is a lost time when surgical treatment would have been much more effective. means. The surgery to secure an implantable orthosis to the spinal bony structure using multiple wire fasteners is time-consuming and labor-intensive, and it is virtually impossible to control the degree of tortuosity of the rod wire fasteners. It's impossible. If the wire is twisted too much to tighten it enough, it can destroy the bony structure of the spine. However, if there is less twist, the strength of the rod's fixation to the spinal column is compromised. As a result, in the postoperative period, the rod may have to be moved relative to the spinal column and the achieved correction of spinal curvature is lost. This results in the need for long post-operative treatment of patients using plaster of Paris or removable jackets, ranging from 18 to 24 months. This inhibits the patient's active mobility and prevents the use of exercise therapy devices and techniques for more rapid rehabilitation.

Therefore, the surgical procedures associated with implanting orthoses are extremely complex and involve significant shock and blood loss, as well as long duration, which may be detrimental to the outcome of scoliosis treatment. It was found that it has an impact.

The present invention provides an implantable corrector for spinal curvature having a structure that increases effectiveness in treating scoliosis while reducing surgical traumaticity when inserting the corrector. That is its purpose.

The purpose was to create a spinal column with an arcuate shape, with its convex side facing the convex side of the spinal column, to be placed along the spinous process and to be held on the spinous process using a fixation device. This is achieved by means of an implantable corrector of curvature, which is partially straightened to create an effort to straighten the spinal column, and according to the invention an elastic member fixed to one side of the spinous process. Contains a single flat rod of material.

In order to abut the rod against the spinal column by conventional techniques, i.e. by pushing it into the soft tissue, one or both ends of the rod are preferably made tapered and the convex end The surface is
The concave surface of the continuous rod surface is
It defines a slope that merges with the concavity of the rest of the rod.

In order to hold the vertebral column in the coronal plane, the device for fixing the rods preferably includes two combs placed at each end of the rod on the convex side of the rod and having teeth facing the rod, In order to adjust the straightening force, it has a number of clamping bodies corresponding to the number of combs, each clamping body having one end connected to the rod and the other end connected to the respective comb. Ru.

Particularly in the case of established spinal curvature, the device for fixing the rods includes a number of auxiliary combs placed between the rods and each main comb, corresponding to the number of the main combs, the teeth of which Conveniently, it is fixed to the clamping body of each main comb, facing the teeth of the comb.

To hold the vertebral column in the sagittal plane, the device for securing the rods includes one or two hooks at each end of the rod that are mounted to engage the arch of each vertebra. Convenient to include.

The end of the rod has a tapered shape and is preferably provided with oval holes therein, the device for securing the rod includes screws received in these holes, and the clamping body rotates about the rod. This can be fixed directly onto these screws.

When the curvature of the spinal column is severe, the device for fixing the rods is an additional pair of combs extending parallel to the rods on the convex side of the central portion of the rods, and a tightening body attached to one end of the combs. It is further convenient for said additional pair of combs to be mounted on the rod with their teeth facing each other.

The invention will be further described with reference to embodiments thereof with reference to the accompanying drawings, in which: FIG.

Referring to the drawings, the implantable spinal curvature corrector consists of a single flat rod 1 with an arcuate shape.
Figure). This rod 1 is made of a flexible material such as titanium alloy, and its convex side is connected to the spinal column 2.
along the longitudinal direction of the spinal column 2, facing the convex side of the
It is fixed to one side of the spinous process 3 of the spinal column. Since the rods are fixed to the spinal column with the help of a fixation device consisting of
Generates a force that straightens the spinal column 2. The bending angle is
In order to correct spinal column 2 when it reaches 50°,
It is necessary to apply a force in the range of 400 to 600N; for bends greater than 50°, the required force is 1000N.
Or maybe even more. Preferably, the rod 1 has a length of 265 to 285 mm, a thickness of 1.5 to 2.0 mm, a width of 8 to 10 mm, and a radius of curvature of about 200 mm. Rod 1 is spinal column 2
By pushing it lengthwise into the soft tissue, it can be fixed in the soft tissue without transection of the soft tissue. To make this possible, the ends 4 of the flat rod 1 are made tapered so that the surface of the convex end is a continuation of the surface of the rod 1, while the surface of the concave end is a continuation of the surface of the rod 1. Define a slope that joins the rest of the surface on the concave side.

The device for fixing the rod 1 to the spinal column 2 is
The comb 5 has three combs 5 whose pointed teeth keep the spinal column 2 in the frontal plane.
The comb 5 is arranged at both ends of the rod 1 on its convex side, with the teeth facing towards the rod 1. One end of each tightening rod 6 holds the stem 7 of the comb 5 by means of a screw connection. On the other hand, the other end of the clamping rod 6 carries a clamp 8 and engages with the rod 1 by its bent end. This end of the tightening rod 6 also has a thread, which adjusts the force of straightening the spinal column 2 by rotating a nut 9 threaded onto it.

Both ends 4 of the rod 1 have a tapered shape, and an oblong hole 10 is formed therein. One of these holes 10 receives a screw 11, the head of which is tapered with a rounded tip.
This end 4 has a round head shape and is fixed to the spinal column 2 by the rod 1, and is firmly fixed to the spinal column 2. The other end 4 is a tail fixed to the spinal column 2 by the rod 1, which is fixed to the spinal column 2 but can move in the longitudinal direction of the spinal column 2 as the child grows. The rod 1 is positioned on one side of the spinous processes 3 and the comb 5 is placed on the opposite side of these spinous processes 3. These combs 5 therefore participate in the action of fixing the spinal column 2 in the frontal plane. A clamping rod 6 of a comb 5 is attached to the round-headed end 4, and a clamp 1 is attached to the round-headed end 4.
2, this clamp engages the screw 11 with its bent end and clamps the tightening rod between the head of this screw 11 and the tapered end 4 of the rod 1. are doing. In this way, a strong clamping of the rounded portion of the end 4 is obtained. A clamp 8 is engaged with the rod 1 to secure the caudal end 4 for movement in the longitudinal direction of the spinal column 2. Alternatively, the rounded end 4 may also be secured by a clamp 8 and placed against the enlarged tapered portion of this end 4. In order to allow extension of the rod 1, a screw 11 may be set in the hole 10 in the tail end 4 of the rod 1 and in the tightening rod 6 of the comb 5.
is secured with the aid of a clamp 12 and positioned with a distance defined between the edge of the clamp and the head of the screw 11 to allow the rod 1 to be attached to the spinal column 2 as the child grows. It can be made to be able to move longitudinally.

The length of the comb 5 is such that it engages at least two spinous processes 3 when fixed along the length of the spinal column 2. Preferably, the length of the comb 5 is approximately 85 mm. The teeth of the comb 5 are sharp so that they can easily enter the spinous processes 3. Preferably, the number of teeth of the comb is 8, and the spacing between the teeth is 5.
Each spinous process 3, which is positioned with a holder attached to it, is pierced by one or two teeth.

In order to hold the spinal column 2 in the sagittal plane, the device for fixing the rod 1 is
The rod 1 has two hooks 13 which are fastened to both ends of the rod 1. When the rod 1 is fixed, the hook 13 engages the respective spinal arch 14 (FIG. 2). Hook 13 is
The edge of the rod 1 has a complementary groove 15 (FIG. 3), the threaded rod 16 carrying a clamp 17;
The nut 18 rotates when fixing the rod 1 to the spinal column 2, moving the clamp 17 and fixing it. To treat scoliosis, the rod 1 is positioned with its convex side facing the spinous process 3 (FIG. 4). To treat kyphoscoliosis, the rod 1 (FIG. 5) is rotated relative to the spinous process 3. For kyphosis treatment, the rod 1 (FIG. 1) faces its arch 19 with its convex side. In the two last-mentioned examples, the comb 5 and the hook 13 are fixed to the screw 11 for rotation around the rod 1, and the fixation of the spinal column 2 in the sagittal plane is
This is accomplished by engaging the two hooks 13 (FIG. 7) in their adjacent vertebral arches 19 and rotating them in opposite directions when fixing the rod 1. In the case of a vertebral fracture due to a kyphotic deformity, the rod 1 is positioned as in the case of a kyphotic deformity, the length of the rod 1 depending on the distance between the damaged vertebrae. This proposed design of the device for fixating the rods 1 thus distributes the forces that straighten the spinal column 2, reducing the loads applied to each bony structure and reducing the effort to straighten the spinal column 2. In addition, it is possible to prevent the destruction of the bone structure.

If the spinal column 2 is highly curved, it may be convenient to use a pair of combs to fix the rods 1, i.e. in one of its embodiments The device for fixing is
It additionally has a number of auxiliary combs 20 (FIG. 8) equal to the number of main combs 5, these combs 20 also having sharp teeth and located midway between the rod 1 and the respective main comb 5. The combs 20 are placed on the main comb 5 so that their teeth face each other, and each comb 20 is fixed to the tightening rod 6 of the respective main comb 5. When the rod 1 is positioned, the plurality of auxiliary combs 20 are placed on the same side of the spinous process 3 with which the rod 1 is placed, and the tightening rod is tightened by rotating the nut 21. 6 is moved along.

If the spinal curvature is 50° according to Mr. Cobb or greater, an additional pair of combs 22 may be placed at the top of the curvature.
(FIG. 9), the clamping rod 6 of which is mounted in the central part of the rod 1. To make the procedure more effective, preliminary correction of the spinal curvature may be performed. To do this, attach a specially designed adapter (not shown) to the clamping rod 6.
This adapter may be screwed onto the threaded end of the
A Kirschunel wire or nylon cord or the like is attached (indicated schematically in the drawing by an arrow line) and extends outwardly on the side of the patient's body, and is of any suitable type known per se, such as the Latipov-Akvelov device. Attached to external equipment.

In order to advance the rod 1 along the length of the spinal column 2 within the patient's body by conventional techniques, two incisions 23 and 24 (FIG. 10) are made and a specially designed handle 25 is inserted into the rod 1. The rod is screwed into the hole 10 in the caudal end 4 of the rod for use in pushing the rod into soft tissue. When rod 1 is installed, tighten nut 9 (Figure 11) until the spine is straight.

The implantable corrector of spinal curvature is secured as follows. Radiographs of the spinal column 2 in the frontal and sagittal planes (FIG. 10) are examined anteriorly to determine the position of the comb 5. i.e. surgical incisions 23, 24
The points can be determined. The surgery is performed with the patient paralyzed and lying on their stomach. The curve of the spinal column 2 in the sagittal plane is straightened by placing a hard table or cushion under the patient's abdomen or chest.

The incisions 23 and 24 are made in the spinal column 2 (Fig. 1), respectively.
It is carried out on the convex side of the spinous process 3 in the longitudinal direction in the thoracic and lumbar regions of the body. The length of each incision 23, 24 (FIG. 10) need not exceed the length of the comb 5 (FIG. 1). Once the incision has been made, the spinal column 2 is exposed by separating the muscles. next,
A hook 13 (FIGS. 2 and 3) is introduced below each vertebral arch 14, and one hook is inserted into each of the thoracic and lumbar incisions 23, 24 (FIG. 10).
Insert each hook.

Next, within the incisions 23, 24, the muscles are separated from the spinous process 3 (FIG. 1) on the concave side of the spinal column 2, the comb 5 is placed within the incision 23, and the tightening rod 6
is screwed into the stem 7. In the case of a low spinous process, the tightening rod 6 is placed above the process 3; in the case of a high spinous process, the tightening rod 6 passes through the process;
or guided through the space between adjacent projections.

The next very important step in surgery is rod 1.
This is the setting. At the front, insert the screw 11 (FIG. 10) into the hole 1 in one tapered end 4 of the rod 1.
0 and screw the handle 25 into the hole 10 in the opposite end 4. The orthotic rod 1 is then introduced from the lower incision 24 to the upper incision 23 or vice versa. At this time, the head of the screw 11 slowly pushes the muscle apart. When the rod 1 is introduced, it is held in the groove 1 of the hook 13 by the clamping rod 6 of the comb 5.
5 (FIGS. 3 and 4).
Next, the clamp 12 (FIG. 1) is inserted into the clamping rod 6 of the comb 5, passes through the nut 9, and the clamp 1
7 (FIG. 3) is inserted into the stem 16 and the nut 18 is passed through. Next, nuts 18 and 9 (first
(Figure) to fix the head end 4 of the rod 1 to the spinal column 2. In the case of scoliosis, the rods 1 extend in the sagittal plane and the teeth of the combs 5 pierce the spinous processes 3 at their base. The excess length of stem 16 and clamping rod 6 is cut off with cutting pliers.

In the lumbar incision 24 (FIG. 10), the fixation of the caudal end 4 of the rod 1 is carried out in a similar sequence of steps. However, as the child grows, the tightening of the nuts 9 and 18 becomes more difficult as the rod 1 is tightened in the clamp 8 (Fig. 4) and in the hook 13 (Fig. 1).
It is necessary to be able to slide upwardly relative to the spinal column 2 in the groove 15 (FIG. 3). Also,
Clamp 8 and hook 13 are attached to rod 1 at a distance not less than the expected elongation of the child's spinal column 2 until puberty.
should be located on the rod 1 from the adjacent end 4 of the rod. Once rod 1 is fixed, spinal column 2 (11th
The eyelids in the patient's eyelids are already becoming straighter on the operating table.

Next, the incisions 23 and 24 are sutured layer by layer.

The straightening action of the orthosis applied to the vertebral column 2 is applied up to the moment of removal of the orthosis, during which the targeted growth of the bony structure of the vertebral column 2 and the straightening of the vertebral column take place; This is because there is stronger growth of the vertebrae on the concave side, and growth is suppressed on the convex side.

With the patient's growth arrest, Rod 1 (Fig. 1)
is removed by known techniques. The beveled surface of the tapered end 4 of the rod 1 allows the rod 1 to be withdrawn by simply pushing the soft tissue laterally.

If the rods 1 were fixed relative to the kyphoscolium, the surgical procedure would be performed in the same order, but by rotating the rods 1 (FIG. 5) relative to the longitudinal axis of the spinal column 2. To do this, the clamp 12 of the comb 5 (FIG. 7) and the clamp 17 of the hook 13 are inserted into the holes 10 provided at both ends of the rod 1.
The screw 11 is engaged with the screw 11 received in the holder. To increase the fixing strength of the rod 1, two hooks 13 are used. When thus positioned, the rod 1 acts simultaneously on the sagittal and frontal planes of the spinal column 2.

Is the curvature of spinal column 2 equal to 50° according to Mr. Cobb?
or when exceeding, rod 1 is used to comb 5 and 2.
Three pairs of 22 (FIG. 9) are placed and fixed at three levels: chest, waist and top of the curve. The surgical procedure is performed as follows.

Three incisions are made in the thoracic and lumbar regions of the spinal column 2 and at the top of the curve. The hook 13 (FIG. 7) is secured as already described above, after which the combs 5, 20 (FIG. 8) are secured on either side of the spinous process;
Their teeth are facing each other. The tightening rod 6 is attached to the stem 7 of the comb 20 positioned on the convex side of the spinal column 2.
and then screwed into the stem 7 of the comb 5 positioned on the concave side of the spinal column 2. Natsuto 2
1, pull the comb 20 toward the spinous process 3 and stick the teeth of the comb into the process 3, and then
(Fig. 1) and pull the comb 5 located on the concave side of the spinal column 2. The next step in fixing the rod 1 is as described above.

In the case of a scoliosis with a curvature not exceeding 70° according to Mr. Cobb, if the straightener rod 1 can still be bent, the clamping rod 6 (Fig. 9) can be fitted with an adapter (not shown). Wire or nylon cords are attached to these adapters and their free ends are extended outwardly and secured to a frame (not shown) to provide gradual lateral action to the curved spinal column 2. Once the desired degree of correction has been achieved, the adapter and wire or cord are removed.

In the case of scoliosis with a curvature angle exceeding 70° according to Mr. Cobb, if the rod 1 of the corrector cannot be bent any further, the bone structure of the spinal column 2 must be destroyed, so the surgical treatment is 2. It is done in stages. First, each pair 22 of combs 5, 20 (9th
) and hook 13 are fixed at three levels,
The curvature of the spinal column 2 is temporarily corrected by means of a suitable structural frame device known per se. In the second stage, the rod 1 is implanted with the required degree of correction of the spinal column 2.

In the case of surgery to treat kyphotic spinal curvature, the rod 1 is fixed in the coronal plane.

To treat new and diffuse vertebral fractures with kyphotic deformity, the rods are secured in the same manner as in the case of kyphosis, but the rods used are relatively short.

Next, a clinical trial of the implantable orthotic device of the present invention will be described.

Fifteen patients aged 7 to 16 years, representing tertiary advanced cases of thoracic and thoracoabdominal scoliosis of the spine, i.e., with a curvature angle of less than 50° according to Cobb, were fixed with an implantable corrector of spinal curvature. A surgical operation was performed. For older children, the rod was secured using two combs and a hook attached to each end of the rod. For children between 8 and 11 years of age, with an unfixed form of scoliosis, it was considered sufficient to fix a pair of combs at each end of the rods on the concave and convex sides of the spinal column.

In the three cases with spinal curvature angles greater than 50°, a third pair of combs was fixed at the top of the curvature. In the postoperative period, a frame device was used to tension the spinal column with Kirschunel wire to bulge the spinal column. The device was then removed and subsequent fixation of the spinal column was performed with an implantable orthosis.

In cases of scoliotic spinal curvature with a curvature angle of more than 70°, three pairs of combs are first used to lengthen the spinal column and straighten it in a frame device. was implanted, and then an orthodontic rod was implanted.

The orthotic implant surgery took 1 to 2 hours depending on the degree of curvature. All patients tolerated the surgery well. No complications occurred. Patients were allowed to leave the bed on the third or fourth day. They were able to leave the hospital on the 9th or 10th day after the sutures were removed.
Schoolchildren were able to attend classes at their local schools. There was no need to use plaster of Paris or removable orthodontic jackets.

[Brief explanation of the drawing]

FIG. 1 is a general view showing an implantable spinal curvature corrector fixed to the spinal column according to the invention, and FIG. 2 is a section of the spine in the sagittal plane with hooks for engaging the spinal arch according to the invention. FIG. 3 is a cross-sectional view of the spine illustrating the placement of hooks and rods on the spinal arch according to the present invention; FIG. 4 is a cross-sectional view of the spine where the comb is positioned according to the present invention;
FIG. 5 is a cross-sectional view showing the vertebrae and rods illustrating the positioning of the rods with respect to the spinal structure in kyphoscoliosis according to the present invention; FIG.
Similar figures, FIG. 7 shows a modification of rod fixation to the spinal column in scoliosis according to the present invention, and FIG. 8 shows a device for positioning and fixing the rod to the spinous process according to the present invention. FIG. 9 is a schematic diagram illustrating the use of three pairs of combs according to the invention to secure rods on the spinal column; FIG. Figure 11 shows a stage of the surgical procedure for inserting the orthodontic rod before fixing the orthodontic rod in the vertebral column (the spinal column is elongated);
FIG. 10 is a continuation of FIG. 10. 1...rod, 2...vertebral column, 3...spinous process,
4...Rod end, 5...Comb, 6...Tightening rod, 7
...Comb stem, 8...Clamp, 9...Natsuto,
10...hole, 11...screw, 12...clamp,
14...vertebral arch, 15...sulcus, 16...stem,
17... Clamp, 18... Natsuto, 19... Spinal arch, 20... Auxiliary comb, 21... Natsuto, 22...
...Pair of combs, 23, 24...Longitudinal incision of the spinal column,
25...handle.

Claims (1)

[Scope of Claims] 1. A correction device main body 1 made of a flat rod of an elastic material molded into a substantially arcuate shape and placed along the spinous process on one side of the spinous process of the spinal column, and this correction device. a fixing device for fixing the main body 1 to the spinal column and generating a straightening force on the spinal column; combs 5 and a number of tightening rods 6 corresponding to the number of combs 5, one end of each tightening rod 6 is connected to the straightener body, and the other end is connected to the comb 5. An implantable corrector for spinal curvature characterized by: 2 The fixing device has a number of auxiliary combs 20 corresponding to the number of main combs 5 disposed between the straightener main body 1 and the main comb 5, and the auxiliary combs connect teeth to the teeth of the main comb 5. The implantable corrector for spinal curvature according to claim 1, characterized in that the device is fixed to the tightening rod of the main comb 5 so as to face each other. 3. The fixation device comprises one or two hooks at each end of the orthotic body 1, each hook being mounted to engage each of the vertebral arches 14. An implantable corrector for spinal curvature according to item 1 or 2. 4. In the tapered part of the straightener body, circular holes 10 are provided, the fixing device includes screws 11 received in these holes 10, and the tightening rod 6 is fixed directly to these screws 11. An implantable corrector for spinal curvature according to any one of claims 1 to 3, characterized in that the corrector is rotatable around the corrector body 1. 5. The fixing device has an additional pair 22 of combs 5 and 20 extending parallel to the convex side of the central portion of the straightener body 1, and a tightening rod 6 having one end fixed to the straightener body 1, Claims 1 to 4, characterized in that the combs 5, 20 of the additional pair 22 are mounted on the tightening rod 6 with their teeth facing each other.
An implantable corrector for spinal curvature according to any of clauses.