RU2266070C2 - Method for fixing spondylolysis - Google Patents

Abstract

FIELD: medicine, vertebrology.

SUBSTANCE: at the bottom of spinous process and posterior part of its arch in frontal plane one should form a canal, resect caudal part of spinous process and semi-arch of the above-located vertebra so to form two transplants upon connecting flaps to replace the defect of inter-articular parts of arch after dissecting the obtained osseous fragment and inter-spinous ligament. Then on should introduce a rod into this canal and move it cranially to fix the ends in screws' caputs inserted into the roots of vertebral arches in case of spondylolysis that enables to restore the function of vertebral mobile segment.

EFFECT: higher efficiency of fixation.

10 dwg, 1 ex

Description

The invention relates to medicine, in particular to traumatology and orthopedics, and can be used for damage to the posterior vertebral structures.

There is a method of fixing the posterior vertebral structures in the presence of a defect in its interarticular part using a wire by holding it behind the transverse processes with the transition and capture of the base of the spinous process and exposing the bone in the area of the defect and contracting fragments (Keith H. Bridwell. The Textbook of Spinal Surgery. Second Edition, Vol.2. Lippincott Raven. 1997. P.1202-1206). However, this does not create rigid fixation; under load conditions, the movements of vertebral fragments are preserved and the restoration of the isthmus of the arch does not occur.

Closest to the claimed is a method of fixing the isthmus of the vertebral arch using hooks, wound behind the lower part of the arch with pulling and fixing them to the heads of the screws, carried out transpedicularly, preliminary introduction of a free bone graft into the defect zone (John W. Friemoyer. The Adult Spine. Principles and Practice. Second Edition. Vol. 2. Lippincott Raven. 1997. P.1894-1897). The disadvantages of the method are the preservation of mobility in the area of spondylolysis due to the remaining mobility of the back of the arch during rotational and extensor movements in the spine, which does not create optimal conditions for bone fusion in the zone of defects.

The objective of the invention is to restore the anatomical integrity of the arch of the affected vertebra and restore the function of the affected segment of the spine.

When performing the method, there is a positive therapeutic effect, which consists in restoring the anatomy of the vertebra, preventing the progression of the disease, eliminating pain and fatigue in the spine. The economic effect is to reduce the length of the patient’s hospital stay. Social effect: the method improves the quality of life of victims.

The technical result is achieved due to the stable fixation of the defect zone of the inter-articular part of the arch and plastic by its transplant on the ligament-subperiosteal flap, accelerating bone fusion, which leads to restoration of the function of the motor segment of the spine.

The problem is solved due to the fact that a channel is formed in the base of the spinous process and the posterior part of the arch in the frontal plane, the caudal part of the spinous process and half-arch of the superior vertebra are resected in such a way that after dissection of the obtained bone fragment and interspinous ligament in the sagittal plane and partial excision of the yellow ligaments form two grafts on ligamentous flaps, which perform the defect of the inter-articular parts of the arch, a metal rod is carried out into the formed channel b, they advance it in the cranial direction and the ends are fixed in the heads of the screws inserted into the roots of the arches of the vertebra having spondylolysis.

The method is as follows. In the position of the patient on the abdomen, under general anesthesia, access to the posterior structures of the vertebra with spondylolysis defect in the interarticular part of the arch. To create conditions for restoring the anatomical integrity of the inter-articular part of the arch in the vertebra having spondylolysis, transpedicular screws 1 are carried out according to the anatomical landmarks (Fig. A). Scar tissue is removed from the region of defects 2 (Fig. A) in its inter-articular parts on both sides, and sclerotized bone tissue of the surfaces of this part and the adjacent part of the posterior surface of the arches and the base of the transverse processes on both sides are also removed. The caudal part of the spinous process and half-arch above the located vertebra is marked 3 (Fig. A), and then they are resected in such a way that after transection of the obtained bone fragment and interspinous ligament in the sagittal plane and partial excision of the yellow ligament, two grafts 4 are formed (Fig. B) on ligamentous flaps 5 (Fig. B). The grafts on the right and left are rotated and inserted into the defects of the inter-articular parts of the arch. Channel 6 is formed in the lateral-lateral direction at the base of the spinous process and the posterior arch of the vertebra having spondylolysis (Fig. B). A wire is passed through it and modeled in such a way that, in its shape and length, the necessary bends are given to the rod, the diameter of which corresponds to the diameter of the formed channel in the spinous process and half-arch. Curved rod 7 (Fig. B) is carried out through the channel, its end parts are laid in the heads of the screws carried out transpedicularly. Compression is created in the defects of the inter-articular parts of the arches where the grafts are introduced, by moving the rod in the cranial direction and fixing it in the heads of the screws by tightening the nuts 8 (Fig. B). The stable fixation carried out in this way allows you to eliminate mobility in the inter-articular part of the arch, and the plastic with autografts on the ligamentous flaps provides fast bone fusion in this area and restoration of the anatomical integrity of the vertebra, which ultimately leads to the elimination of pain, functional spinal failure.

Clinical Example

Patient V. 15 years old (medical history No. 1562/2001) complained of pain in the lumbar spine that occurs when standing, working in an incline, prolonged sitting, and carrying heavy loads. Conducted clinical and radiological examination. On radiographs of the lumbar spine (figure 1) revealed bilateral isthmic spondylolysis of L3 vertebra. Based on the clinical and radiological examination, the diagnosis was established: bilateral isthmic spondylolysis of the L3 vertebra. Lumbalgia. Functional failure of the lumbar spine.

Conducted conservative treatment was ineffective. A decrease in pain occurred only when wearing a hard orthopedic belt.

Given this, the patient underwent surgical treatment by the method of fixation of spondylolysis. Under general anesthesia in the supine position, access was made to the posterior anatomical elements of the L3 vertebra. Revealed bilateral spondylolysis of the isthmic part of the arches, from which the scars were removed, sclerosed bone tissue was resected. According to the anatomical landmarks, in the roots of the L3 arms, channels are formed on both sides through which transpedicular screws were drawn. The caudal parts of the spinous process and half-arch of the L2 vertebra are initially resected on the left in such a way that a bone graft is formed on the subperiosteal ligamentous flap of the yellow and interspinous ligaments (Fig. 2). The graft is rotated (Fig. 3) and inserted into the defect of the inter-articular part of the L3 half-arch (Fig. 4). A similar manipulation was made from the opposite side. A channel is formed at the base of the spinous process and the posterior part of the arch L3 from left to right using a drill (Fig. 5). A rod is drawn through it, to which the necessary bend is given. The rod is laid in the heads of the pedicle screws. Then it is advanced in the cranial direction and simultaneously fixed in the screw heads with nuts (Fig. 6), which created compression in the spondylolysis zone on both sides where the grafts were installed, and ensured the immobility of the fixed anatomical elements L3 of the vertebra. The stitched wound healed by primary intention. For 3.5-4 months, the patient observed a gentle regimen. Pain in the lumbar spine disappeared. Clinical recovery has come. On radiographs of the spine 1.5 years after the operation, the restored anatomical integrity of L3 is preserved (Fig. 7). Spondylolysis zones are not traced.

Claims (1)

A method of fixing spondylolysis by introducing screws into the vertebra, transpedicularly, creating compression in the spondylolysis zone and its bone grafting, characterized in that a channel is formed at the base of the spinous process and the posterior part of the arch in the frontal plane, the caudal part of the spinous process and half-arch of the superior vertebra are resected in this way that after dissection of the obtained bone fragment and interspinous ligament in the sagittal plane and partial excision of the yellow ligament, two grafts are formed on the ligament x flap which operate defect interarticular arch portions, formed in the channel carried the metal rod, it is advanced in the cranial direction and the ends are fixed in the heads of screws introduced into roots bifida having spondylolysis.

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