RU2331378C1 - Method of anterior transpedicular spondylodesis - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to spinal column surgery, and can be used when treating complicated trauma of thoracic and lumbar parts of spinal column. Method includes anterior decompression of spinal cord, reclination of the broken vertebral body and anterior spondylodesis. Longitudinal canal is formed in vertebral body by means of canulated drill inserted into vertebral body on guide pin, which is preliminary inserted into vertebral body through pedicle. Reclination is performed with rigid reclinator through the formed canal. Bone transplant is formed from spinal processes and vertebral arches as a single unit, diameter of drill exceeding vertical size of pedicle.

EFFECT: performance of anterior transpedicur spondylodesis with support-capable autotransplants in acute period of trauma of spinal column.

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Description

The invention relates to medicine, namely to spinal surgery, and can be used in the treatment of complicated trauma to the thoracic and lumbar spine.

There is a method of anteroposterior interbody fusion in the treatment of unstable spinal injuries, including the formation of a channel in the vertebral body through the right leg of the arch with a drill with a diameter of 5.5-6 mm, introducing into the formed channel using a syringe an altered demineralized bone matrix of 5-6 ml autologous blood and rigid auto or allografts. In the preoperative period, patients undergo spinal implantation on a hammock (patent No. 347554-A, 2001, Ukraine).

However, when conducting a drill into the vertebral body, there is a high risk of damage to the cuffs of the roots, epidural and radicular vessels. The introduction of oblique shavings into the vertebral body provides its support only by the time of the formation of bone callus after 4-6 months. The dimensions of the transpedicular access, formed with the help of a drill, do not allow the autograft to be introduced into the vertebral body with a size comparable to the height of the vertebra, which would ensure restoration of the supporting ability of the vertebral body immediately after the operation. Performing external spinal reclinations on a hammock can lead to damage to the paravertebral tissues due to the curvature of the patient's body during this manipulation.

A known method of balloon kyphoplasty during operations on the spine, in which internal reclining is performed using a soft balloon embedded inside the vertebra (Injury, Volume 36, Issue 2, Supplement 1, July 2005, Pages S82-S89).

However, with balloon dilatation, the vertebral body expands not only up and down, but also to the sides, which can lead to damage to segmental vessels.

The objective of the invention is to perform anterior supportive fusion from posterior approach in the acute period of a vertebral-spinal injury of the thoracic and lumbar spine.

The problem is solved in that in the method of anterior transpedicular spinal fusion, including anterior decompression of the spinal cord, reclination of a broken vertebral body and anterior spinal fusion by forming a longitudinal channel in the vertebral body and its legs and introducing a bone autograft into it, the channel is formed using a cannulated drill, introduced into the vertebral body along the guide needle, previously installed in the vertebral body through its leg, the reclamation is performed by a rigid declinator ithout shaped channel, and the bone graft is formed from a portion of spinous process and vertebral arch broken "en bloc", the cannulated drill diameter is greater than the vertical size of the vertebra legs.

Figure 1-6 shows the steps of the operation:

Figure 1 - introduction of the Kirschner needle into the body of the vertebra through the legs of the vertebra.

A is a three-dimensional image. B - side view. B - autograft from the spinous process and arch of the vertebra "single block".

Figure 2 - drilling of the legs and channels in the vertebral body by a cannulated drill.

Figure 3 - internal declination of the vertebral body by a rigid declinator.

A three-dimensional image. B - side view.

Figure 4 - removal of fragments of the vertebral body and part of the overlying disc with a spoon.

Figure 5 - installation of autografts from parts of the arches and spinous processes between the vertebral bodies.

6 - fixation of the transpedicular system in the compression position, where 1 is the legs of the vertebra, 2 is the guide needle, 3 is the spinal cord, 4 is the broken vertebra, 5 is the cannulated drill, 6 is the spoon, 7 is the hard declinator, 8 is the autograft spinous process and parts of the arch of the vertebra, 9 - transpedicular fixators.

The method is carried out in the following way. A laminectomy is performed, during which, at the level of the broken 4 and overlying vertebrae, the spinous processes and parts of the arches 8 are removed in a “single block” for the subsequent formation of autografts. After laminectomy, the articular processes of the superior and underlying vertebrae are resected. Subtotally using the nippers on both sides, the legs of 1 broken vertebra are removed up to the level of the spinal roots. Using a raspatory, the dura mater is separated from the remains of the vertebral pedicle. Under x-ray control through the center of the legs 1 in the vertebral body set the spoke 2 for holding the drill. The remains of leg 1 are removed, and a channel is formed in the vertebral body using a cannulated drill 5 held in the vertebral body along a guide pin 2 previously inserted into the vertebral body through its leg 1, and the diameter of the drill exceeds the vertical size of the vertebral leg 1 and is 10-12 mm Manipulations are carried out from the second side. Fragments of the posterior parts of the vertebral body that compress the spinal cord 3 are removed through the channels in the vertebral body by means of conniotomes, providing anterior decompression of the spinal cord at the level of the damaged vertebra 4. After the internal reclination step, the fragments are removed with the help of a hard declinator 7 inserted into the formed canal, spoon 6 the upper parts of the broken vertebra 4 and the overlying disc in the projection of the formed channels. Through transpedicular accesses, autografts 8 are introduced into the channels, formed from the spinous processes and parts of the arches in a “single unit”. After the manipulations, transpedicular fixation of the damaged segment is carried out in the compression mode with titanium implants 9.

Clinical example: Patient P., 28 years old. Was admitted to the clinic with a diagnosis: “Closed complicated compression-comminuted fracture L1 vertebra. Bruise, compression of the spinal cord. " From the anamnesis it is known that the victim fell out of the window of the 2nd floor. Clinical and neurological examination revealed lower distal paraparesis up to 4 points, impaired sensitivity of the conductor type from the level L2 of the spinal cord segment. Violation of the functions of the pelvic organs as a delay. When spondylography revealed comminuted fracture L1 of the vertebra (Figa, B) with kyphotic deformation at this level. CT scan visualized a fragment in the upper part of the vertebral body, embedded in the lumen of the spinal canal and overlapping it by more than 50% (Fig. 7B).

An operation of the anterior transpedicular fusion was performed according to the method described above in the acute period of trauma according to emergency indications.

On the control radiographs after the operation, the position of the autograft between the bodies of the Th12-L1 vertebrae is noted, the kyphotic deformity is eliminated (Fig. 8A, B). Control CT confirmed the restoration of the size of the spinal canal and the position of the autografts inside the body of the broken vertebra (Fig. 8B). The surgical wound healed by first intention. Sutures were removed on the 11th day.

In the postoperative period, a complete regression of spinal neurological disorders was noted. The patient is activated in a tight corset on the 5th day.

The positive effect of using the method:

1. The use of a cannulated drill to remove the legs of the vertebrae allows you to exclude lateral displacements of the instrument during drilling, and to reduce the risk of damage to the vascular and nerve formations located next to the leg. The diameter of the drill can exceed the size of the legs, which allows to increase the parameters of transpedicular access.

2. A rigid reclinator restores the vertical dimensions of the vertebra without dislocation of the lateral parts of the vertebral body while eliminating kyphotic deformation.

3. Modified transpedicular access provides anterior transpedicular spinal fusion with supportive autografts from the spinous processes and parts of the vertebral arches, comparable in size to the height of the vertebral body.

Claims (1)

A method of anterior transpedicular spinal fusion, including anterior decompression of the spinal cord, reclamation of a broken vertebral body and anterior spinal fusion by forming a longitudinal channel in the vertebral body and then introducing a bone autograft into it, characterized in that the channel is formed using a cannulated drill inserted into the vertebral body via a guide pin previously inserted into the vertebral body through its arch leg, the reclination is carried out by a rigid recliner through the formed th channel, and the bone graft is formed from the spinous processes and arches of the vertebrae "in one block", and the diameter of the drill exceeds the vertical size of the legs of the vertebral arch.

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