RU2343861C2 - Method of stabilisation of intervertebral segment - Google Patents

Abstract

FIELD: medicine; orthopedy and neurosurgery.

SUBSTANCE: carry out transcutaneous puncture of an intervertebral disk using needle through the basis of leg of vertebra body, located below, in a direction to the middle of the intervertebral disk, located above, and enter stabilising material into a disk.

EFFECT: depression of possible traumatic effects of surgical intervention and prevention of development of complications in postoperative period.

2 cl, 1 ex

Description

The invention relates to medicine, and specifically to traumatology, orthopedics and neurosurgery, and is intended for the treatment of patients with manifestations of instability in the intervertebral segment and spondylolisthesis, the so-called dislocation syndrome.

In osteochondrosis of the lumbar spine due to degeneration of the intervertebral segment, instability of the intervertebral segment develops, which is not always accompanied by the formation of a herniated disc.

Also, as a result of this, degenerative listhesis, or an independent disease, spondylolysis spondylolisthesis can develop.

As a rule, the most complex cases occur in older and older people with concomitant diseases. Conventional methods of surgical intervention are unacceptable here because of the somatic status of the patient.

A known method of chemical destruction of the disk using papain (lecopain), including the introduction of a papain solution into the intervertebral disc with subsequent activation of the patient in a plaster corset (see, for example, the monograph of A. I. Kazmin "Scoliosis". - M. Medicine. 1982. )

The disadvantage of this method is the inability to control the position of the injected solution into the disk, the possibility of penetration of the substance into the spinal canal with severe consequences, static disturbances due to a decrease in the height of the disk due to chemonucleosis and the need to apply a corset for a long period.

Closest to the claimed method is the "Method of prosthetics of the intervertebral disc at the lumbosacral level" (Russian Research Neurosurgical Institute named after prof. Polenov, patent No. 2147843 dated 04/27/2000, bull. No. 12), which includes performing percutaneous puncture of the intervertebral disk of the working cannula, removal of part of the pulpous nucleus with a special surgical instrument and the introduction of prosthetic material into the cavity of the disk through the working cannula. The position of the material in the cavity of the disk is evaluated by x-ray. This method is adopted as a prototype.

The disadvantage of this method is a significant risk of damage to blood vessels and nerve structures, a violation of the integrity of the musculoskeletal system of the intervertebral segment.

The purpose of the invention is the creation of a method for stabilizing the intervertebral segment, which can significantly reduce the invasiveness of surgical interventions and the development of complications in the postoperative period.

The essence of the method consists in performing percutaneous puncture of the intervertebral disc through the base of the leg of the lower vertebra to the middle of the intervertebral disc, using a special needle and introducing through the needle a contrasted cement of low viscosity under x-ray control.

The inventive method differs from the prototype in that the puncture access is through the leg of the underlying vertebra without damaging the fibrous ring of the disk outside the zone of passage of blood vessels and nerve structures and at the same time, low-viscosity contrast cement is introduced.

The method is used as follows:

The patient is placed on the operating table in a position on the abdomen. Under X-ray control with the image intensifier, the level of pathology is determined. Under local anesthesia of Markain's solution 0.5% -30.0, a special needle with a mandrel 3 mm in diameter is passed through the base of the leg of the arch of the lower vertebra in the direction to the middle of the superior intervertebral disc in both projections. Then, Omnipack 1.0-2.0 is introduced in order to determine the severity of cement penetration outside the disk. Then slowly under the x-ray control 2.0 cement of low viscosity is introduced into the intervertebral space so that it does not go beyond the disk. After that, the needle is removed. An aseptic dressing is applied. After 2 hours, after the completion of the polymerization process, the patient is activated and can be treated on an outpatient basis.

Using the proposed method allows for intervertebral fusion under local anesthesia, provides minimal soft tissue injury, without violating the integrity of the musculoskeletal system, does not damage the vessels and nerve structures, does not cause the development of scar-adhesions in the epidural space, provides reliable stabilization of the intervertebral segment does not cause severe operating injury.

The method does not cause psycho-emotional stress, provides a quick return to the usual way of life and previous physical activity.

Clinical observation example:

B-naya N.I.F., 62 years old, retired. Medical history No. 4391.

Was admitted to the hospital on the day of the injury. Injury from a fall from a height of 0.5 meters. Upon admission, the patient has severe pain in the lumbar spine, radiating along the back of the right thigh to the level of the knee joint. On palpation - the maximum pain in the projection of the spinous process of L4 and in the paravertebral points L3-L4-L5, Laseg symptom on the left is pronounced, tendon reflexes are lively, symmetrical. There are no pathological signs. On the review spondylograms: antalgic scoliosis, flattening of lumbar lordosis, the height of the intervertebral spaces is reduced, there are no pliesis, there are marginal osteophytes. MRI of the lumbosacral spine: there is no stenosis of the spinal canal, posterior-lateral herniation of the L5-S1 disk up to 2 mm in size with no signs of root irritation, or interest from the soft tissue formations of the spinal canal.

April 23, 2003 the operation was performed. The patient was laid on the operating table in a position on his stomach. Under the image intensifier control, the level of needle introduction with manren was determined. Under local infiltration anesthesia of the Markain solution of 0.5% -30.0, a special needle was held with a mandrel 3 mm in diameter through the base of the leg of the arch of the lower vertebra in the direction to the middle of the superior intervertebral disc under image intensifier in two projections (direct and lateral). Then, Omnipack 1.0-2.0 was introduced to determine the severity of cement penetration outside the disk. Then slowly under the image intensifier control 2.0 contrasted cement of low viscosity was injected into the intervertebral space so that it did not go beyond the disk. After that, the needle was removed. At the time of the introduction of cement, the patient felt a sense of "bursting" at the injection site. An aseptic dressing was applied to the injection site. 2 hours after the completion of the polymerization process, the patient was allowed to get out of bed and walk around the ward. Subjectively, patients after the intervention noted the disappearance of pain, the appearance of a sense of "stability", "strength" in the spine.

On control spondylograms and CT studies, a sufficient width of the intervertebral gap is determined. The implant has the shape of a biconvex lens, which contributes to uniform axial load. The fibrous ring has no mechanical damage.

After 1 day, the patient was discharged for outpatient treatment.

Claims (2)

1. A method of stabilizing the intervertebral segment in case of dislocation syndrome or instability, including puncture access to the intervertebral disc and introducing material into the disc, characterized in that the puncture access is through the base of the foot of the body of the inferior vertebra in the direction toward the middle of the superior intervertebral disc and the stabilizing material is introduced through a needle . 2. The method according to claim 1, characterized in that as a stabilizing material using cement of low viscosity.