RU2454961C1 - Method of treating spine hemangiomas - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to field of medicine, namely to vertebrology and surgery of spine, and can be applied in treatment of spine hemangiomas. Essence of method consists in realisation of phlebospondilography and carrying out vertebroplasty. Phlebospondilography is carried out in process of performing surgery from its beginning to end. Introduction of bone cement in case of vertebroplasty and contrasting substance for carrying out phlebospondilography is realised through separate manipulation devices by their partial introduction in several steps. Alternated are about 1-2 ml of bone cement and 5-10 ml of contrasting substance with further repetition. Introduction of contrasting substance is performed through manipulation device, installed in spinous process adjacent with respect to injured vertebra.

EFFECT: application of claimed invention makes it possible to increase efficiency of treating patients with spine hemangiomas with reduction of risk of development of complications, associated with impact of bone cement on content of dural sac and its extravertebral expiration.

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Description

The invention relates to medicine, namely to spinal surgery, orthopedics, neurosurgery, vertebrology, and can be used in the treatment of hemangiomas of the spine, in particular aggressive ones and in the presence of myelosemia of the type of robbery.

Tumors of the spine among all neoplasms of the skeleton make up 5-7%. Hemangiomas occur in 2-3% of cases of all neoplasms of the spinal column. They are benign tumors consisting of newly formed blood vessels of the cavernous and capillary types [Hemangiomas of the spine / I.A. Norkin [et al.] // Saratov Journal of Medical Scientific Research. 2010. Volume 6. No. 2. S.428-432].

There are various methods of treating spinal hemangiomas: radiotherapy, surgical removal of the tumor, embolization of the vessels feeding the tumor, alcoholization of hemangiomas, puncture vertebroplasty with polymethyl acrylate derivatives [Pedachenko EG, Garmish A.R. Hemangiomas of the spine (literature review) // Ukrainian Neurosurgical Journal. 2002. No4. S.17-23].

However, when using all of the above methods for the treatment of hemangiomas of the spine, the risk of postoperative complications increases.

When performing radiotherapy, complications such as damage to the spinal cord and surrounding tissues, the development of radio-induced tumors may occur.

Surgical removal of spinal hemangiomas in most cases is accompanied by profuse blood loss, which contributes to an increase in the occurrence of intra- and postoperative complications.

A method for the treatment of spinal hemangiomas by embolization of the vessels supplying the tumor is complicated in technical design and is characterized by frequent relapses of the disease.

In the treatment of spinal hemangiomas with alcoholization, the risk of osteonecrosis and compression fractures of the affected vertebrae, requiring surgical stabilization of the spine in all patients undergoing this manipulation, is increased. With the introduction of alcohol into the hemangioma, neurological complications are also possible.

The closest analogue to the claimed invention is a method for the treatment of spinal tumors, including hemangiomas [Durov OV, Shevelev NN, Thyssen TP Vertebroplasty in the treatment of spinal tumors // Spinal Surgery. 2004. No4. C.6 8-73], including the implementation of phlebospondylography and vertebroplasty. The first stage, under local and neuroleptanalgesia, is the installation of a manipulation device in the form of a needle by passing it through the skin, subcutaneous fat and muscle along the intended path under the control of an electron-optical transducer (EOP). In the anteroposterior projection under the control of the image intensifier, the needle is inserted into the leg of the vertebra and advanced to the cortical compaction, indicating the beginning of the vertebral body. After passing the legs, the image intensifier is moved to the lateral projection, and the needle is inserted to the border of the anterior and middle third of the vertebra. The second step is phlebospondylography by direct injection of a contrast medium into the vertebral body through an installed needle under the supervision of an image intensifier tube to assess the intensity of the venous outflow. In the third stage, bone cement is poured into a high-pressure syringe and, when the consistency of toothpaste is reached under the control of the image intensifier tube, it is slowly injected through the installed needle into the vertebral body. The volume of injected bone cement: from 2-4 ml in the chest, to 5-7 ml in the lumbar. To control the replacement of the cavity of the vertebral body with bone cement, a spiral computed tomography is performed in the postoperative period.

However, phlebospondylography as the second stage of surgical intervention prior to vertebroplasty allows only venous drainage of interest to be assessed and cannot more likely predict cement leakage during the manipulation due to the different viscosity of the contrast agent and bone cement. The implementation of the introduction of contrast medium and bone cement through one manipulation device can lead to blocking the lumen of the needle, and therefore, the impossibility of introducing bone cement and the occurrence of postoperative complications. This method does not provide for the assessment of spinal blood flow and blood supply, which is of great importance in the treatment of hemangiomas in the presence of myelosemia by the type of robbery.

The objective of the invention is to increase the effectiveness of treatment of patients with hemangiomas of the spine while reducing the risk of complications associated with the effects of bone cement on the contents of the dural sac and its extravertebral outflow.

The essence of the claimed invention lies in the fact that in a method of treating hemangiomas of the spine, including phlebospondylography and vertebroplasty, phlebospondylography is performed during the surgical procedure from its beginning to the end, the introduction of bone cement in vertebroplasty and contrast material for phlebospondylography is carried out through separate manipulation devices by their partial introduction in several stages, alternating in an amount of about 1-2 ml of braids cement and 5-10 ml of contrast medium with subsequent repetition, while the introduction of contrast medium is carried out through a manipulation device installed in the spinous process of the adjacent relatively affected vertebra.

The technical result of the claimed invention consists in solving the problem posed earlier. Performing phlebospondylography during a surgical procedure from its beginning to the end allows:

- intraoperatively determine the localization of hemangiomas in the vertebral body, thereby taking into account the data obtained, make more accurate insertion and positioning of the puncture needle for vertebroplasty in the vertebral body;

- evaluate venous drainage of interest level;

- to carry out dynamic control over the filling of the tumor body with bone cement and the state of the bloodstream of the hemangioma;

- use a minimum amount of bone cement, which helps to reduce the risk of complications associated with the polymer acting on the contents of the dural sac and its extravertebral outflow, thereby reducing the likelihood of extensive thermal osteonecrosis of the vertebral body;

- dynamically control the change in the intensity of the medullary blood flow by the degree of filling of the spinal veins, which is necessary to determine the effectiveness of surgical intervention in the presence of myelosemia by the type of robbery.

The introduction of bone cement in vertebroplasty and a contrast agent for phlebospondylography is carried out through separate manipulation devices, which makes it possible to introduce a contrast agent and bone cement in turn, excluding the blocking of the lumen of the manipulation device, and, consequently, the occurrence of intra- and postoperative complications.

A method for the treatment of hemangiomas of the spine is as follows.

The patient is placed on the operating table in a position on the stomach. After local anesthesia is performed, the surgical field is treated. Under the x-ray control, a manipulation device of the trocar type is inserted into the apex of the spinous process of an adjacent relatively affected vertebra. Phlebospondylography is performed to assess the localization of the hemangioma, the intensity of the venous outflow by introducing 5-10 ml of a contrast medium, for example, Omnipack 30.0, through an established trocar. Based on the results obtained, a manipulation device is installed as a puncture needle in the area of the vertebral body affected by hemangioma. Then, under fluoroscopic control, through the appropriate manipulation devices, the following is introduced: bone cement through a puncture needle and contrast medium through a trocar by their partial introduction in several stages, alternating in the amount of about 1-2 ml of bone cement, for example polymethyl acrylate, and 5-10 ml of contrast medium followed by repetition. When radiographs in two projections indicate a complete cessation of the contrast of pathological vessels of the hemangioma and increased contrast of the spinal veins, the introduction of bone cement is stopped. A control phlebospondylography is carried out by introducing 5-10 ml of contrast medium through an established trocar. Upon reaching the radiological signs of vascular embolization of the hemangioma, the manipulation devices are removed. An aseptic dressing is applied.

Example.

Patient I., 56 years old, was admitted with a diagnosis of “Aggressive hemangioma L2 of the vertebra. Vertebrogenic pain syndrome. "

After preoperative preparation, the patient underwent surgery according to the method described in this application. Phlebospondylography was performed during the entire surgical procedure from its beginning to the end. Given the localization of the pathological focus, a transpedicular right-sided insertion of a needle for vertebroplasty was performed. The introduction of bone cement was stopped when the contrast of the pathological vessels of the hemangioma was completely stopped and the contrast of the spinal veins was increased. The volume of injected bone cement was 6 ml.

The patient was activated in an upright position 2 hours after surgery. During the control CT study, the hemangioma cavity was filled with the polymer in full, no extravertebral outflow of bone cement was observed. Vertebrogenic pain syndrome completely regressed. The patient was discharged after 2 days without external immobilization. When examining a month after the operation: no complaints, spinal support is preserved, walks without external immobilization.

Claims (1)

A method for the treatment of spinal hemangiomas, including phlebospondylography and vertebroplasty, characterized in that phlebospondylography is performed during the surgical procedure from its beginning to the end, the introduction of bone cement in vertebroplasty and a contrast agent for phlebospondylography is carried out through separate manipulation devices by their partial introduction in several stages, alternating in the amount of about 1-2 ml of bone cement and 5-10 ml of contrast ve ETS followed by repetition, with the administration of contrast agent produced through a handling device mounted on the adjacent spinous processes with respect to the affected vertebrae.