RU2546931C2 - Method of prosthesis of anterior longitudinal ligament in cervical spine - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to neurosurgery, traumatology, orthopaedics for a prosthesis of the anterior longitudinal ligament. A cramp from titanium nickelide with thermal shape memory and self-adjusting compression with the submergence of the cramp legs into the vertebrae bodies to the depth of 3.5-4.0 mm, is installed at the level of surgery on the middle line of two adjacent vertebrae, which form an operated vertebral-motor segment.

EFFECT: method ensures the preservation of biomechanics of the vertebral-motor segment due to the preservation of the volume of movements in the cervical spine.

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Description

Technical field

The invention relates to medicine, namely to neurosurgery, traumatology and radiation diagnostics, and can be used for prosthetics of the anterior longitudinal ligament in the surgical treatment of degenerative diseases of the cervical spine.

State of the art

Known methods for prosthetics of ligaments of the spine using fascia (Movshovich I.A., Operative orthopedics. - M .: "Medicine", 1983. - p. 321) and lavsan tape (G. Yumashev. Traumatology and orthopedics. - M .: “Medicine”, 1990. - p.365-366).

The disadvantages of the known technical solutions are the limited margin of safety and the possibility of prosthetics only for ligaments having pronounced protrusions for attachment - supraspinous and interspinous.

The closest technical solution (prototype) is a method for prosthetics of the anterior longitudinal ligament in the cervical spine (Dreval ON, Neurosurgery. A manual for doctors. - M.: “GEOTAR-Media”, 2013. - Volume 2. - p.214- 219). In degenerative diseases of the spine, anterior fixation with a metal plate is used, which has the function of constriction during extension and support, when the spine is bent. On the front surface of the bodies of the fixed vertebrae, a metal plate is fixed using 4-6 standard screws 10-16 mm long, rigidly fixed in the plate itself and acting as supports. Layered seams on the wound. During extension, the plate prevents distraction along the anterior surface of the vertebral bodies, functioning as a stretched anterior longitudinal ligament.

The disadvantages of the prototype are 1) due to the rigid fixation of the plate at 4-6 points, fusion of adjacent vertebrae occurs, which leads to a violation of the biomechanics of the spine and the involvement of neighboring vertebral motor segments in the degenerative process;

2) when bending the spine, eruption of screws, migration and deformation of the plate are possible;

3) in connection with the fastening of the plate with screws with a length of at least 10 mm, a long lever arises that destroys the spongy substance of the vertebra.

The invention is aimed at creating a method for prosthetics of the anterior longitudinal ligament, which ensures the preservation of the biomechanics of the vertebral motor segment.

The specified technical result in the implementation of the invention is achieved by the fact that in the method of prosthetics of the anterior longitudinal ligament in the cervical spine by fixing the front of the spine after surgery on a degeneratively altered vertebral-motor segment, the feature is that at the level of intervention along the midline of the bodies of two adjacent vertebrae forming the operated vertebral-motor segment, a bracket of titanium nickelide with a thermal memory of the form and amoreguliruyuscheysya compression with immersion legs bracketed in the vertebral body to a depth of 3.5-4.0 mm.

Disclosure of invention

The method is as follows. At the level of intervention along the midline of the bodies of two adjacent vertebrae that form the operated vertebral-motor segment, holes are made in the vertebral bodies under the legs of the bracket of titanium nickelide with thermal memory shape and self-regulating compression with a depth of 3.5-4 mm. A bracket with a length of 20-26 mm and a leg size of 3.5-4 mm is cooled, squeezed with a tool and inserted into the prepared holes, setting the brackets into the vertebral bodies to a depth of 3.5-4.0 mm with immersion of the legs. Then the structure is irrigated with warm saline. Sutures on the superficial muscle of the neck and on the skin. Cervical orthosis. Fixing the brace at two points allows you to save the biomechanics of the vertebral-motor segment, the legs of the brace 3.5-4 mm long hold the vertebral-motor segment sufficiently when the spine is extended, as they are located mainly in the cortical layer of the vertebra and have the least possibility of eruption when bent spine compared to longer ones due to short leverage.

The claimed method for prosthetics of the anterior longitudinal ligament in the cervical spine has passed clinical trials in the treatment of 4 patients with degenerative diseases of the cervical spine.

We give a clinical example - an extract from the medical history.

Patient Sh., 36 years old, East. disease number 2531, was admitted to the neurosurgical department of the Elizabethan Hospital of St. Petersburg in a planned manner with complaints of pain in the cervical spine and left arm. Headaches are periodically disturbing, mainly in the occipital region on the left.

A neurological examination revealed ischemic myelopathy with moderate conduction disturbances, manifested by hypertonicity and hyperreflexia, vertebral artery syndrome on the left, syndrome of compression radiculoemia of C4-C5 segments on the left. When assessing orthopedic status, there is a sharp restriction on the range of movements in the cervical spine in all directions, especially posteriorly and to the left.

A comprehensive examination was carried out, including survey and functional radiographs, spiral computed and magnetic resonance imaging of the cervical spine.

Diagnosis: degenerative-dystrophic disease of the cervical spine; median hernia of the intervertebral disc C4-C5 with compression of the anterior chamber and spinal cord; acquired circular stenosis of the spinal canal at this level; compression-ischemic myelopathy, compression radiculoischemia of C4-C5 roots on the left; vertebral artery syndrome on the left; spinal instability at the level of the spinal motion segment C4-C5.

Surgical treatment was performed: removal of the median hernia of the intervertebral disc C4-C5. Under endotracheal anesthesia in the patient’s position, lying on his back with his head slightly tilted back on the neck roll, a skin incision was made along the skin fold at the level of C4-C5 vertebrae. The anterior longitudinal ligament at the level of C4-C5 vertebrae is thinned, atrophic, and does not fulfill its supporting-fixing function. Degeneratively altered intervertebral disc C4-C5 was removed. According to the claimed method, prosthetics of the anterior longitudinal ligament is performed. For this, at the level of intervention along the midline of the vertebral bodies, holes were formed in the bodies of neighboring vertebrae under the legs of the bracket of titanium nickelide with thermo-memory shape and self-regulating compression 4 mm deep. A bracket with a length of 20 mm and a leg size of 4 mm is cooled, compressed by a tool, and then inserted into the prepared holes with the brace legs immersed in the vertebral bodies to a depth of 4.0 mm. The design is irrigated with warm saline. Sutures were applied to the superficial muscle of the neck and to the skin. Cervical orthosis.

The postoperative course is smooth, wound healing by primary intention. At first he regressed pain and then gradually - neurological deficit. The patient was discharged in satisfactory condition for further treatment by a neurologist at the place of residence. Examined 6 months after surgery. No complaints, no pain. The range of motion in the cervical spine is not limited. Neurologically without focal symptoms, strength in the left upper limb is 5 points. He began his previous work without restrictions.

Thus, in the presented observation with degenerative-dystrophic disease of the cervical spine, complicated by herniation and the development of radiculoischemic and myelo-ischemic syndrome as a result of stenosis of the spinal canal, anterior decompression operation with prosthesis of the anterior longitudinal ligament was performed. Follow-up observation for 6 months showed a complete regression of neurological and orthopedic disorders with excellent long-term results.

Claims (1)

A method for prosthetics of the anterior longitudinal ligament in the cervical spine by fixing the anterior spine after surgery on a degeneratively altered vertebral-motor segment, characterized in that at the level of the intervention along the midline of the bodies of two adjacent vertebrae forming the operated vertebral-motor segment, a bracket is made of titanium nickelide with thermal shape and self-regulating compression with immersion of the brace legs in the vertebral bodies to a depth of 3.5-4.0 mm.