RU2573057C1 - Method for segmental vertebrotomy - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: posterior structure of roots of vertebral arches and bodies are excised, and a deformity is corrected until edges of the formed excision defect close completely by means of a fixation device. A cranial portion of the broken spine, a degenerated disk and a caudal vertebral end plate of an overlying spine are excised horizontally throughout the entire anteroposterior length up to an anterior longitudinal ligament in order to ensure the planned correction manipulations in all planes and bring bones of the two adjoining spines in close contact in the position of the ensured correction.

EFFECT: method allows correcting kyphosis, shift and rotation of thoracic, thoracolumbar and lumbar spines.

1 ex, 7 dwg

Description

The invention relates to medicine, namely to traumatology and orthopedics, and is intended for the correction of post-traumatic deformations of the thoracic, thoracolumbar, lumbar spine, accompanied by kyphotic, shear, rotational deformity and their combination.

Known Smith-Petersen osteotomy (SPO), characterized by resection of the posterior structures of the spine (articular processes, arches at the level of the intervertebral disc) at the disc level, with subsequent gradual extension of the extremity on the operating table, the edges of the formed bone defect are closed, thus extensia is achieved at the level of the intervertebral disc and deformation correction (Shimode M, Kojima T, Sowa K. Spinal wedge osteotomy by a single posterior approach for correction of severe and rigid kyphosis or kyphoscoliosis. Spine 2002; 27: 2260-7).

The disadvantages of this method are that there is a low result of bone fusion, the correction value is insignificant (about 10 °), large blood loss during surgery, it is impossible to correct kyphotic and shear deformation in the thoracic spine, the spine remains in an unstable position.

Closest to the claimed is the method adopted for the prototype, subtractive pedicular osteotomy (PSO), which consists in removing the posterior structures, the roots of the arches, the back of the vertebral body and when giving a gradual extension to the operating table, the edges of the formed defect are closed, thus, correction of deformation for by reducing the height of the posterior structures and the back of the vertebral body while maintaining the height of the anterior vertebrae (Buchowski JM, Kuhns CA, Bridwell KN, Lenke LG. Surgical management of posttraumatic thoracolumbar kyphosis. Spine J. 2008; 8: 666-677) .

The disadvantages of this method are that it is impossible to correct kyphotic and shear and rotational deformity in the thoracic, thoracolumbar, lumbar spine, the spine remains in an unstable position.

The technical result of the invention is the creation of a method free from the above disadvantages.

The specified technical result is achieved by resecting the posterior root structures of the arches and vertebral body with subsequent correction of deformation until the edges of the resulting resection defect are closed with a fixative, the cranial part of the broken vertebra, the degenerated disk and the caudal closure plate of the overlying vertebra are resected horizontally to the entire anteroposterior size up to anterior longitudinal ligament, providing planned correction in all planes and tight bone contact of two adjacent vertebrae in the position of the achieved correction.

The invention is illustrated by the following graphic materials, where in FIG. 1 - multislice computed tomography (MSCT) of the spine before the implementation of the method, side view, FIG. 2 - multislice computed tomography (MSCT) of the spine after the implementation of the method, side view, FIG. 3 - multislice computed tomography (MSCT) of the spine before the implementation of the method, side view, FIG. 4 - magnetic resonance imaging (MRI) of the spine before the implementation of the method, side view, FIG. 5 - multislice computed tomography (MSCT) of the spine before the implementation of the method, axial view, FIG. 6 - multislice computed tomography (MSCT) of the spine after the implementation of the method, side view, sixth day after surgery, FIG. 7 - multislice computed tomography (MSCT) of the spine after the implementation of the method, side view, 6 months after surgery.

An embodiment of the invention.

At the preoperative stage, multislice computed tomography (MSCT) is performed, where kyphotic, shear, and rotational deformities in the thoracic spine are determined in Fig. 1. The size of the defect of the rear and front structures to achieve a given correction is determined in advance during preoperative planning. Surgery is performed in the patient’s position on the abdomen. Exercise posterior median access. After skeletonization of the spinous, articular processes in accordance with the anatomical landmarks, x-ray control devices are used for fixing devices, for example (transpedicular screws, infra-laminar and supralaminar hooks) at least 2 segments above and below the deformation apex. Next, a laminectomy and facetectomy are performed at the vertebrotomy level, posterior decompression, foraminotomy of the overlying vertebra and resection of the roots of the arches by a predetermined amount are performed. Spend meningolysis, audit of the dural sac. Next, using the electric bur, nippers under the protection of retractors, the cranial part of the broken wedge-shaped vertebra, the degenerated disc and the caudal closure plate of the overlying vertebra are resected horizontally by the entire anteroposterior size to the anterior longitudinal ligament by a predetermined amount. Then, by giving the patient a gradual extension on the surgical table, deformation correction is carried out in all planes until the edges of the resection wedge are closed. The rods of the structure bent in accordance with the proposed correction of kyphosis are fixed in the heads of screws or other fastening devices and the final installation of the structure is carried out. After closing the edges of the resection wedge, the position of the dural sac and spinal roots is revised. The operation is completed with bone autoplasty in the area of the resected posterior structures, residual defects of the ventral vertebrae. Manipulations are carried out under radiological control (Fig. 2). The wound is washed with saline, the wound is drained. The wound is sutured in layers and an aseptic dressing is laid.

Example.

Patient Ch-o, born in 1963, was admitted to the FSBI NNIITO named after Ya.L. Tsivyan of the Ministry of Health of Russia in March 2014 with complaints of lack of movement, sensation in the legs, pain in the thoracic spine when trying to sit, impaired function pelvic organs. Prescription injury 6 months.

After a comprehensive clinical and radiological examination of MSCT (Fig. 3, Fig. 5) and MRI (Fig. 4), examinations by specialists, a clinical diagnosis was established: Late period of traumatic disease of the spinal cord. Post-traumatic kyphotic, left-sided rotational and anterior shear deformity at the level of Th6-Th7 vertebrae due to a bilateral bilateral sliding subluxation of Th6 vertebra, horizontal fracture of the lower articular processes, arch of the Th6 vertebra, compression fractures of the bodies of Th6, Th7 vertebrae. Compression of the spinal cord at the level of the Th6 vertebra. Lower paraplegia. Violation of the functions of the pelvic organs as a delay. ASIA A.

The treatment of post-traumatic multiplanar deformity at the level of Th6-Th7 vertebrae by the proposed method, transpedicular fixation of Th4-Th5-Th6-Th8-Th9-Th10 vertebrae. Skin, fiber, superficial fascia are dissected by a linear incision along the line of the spinous processes from Th3 to Th10 vertebrae. To the right and to the left of the spinous processes, the trapezius muscle is cut off. The spinous processes from Th4 to Th10 are skeletonized. Half-arms, articular processes are exposed. Marked kyphotic, anterior shear and left-sided rotational deformity at the level of Th6-Th7, a horizontal fracture of the articular processes at this level with signs of consolidation on both sides were noted, paraossal ossifications were noted. In accordance with the anatomical landmarks under X-ray control, pedicle screws are inserted into the roots of the arches of Th4, Th5, Th8, Th9, Th10 on both sides, and in the Th6 vertebra on the left. The spinous processes of Th6, Th7 vertebrae are cut off at the base. The lower articular processes of Th6, the superior articular processes, and the arch of Th7 are resected. Using the boron and angle chisels, the roots of the Th7 temples were resected on both sides, the Th6-Th7 disk, the cranial part of the Th7 body, and the caudal locking plate Th6 were resected to the entire anteroposterior size to the anterior longitudinal ligament. Thus, a wedge-shaped defect is formed up to the anterior longitudinal ligament with a base of 24 mm. The dural sac is visualized and circularly highlighted. After giving additional extension at the vertebrotomy level, a correction of kyphotic deformation within 25 ° was obtained, the anterior shear and left-sided rotational deformities are fully corrected. The installation was carried out. Additional compression is given along the bars of the transpedicular structure at the level of Th6-Th7 7 mm. The fixation is stable. Bone autografts from resected vertebral structures are placed in the area of residual defect of the posterior structures and vertebral bodies. The wound was washed with saline, the wound was drained. The wound is sutured in layers, an aseptic dressing is laid. The postoperative period was uneventful. On the 6th day, the patient is activated, adapted to sitting. On the control MSCT (Fig. 6) in the postoperative period, it was noted that correction of kyphotic, anterior shear and rotational deformity was achieved. On the control MSCT after 6 months, the achieved correction is preserved, there are signs of a ventral bone block Th6-Th7 vertebrae (Fig. 7).

The advantage of the proposed method compared to the existing ones is that in this method, a high result of bone fusion, a high percentage of correction when performing the method is traced. When using the method, kyphotic, shear and rotational deformities in the thoracic, thoracolumbar, lumbar spine are corrected. The spine remains in a stable position.

The method of segmental vertebrotomy is implemented on modern equipment, using modern technologies and materials.

Claims (1)

A method of segmental vertebrotomy, including resection of the posterior root structures of the arches and vertebral body with subsequent correction of deformation until the edges of the obtained resection defect are closed using a fixator, characterized in that the cranial part of the broken vertebra, the degenerated disk and the caudal closure plate of the overlying vertebra are resected horizontally to the entire anteroposterior size to the anterior longitudinal ligament, providing planned correction in all planes and tight bone contact of two adjacent poses onkov position correction achieved.

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