RU2601855C1 - Method of posterior spinal-fusion care - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to traumatology, orthopaedics, neurosurgery, and it can be used for posterior spinal-fusion care. Support implant is placed between acanthas of two adjacent vertebrae for unloading posterior support system. Contractor is installed in the form of titanium implant with shape memory at the level of middle one-third of vertebra spinous processes for creating dynamic fixation of VMS.

EFFECT: method enables to reduce injury rate and length of the surgery, to decrease the length of rehabilitation.

1 cl, 2 dwg

Description

The invention relates to medicine, in particular to neurosurgery, traumatology, orthopedics, and can be used to fix the vertebrae during the surgical treatment of osteochondrosis of the lumbar spine.

There are various methods of using interspinous dynamic stabilizers, providing fixation of the rear support structures due to various materials and structures. The most commonly used clamps are DIAM from Medtronic, X-Stop from St. Francis Medical, Interspinous U (coflex) from Fixano and UniWallis from Spine Next. The disadvantages of the DIAM system are the complexity of installation and flashing of the spinous processes, the X-Stop system - Only functions in the state of extension of the spine. Multicomponent and difficult to install, system (coflex) - Increased risk of migration. Displacement of the posterior rotation center, the risk of local kyphosis during distraction and fracture of the spinous processes, UniWallis systems - Difficulty in the intraoperative assembly of the system.

The method of posterior fusion within only one vertebral-motor segment has not been described in the periodic and patent literature (Medical materials and shape memory implants. - Tomsk, 1998. - 489 p .; Sergeev KS Surgical stabilization in the complex treatment of lower chest fractures and lumbar vertebrae: abstract of thesis of a doctor of medical sciences, 2003; patents: RU 97122155/14; RU 2263480; RU 200313834/14).

Closest to the proposed invention is a method of posterior fusion (RU 2076654, A61B 17/56, A61B 17/70, publ. 04/10/1997). The method includes the use of means for contracting a group of vertebrae in the form of a bracket with shape memory, implants of a cylindrical and lamellar shape. One of the main disadvantages of the method is the complexity of the surgical intervention, fixing a group of vertebrae with a constrictor device, which leads to an increase in the duration of the operation, significant blood loss and prolongation of the rehabilitation of patients.

The basis of the present invention is the development of a method of performing an operation within only one vertebral-motor segment, which will reduce injuries and the duration of the operation. It can be performed only on one side without crossing the supraspinatus ligament.

The technical result is achieved by the fact that in the method of posterior spinal fusion, including the use of a support implant and a contracting device, according to the invention, the support implant is placed between the spinous processes of two adjacent vertebrae in the position of increasing the interlaminar distance, unloading the arched joints and nerve roots, and the contracting device, with memory metal forms established at the level of the middle third of the spinous processes of the vertebrae, allows you to create reliable dynamic fixation of the PDS.

The technical result consists in the fact that a simple, low-cost method of fixing the vertebrae within one segment is proposed, based on the use of porous titanium nickelide as a supporting element for increasing the interlaminar distance, unloading the arched joints and nerve roots, eliminating pain, transferring load on the implant. Subsequently, the restoration of muscle and sagittal balance and the function of the posterior ligamentous complex, as well as disk unloading, is facilitated.

The solution to this problem is provided by the fact that in the method of posterior fusion, including the use of support implants and a tightening device in the form of a bracket with shape memory, the support implant is placed between the spinous processes of two adjacent vertebrae to unload the back support complex, and the tightening device is in the form of a titanium implant with memory forms are set at the level of the middle third of the spinous processes of the vertebrae to create dynamic fixation of the PDS.

The essence of the method is ensured by the fact that, according to the invention, a porous implant is used as a support element for unloading the back support complex and a titanium implant with shape memory to create dynamic fixation of the PDS.

The invention is illustrated in FIG. 1-2, which shows the implant, which is installed in the interspinous gap, and the wire (bracket) with shape memory, with which the spinal segment is fixed, which is installed in the groove of the implant and fixed with a screw.

In FIG. 2 shows the ratio of vertebrae after surgery, where 1 is a bracket with shape memory, 2 is an implant, 3 is a spinous process of the vertebra.

The implant has an H-shape, one half of it is twice as thick as the opposite, which allows the thinner part of the implant (in the upright position) to be inserted into the interspinous gap (after distraction) without crossing the supraspinous ligament. Then the implant is moved to the horizontal position and performs the function struts. At the same time, the following increases: the interspinous distance, the size of the intervertebral foramen, the load on the intervertebral disc decreases, thanks to the wire with shape memory the PDS is stabilized, which reduces the possibility of spinal stenosis formation at this level. Allows you to perform surgery on only one side. A wire with shape memory is selected individually for each case (sizes from 30 to 45 mm in increments of 5 mm). First, the wire is inserted into the groove of the implant and its ends (after cooling) are held for adjacent spinous processes. Then the wire takes its original shape, pulling together the spinous processes, after which the wire is fixed in the implant using a screw.

Compared with the prototype, the proposed method can be used in the surgical treatment of various pathologies with degenerative-dystrophic lesions of the spine and used in fixing the spine after a laminectomy, even at several levels, reduces the likelihood of a laminectomized spine.

The first option is stabilization of the vertebral-motor segment after removal of sequestered disc herniation.

The proposed method is as follows. After laying the patient on the stomach in the projection of the spinous processes of the closed vertebrae, an incision is made of the skin and underlying soft tissues 5-6 cm long. After the aponeurosis is cut, the spinous processes and arches of two adjacent vertebrae are skeletonized from the disc herniation. After removal of the yellow ligament of the hernia of the intervertebral disc and decompression of the neurovascular formations of the spinal canal, the interspinous ligament is resected. In the interspinous gap, the lower edge of the arch is resected with kerison to open the spongy part of the spinous processes. A porous titanium nickelide implant is inserted into the defect formed, and at the beginning, the implant of the desired size is inserted vertically, and then, after the distraction of the spinous processes, it is rotated horizontally. Then the distractor of the spinous processes is removed and the implant is tightly fixed in the interspinous gap. After that, a bracket is selected (U-shaped form of the appropriate size), which has the shape memory effect. The internal size between the hooks of the bracket is 30 to 45 mm in increments of 5 mm. The selection of staples is carried out during the operation. Place the bracket in the slot on the implant and fix it for adjacent spinous processes at the level of the middle third so that it is placed in tension to provide the effect of dynamic fixation in the compression mode and the spinous processes approach each other. After that, the bracket is fixed in the implant using a screw. The criteria for the adequacy of fixation are a strong infringement of the interspinous implant in its bed and strong fixation of the staples on the spinous processes. Suturing the wound in layers, drainage of the wound according to Redon.

The second option is the use of an interspinous dynamic implant after decompression of neurovascular formations with various types of spinal stenosis. Access to the spine is performed on both sides. After skeletonization of the arches and interlaminar decompression of the dural sac and roots, an implant is selected according to the size of the interspinous gap. If a laminectomy was performed, then a large implant is used. The implant after distraction of the spinous processes is installed between them and after removal of the distractor is tightly fixed in the interspinous gap. Then, a titanium nickelide bracket with shape memory is selected according to size, which is installed in the groove of the implant and fixed for adjacent spinous processes. After that, the clamp is fixed in the implant with a screw.

Clinical example

Patient V., 52 years old, was admitted to the Neurosurgery Clinic of VMedA February 17, 2014 with complaints of pain in the lumbar spine with radiation to the left leg. The pain appeared after hard physical work. During a clinical and radiological examination (MRI), the diagnosis was made: degenerative-dystrophic lesion of the lumbar spine, sequestered herniation of the intervertebral disc at the level of L4-L5 with compression of the dural sac and L5 root on the left. 02/19/2014, the operation was performed: Diskectomy with interspinous stabilization at the L4-L5 level according to the proposed method "Posterior interspinous segmental stabilization with a porous H-shaped nickel-titanium implant at the level of L4-L5". The postoperative period was uneventful. Discharged on the 9th day after the operation, started work 2 months after the operation (works as an engineer). At the control examination after 1 year, no complaints, working in the same specialty.

Claims (1)

A method of posterior fusion, including the use of support implants and a tightening device in the form of a bracket with shape memory, characterized in that the supporting implant is placed between the spinous processes of two adjacent vertebrae to unload the posterior supporting complex, and the tightening device in the form of a titanium implant with shape memory is set at the middle third of the spinous processes of the vertebrae to create dynamic fixation of the PDS.

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