RU2610069C2 - Method of surgical treatment of thoracolumbar intervertebral disk hernia in dogs - Google Patents

Abstract

FIELD: veterinary science.

SUBSTANCE: invention refers to veterinary science and can be used for surgical treatment of thoracolumbar intervertebral disk hernia in dogs. Into the area of the dorso-lateral surface of the metapophysis located in caudal direction from the involved disk by means of a guide pin in series, coaxially dilatators are introduced, a tube and a rotary adjutage of the endoscope are installed on them. Metapophysis and zygapophysis are resected with formation of a hole in the vertebra connecting with the vertebrates channel. Nucleus pulposus fragments of the involved disk are removed.

EFFECT: method enables reducing injuries and providing adequate visualization of structures of the spinal cord.

1 cl, 2 dwg

Description

The invention relates to the field of veterinary medicine and can be used in the treatment of dogs with a hernia of the intervertebral disc in the thoracolumbar spine.

A known method of surgical treatment of a hernia of the intervertebral disc using endoscopic techniques. The method provides for access to the intervertebral disc by opening the yellow ligament and partial resection of the arch of the cranially located vertebra (Gushcha A.O., Arestov S.O. Endoscopic spinal surgery. - M .: GEOTAR-Media, 2010. 96 p.).

However, this method cannot be used in veterinary practice, since it does not take into account the features of the anatomical structure of the vertebral column of animals.

A known method of surgical treatment of herniated discs in dogs by hemilaminectomy or mini-gelaminectomy followed by open removal of fragments of the pulpous nucleus (Denny H.R., Butterwof S.J. Orthopedics of dogs and cats. -M.: Aquarium-Print, 2007. 696 from.).

The disadvantage of this method is the need for extensive surgical access to the affected segment, bleeding from surrounding soft tissues and insufficient visualization of the structures of the spinal cord during surgery.

The objective of the invention is to develop a method for the surgical treatment of a hernia of the intervertebral disc of the thoracolumbar region in dogs, which reduces the morbidity of surgical intervention.

This problem is solved by the fact that in a method involving performing a hemilaminectomy with subsequent removal of fragments of the pulpous nucleus of the affected disc, a hemilaminectomy is performed using an endoscopic technique, while initially, through a skin incision, at an angle of 45 degrees relative to the sagittal plane, to the dorsolateral surface of the mastoid process of the vertebra located caudal to the affected disk, dilatators are introduced coaxially sequentially using a guide needle, they tube and a rotatable nozzle of the endoscope, and then resecting the articular and mastoid processes to form a vertebral arch holes communicating with the vertebral canal. At the same time, it is provided that, when fragments of the pulpous nucleus are localized in the region of the fibrous ring, a hole is formed in the central part of the pedicle of the vertebral arch located caudal to the affected disk.

The invention is illustrated by a description, an example of practical use and illustrative material, which shows:

FIG. 1 - MRI image of the dog’s lumbar spine before treatment, Hansen I type herniation of the intervertebral disc at the level of Th _XIII- L _I ;

FIG. 2 - MRI image of the dog's lumbar spine after treatment.

The method is as follows.

After anesthesia and treatment of the surgical field, endoscopic access to the spinal canal is performed in the area of the affected intervertebral disc.

When it is performed, fluoroscopy or radiography of the spinal column is initially performed using an X-ray contrast marker, which is used as an injection needle inserted into the area of the cranial articular process of the vertebra in the projection of the affected disc.

Through the soft tissue at an angle of 45 degrees to the sagittal plane, the guide needle is inserted all the way into the dorsolateral surface of the mastoid process of the vertebra located caudal to the affected disk. Then perform a linear incision of the skin and subcutaneous tissue in such a way that the previously introduced guide needle is located in the center of the generated surgical wound.

A sequential coaxial introduction of dilatators is carried out along the guide pin, the last of which is installed a tube. After that, the dilatators are removed, and the tube is fixed in the operating wound using a hinged tripod fixed to the operating table. A rotary nozzle is mounted on the tube, directly into which an endoscope with a 30 ° viewing angle is inserted.

Under visual control (directly through the tube or focusing on the image on the monitor screen), an audit of the surgical wound is performed. If necessary, additional skeletonization of the anatomical structures of the vertebra and electrocoagulation of bleeding areas of soft tissues are carried out.

Spoon-shaped nippers resect the mastoid and articular processes. Removing the remains of the articular process and part of the vertebral arch is performed using boron. After entering the spinal canal (control of which is carried out using a surgical probe), further expansion of surgical access is carried out using Kerisson's nippers in the ventral and caudal directions.

To prevent thermal damage to the bone and spinal cord, the boron and the reaming area are constantly irrigated with a sterile 0.9% sodium chloride solution, the excess of which is removed from the surgical wound using an aspirator.

If it is necessary to expand surgical access in the cranial direction, the additional articular process and a fragment of the leg of the arch of the cranially located adjacent vertebra are also resected.

Under visual control, fragments of the pulpous nucleus are evacuated with a spoon and / or tweezers.

It is also envisaged that when localizing fragments of the pulpous nucleus in the region of the fibrous ring, the method can be performed using mini-hemilaminectomy. In this case, the guide needle is mounted on the central part of the leg of the arch of the vertebra located caudal to the affected disc. The above methods consistently establish dilators, tube, rotary nozzle and endoscope. After that, also through the tube, using the bur in the central part of the leg of the vertebral arch, a hole is drilled, which, if necessary, is expanded in the cranial direction. Next, through the formed hole under endoscopic control, fragments of the pulpous nucleus are removed.

Then, in all cases, fenestration of the intervertebral disk is performed, during which a part of the fibrous ring is opened and removed with a scalpel from its lateral surface, and then the remains of the pulpous nucleus are removed.

At the end of the operation, the surgical wound is revised, the endoscope is dismantled. The muscles are sutured, the surgical wound is closed with medical glue or a stapler.

The method is illustrated by the following clinical observation.

A dog, dachshund, female, aged 2 years old, was admitted to a veterinary clinic with a diagnosis of Hansen I type intervertebral disc herniation at the level of Th _XIII- L _I , grade 4 neurological disorders according to the modified IR Griffits scale.

During the operation, after anesthesia and treatment of the surgical field, under fluoroscopic control, the guide needle was inserted through the soft tissues at an angle of 45 degrees to the sagittal plane into the dorsolateral surface of the mastoid process of the vertebra located caudal to the affected disc. Then, a linear incision was made in the skin and subcutaneous tissue in such a way that the previously introduced guide needle was located in the center of the generated surgical wound.

A sequential coaxial introduction of dilatators was carried out along the specified guide pin, the last of which was installed a tube. After that, the dilatators were removed, and the tube was fixedly fixed in the operating wound using an articulated tripod fixed to the operating table. A rotary nozzle was mounted on the tube, into which an endoscope with a 30 ° viewing angle was inserted.

Under visual control (directly through the tube or focusing on the image on the monitor screen), the surgical wound was revised and electrocoagulation of bleeding areas of soft tissues was performed.

Spoon-shaped nippers resected the mastoid and articular processes. Using boron, the remnants of the articular process and parts of the vertebral arch were removed.

After entering the spinal canal, further expansion of surgical access was performed using Kerisson nippers in the ventral and caudal directions. Under visual control, fragments of the pulp nucleus were evacuated using a spoon and tweezers.

Next, fenestration of the intervertebral disc was performed. The scalpel was opened and part of the fibrous ring was removed from its lateral surface, and then the remains of the pulpous nucleus were removed with a spoon.

At the end of the operation, the surgical wound was revised, after which the endoscope was dismantled. Two sutures with an absorbable monofilament were applied to the muscles, the incision in the skin was closed using a medical stapler. In the postoperative period, the dog was prescribed analgesics and antibacterial drugs.

On the 3rd day after the operation, restoration of pelvic limb support ability was achieved. At the follow-up examination after 1 year, a neurological deficit was not detected, the achieved treatment result remains.

The implementation of the method provides a reduction in the morbidity of surgical intervention in the surgical treatment of a hernia of the intervertebral disc of the thoracolumbar region in dogs.

Claims (2)

1. A method for surgical treatment of a hernia of the intervertebral disc of the thoracolumbar region in dogs, comprising performing a hemilaminectomy and then removing fragments of the pulpous nucleus of the affected disc, characterized in that hemilaminectomy is performed using an endoscopic technique, initially, through a skin incision, at an angle of 45 degrees relative to the sagittal plane, to the dorsal-lateral surface of the mastoid process of the vertebra, located caudal to the affected disc, using a guide spokes sequentially dilators coaxially injected, mounted on them and the rotary nozzle tube of the endoscope, and then resecting the articular and mastoid processes to form a vertebral arch holes communicating with the vertebral canal. 2. The method according to p. 1, characterized in that when localizing fragments of the pulpous nucleus in the region of the fibrous ring, a hole is formed in the central part of the leg of the vertebral arch located caudal to the affected disk.

Images