RU2641160C1 - Method for treatment of c2 vertebra injury - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: access is performed in the C4 vertebra projection along the outer edge of the nodal muscle in the direction between the sternocleidomastoid muscle and the anterior scalene muscle. Then a channel is formed laterally from the internal jugular vein, common carotid artery and vagus nerve to the C3 vertebra, starting from the bottom edge of the transverse process of the C3 vertebra base, through its body into the C2 vertebra body at an angle of 50-70° of the axial line of the C3 vertebra and 5-10° in the frontal plane of the median line of the spine. The fixing screw is inserted into the created channel. Similarly, the vertebrae are fixed from the opposite side of the neck.

EFFECT: method allows to reduce trauma, labour, avoid prolonged immobilization.

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Description

The invention relates to medicine, namely to traumatology, orthopedics and neurosurgery, to the surgical treatment of spondylolisthesis of the second cervical vertebra.

According to statistics from various sources, traumatic injuries of the second cervical vertebra account for up to 10% of the total number of injuries of the spine, with traumatic spondylolisthesis of the second cervical vertebra occurring in 7% of cases. The most common causes of spondylolisthesis of the second cervical vertebra are traffic accidents (accidents), as well as falls on the head (diver's injury).

Traumatic spondylolisthesis of the second cervical vertebra is a serious disease, often leading to disability of patients.

There is a method of restoring the position of a displaced vertebra in the surgical treatment of spondylolisthesis (RF Patent 2423088, IPC A61B 17/56, publ. 2011), including the introduction of transpedicular screws located on rods with a screw thread in the displaced vertebra and in the underlying one. The rods are fixed to each other, followed by the reduction of the displaced vertebra by rotating the nuts on the rods to the anatomically correct position.

The disadvantages of this method are: high morbidity, the risk of damage to the vertebral arteries, spinal cord and spinal roots and the development in the postoperative period of myofascial syndrome, aggravation of vertebral-basilar insufficiency.

The closest is a method of treating injuries of the cervical spine, including traction of adjacent muscles and fascia, x-ray control of the level of spinal deformity, interbody fusion, fixation of the vertebrae with screws and plate (RF Patent 2434598, IPC A61B 17/56, publ. 2011).

The disadvantage of this method is: high complexity and trauma, since they remove the intervertebral disc, install the plate, which increases the time of surgery, requires long-term immobilization.

The objective of the present invention is to remedy these disadvantages, increase the therapeutic effect by reducing the morbidity of surgery, minimizing the risk of damage to the main vessels of the neck, trachea and esophagus; exclusion of resection of the intervertebral disc C2-C3 and partial resection of the bodies C2, C3 of the vertebrae; elimination of the risk of damage to the dura mater, spinal cord and spinal roots; reliable stabilization of the spinal-motor segment C2-C3, reduction of operation time and postoperative period is provided.

The task is achieved by the treatment of injuries of the C2 vertebra, including traction of adjacent muscles and fascia, X-ray control of the level of deformation of the spine, interbody fusion, fixation of the vertebrae with screws, reduction of the displaced vertebra, it is proposed to access the projection of the C4 vertebra. At the same time, access is first made from one side of the neck, passing the needle along the outer edge of the sternocleidomastoid to the side between the sternocleidomastoid muscle and the anterior scalene muscle, then passing laterally from the internal jugular vein, common carotid artery and vagus to the C3 vertebra. A channel is formed, starting from the lower edge of the base of the transverse process C3 of the vertebra, through its body into the body C2 of the vertebra at an angle of 50-70 ° from the axial line C3 of the vertebra and 5-10 ° in the frontal plane from the midline of the spine, and the fixing screw is inserted into the created channel. Then similarly fixation of the vertebrae from the opposite side of the neck, reduces the time of surgery.

This method of surgical intervention is minimally invasive, which allows to increase the therapeutic effect of the operation by reducing surgical trauma to the tissues, and reducing the risk of damage to the main vessels of the neck, trachea and esophagus.

In FIG. 1 shows a diagram of the location of sections in the projection of the body C4 of the vertebra from two sides; in FIG. 2 - the direction of the spoke when accessing the anterolateral surface to the body C3 of the vertebra; in FIG. 3, 4 - diagram of the introduction of the spokes in the sagittal and frontal planes, respectively; FIG. 5, 6 - CT scan of the cervical spine of the patient before surgery in the sagittal and axial planes, respectively (example); FIG. 7, 8 - X-ray of the cervical spine after surgery in the frontal and sagittal plane (example).

The method is as follows.

It is necessary to have a magnifying technique (microscope or head magnifier), microsurgical instruments, a rigid endoscope, and an electron-optical transducer (EOP).

Surgery is performed under general anesthesia. The patient is lying on his back. The head is thrown back. In the area of the projection of the C4 vertebral body, along the outer edge of the sternocleidomastoid puncture is performed and hydrotreating is carried out by introducing 20 ml of physical solution Then a transverse incision is made 1 of the skin 0.5 cm at the level of C3-C4 (Fig. 1).

Subcutaneous fat is visualized. The guide needle 1 passes through platism, the sternocleidomastoid muscle 2, the lateral-anterior scalene muscle 3 are medially removed. It is carried out further laterally from the internal jugular vein, common carotid artery and vagus nerve 4. The point of insertion of the needle is located lateral to the long neck muscle 5, at the lower edge of the base of the transverse process C3 of the vertebra (Fig. 2). X-ray control of the correct insertion of the guide needle is performed.

A tube retractor is alternately inserted into the guide needle, increasing the diameter of the sleeves from 5 mm to the required field of view for the surgeon, thereby traction the adjacent muscles and fascia. Using the tube retractor sets the angle and direction of introduction of the spokes. The spokes, passing through the vertebral body C3, the C2-C3 disk, into the C2 body, are inserted at an angle ranging from 50 to 70 ° from the axial line C3 of the vertebra, the angle of introduction in the frontal plane is 5-10 ° from the midline.

A channel is formed along the guide needle by a cannulated drill, then the drill is removed.

Then, a cannulated compression screw is inserted into the formed channel, with a diameter of mainly 3-4.5 mm and a length of 23-27 mm, extending from the caudal lateral margin C3 of the vertebra, then through the disk C2-C3 into the body C2 of the vertebra to the base of the dentate process. Then, the spoke and tube retractor are removed. Hemostasis is performed. An intradermal suture is applied. An aseptic dressing is applied to postoperative sutures.

According to the above scheme, the spinal motion segment C2-C3 is similarly fixed on the opposite side. Next, X-ray control of the correct insertion of the screws is performed.

Activation of the patient in bed 1-2 hours after surgery, verticalization with external immobilization of the cervical spine in a semi-rigid cervical orthosis of the Philadelphia type on the next day.

Example.

Patient K, 38 years old, was admitted to the clinic on February 17, 2015, with a diagnosis of Traumatic spondylolisthesis of C2 vertebra. Upon receipt of a complaint of periodic pain in the cervical spine arising from movement, a feeling of numbness in the left leg along the outer surface of the thigh.

Sick since 10.12.14, when he was injured in an accident (he was driving). At the place of residence, an RCT-cervical spine was performed - a fracture of the second cervical vertebra, traumatic spondylolisthesis was revealed. Hospitalized in a hospital for further examination and surgical treatment.

Survey data at admission: general condition is relatively satisfactory. The skin of normal color, clean. Pulse 74 in 1 min, rhythmic. Vesicular breathing, NPV 18 per minute, no wheezing. In the musculoskeletal system: fracture traumatic spondylolisthesis of the C2 vertebra. Palpation in the paravertebral zones is painful in the region of C2-C3 vertebrae. The abdomen is soft, painless. Urination is independent.

In neurological status: in a clear mind, contact, adequate, oriented in place and in time. Cerebral symptoms in the form of a headache. FMN - N. Swallowing and phonation are not disturbed. Tendon reflexes on the hands S = D, animated, tendon reflexes on the legs S = D, strength D = S - 5 points. There are no meningeal signs. There are no pathological stop signs.

CT scan of the cervical spine from 01/19/2015: horizontal oblique fracture of the C2 vertebral body with transition to the arches, tooth-like process without pathology (Fig. 5, Fig. 6).

The operation was performed 04.03.15, the ventral axial corporodesis C2-C3 of the vertebrae with cannulated screws according to the proposed method.

Alternately, a channel was formed on both sides through a tube expander with a drill and cannulated compression screws with a diameter of 4 mm and a length of 25 mm were inserted, passing from the caudal-lateral edge C3 of the vertebra, through the disk C2-C3 into the body C2 of the vertebra to the base of the dentate process at the above angles.

In conclusion, hemostasis was performed. The wound is sutured in layers tightly. An aseptic dressing is applied to postoperative sutures.

The postoperative course is smooth. Antibacterial, vascular, analgesic and vitamin therapy, exercise therapy were carried out. Pain syndrome completely regressed. The patient is activated on the 2nd day, independently gets up and walks in the cervical orthosis. The postoperative wound healed by first intention, the sutures were removed on the 10th day.

Postoperative X-ray control (Fig. 7, Fig. 8) and MSCT control - satisfactory comparison and fixation of the body C2 and the body C3 of the vertebrae with two cortical screws held in the cranial direction. Condition at discharge is satisfactory.

To continue treatment, he was discharged under the supervision of a neurologist and general practitioner at the place of residence. Wearing a cervical orthosis for up to 2 months.

When the control x-ray of the cervical spine after 1 month after surgery from 06/19/2015, the state after surgery. Signs of the formation of primary callus at the fracture level. The beginning of the formation of bone-fibrous block C2-C3 vertebrae.

According to the proposed method, 12 patients were treated.

According to observation over 3 years: all patients had no movement restrictions in the cervical spine. In 10 patients, good stabilization was observed, followed by the formation of a bone-fibrous block. In the 1st patient, the failure of the metal structure, due to an active-aggressive lifestyle. In the 1st patient, the formation of a bone-fibrous block did not occur, subsequently this segment was additionally fixed with TPF. All patients returned to work during the first 2 months after surgery.

This method provides reliable stabilization of the vertebral-motor segment, reduces the time of surgery and the postoperative period, accelerates the formation of bone block, reduces the risk of postoperative complications, reduces hospitalization and, as a result, leads to a quick restoration of efficiency and reduce disability.

Claims (1)

A method for the treatment of injuries of the C2 vertebra, including traction of adjacent muscles and fascia, X-ray control of the level of deformation of the spine, interbody fusion, fixation of the vertebrae with screws, reduction of the displaced vertebra, characterized in that the access is carried out in the projection of the C4 vertebra first from one side of the neck along the outer edge of the sternum muscles to the side between the sternocleidomastoid muscle and the anterior scalene muscle, then laterally from the internal jugular vein, common carotid artery and vagus to C3 nca, form a channel, starting from the lower edge of the base of the transverse process C3 of the vertebra, through its body into the body C2 of the vertebra at an angle of 50-70 ° from the axial line C3 of the vertebra and 5-10 ° in the frontal plane from the midline of the spine, and the fixing screw is inserted into the created channel, then similarly fixation of the vertebrae from the opposite side of the neck.

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