RU2690913C1 - Surgical treatment method of low-dysplastic spondylolisthesis - Google Patents

Surgical treatment method of low-dysplastic spondylolisthesis Download PDF

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RU2690913C1
RU2690913C1 RU2018134384A RU2018134384A RU2690913C1 RU 2690913 C1 RU2690913 C1 RU 2690913C1 RU 2018134384 A RU2018134384 A RU 2018134384A RU 2018134384 A RU2018134384 A RU 2018134384A RU 2690913 C1 RU2690913 C1 RU 2690913C1
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articular
l5
vertebra
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s1
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Сергей Петрович Маркин
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Федеральное государственное бюджетное учреждение "Новосибирский научно-исследовательский институт травматологии и ортопедии им. Я.Л. Цивьяна" Министерства здравоохранения Российской Федерации (ФГБУ "ННИИТО им. Я.Л. Цивьяна" Минздрава России)
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    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor

Abstract

FIELD: medicine.SUBSTANCE: invention refers to medicine, namely to orthopedics and vertebrology, and can be used for surgical treatment of low-dysplastic spondylolisthesis. Allocate displaced vertebra arc L5, a spondylolysis zone in the interarticular arc part, two spaces between arcs adjacent to the displaced vertebra arc on both sides, articular and transverse processes on both sides. Transpedicular screws are inserted into bodies of adjacent vertebrae. Roots L5, S1 from both sides and the dural sac are decompressed. Disk curettage is performed. Interbody implants are installed. Angular and linear angular displacement of vertebra is corrected, rods are fixed in transpedicular screws. After the transpedicular screws are installed, the displaced vertebra L5 arc is separated and removed. Performing decompression of roots L5, S1 and placing extracted arch L5 in place. On both sides through the lower articular process arches in upper articular process S1 vertebra perpendicular to plane of articular surfaces a pin is conducted. A channel is formed on the pin by a cannulated drill with diameter of 2 mm; a cannulated spongious screw with diameter of 2.5 mm and length of 2 cm is screwed on the spoke; the articular process of the arc is screwed tightly to the articular process of the sacrum.EFFECT: method provides complete linear and angular reconstruction of displaced vertebra and improves clinical result by spinal cord root decompression and reliable interbody spondylolysis.1 cl, 8 dwg, 1 ex

Description

The present invention relates to medicine, namely to vertebrology, and can be used in neurosurgical and orthopedic interventions for low dysplastic spondylolisthesis.

Spondylolisthesis is the displacement of the overlying vertebra relative to the underlying vertebra. According to the etiological factor, all spondylolisthesis is divided into 2 groups: developmental spondylolisthesis (dysplastic) and acquired (degenerative, traumatic, iatrogenic). Dysplastic spondylolisthesis in turn are divided into highly dysplastic and low dysplastic. In case of low dysplastic spondylolisthesis (VAT) there is a defect in the articular part of the arch. The rest of the vertebra is practically the same as normal. In this regard, the displacement of the vertebra during low-dysplastic spondylolisthesis is never more than the second degree. However, patients with VAT may experience pains in the lower back and legs that are resistant to conservative treatment, due to instability in the segment and compression of the roots in the spinal canal. In this case, surgical treatment is required.

There are many ways of surgical treatment of VAT. Decompressive, stabilizing, and decompressive-stabilizing operations are performed from the back, front, or combined access.

For decompressive surgery, Gill operation (Gill GG, Manning JG, White HL. Surgical treatment of spondylolisthesis without spinal fusion). J Bone Joint Surg Am 1955; 37: 493-520) performs a laminectomy and decompression of the roots. Disadvantages: 1) the dural sac for a long distance comes in contact with the paravertebral muscles, resulting in an extensive adhesions process, which often leads to radicular pain, 2) the dural sac is deprived of mechanical protection against accidental impacts, 3) aggravation of the already existing instability in segment.

There is a method of surgical treatment of VAT - "in situ fusion with transpedicular fixation" (Bernhardt M. Posterolateral lumbar and lumbosacral fusion screw fixation. Clin Orthop 1992: 284: 109-115), in which the typical installation of pedicle screws in bodies of the upper (displaced) and lower vertebrae, rods are laid and fixed in the heads of the screws, the decortication of the transverse processes of the L5 vertebra and the wings of the sacrum is carried out, pieces of autocaptic tissue, allokost or other bone-replacement material (BMP, hydroxyapatite, t are laid on the exposed spongy bone) ikaltsiyfosfat). Decompression of the compressed roots is carried out by means of a laminectomy. This method is more reliable. In addition to decompression, stabilization is carried out in the segment. However, due to the lack of anterior support (there is no interbody fusion), the probability of a metalwork breakdown and the development of pseudoarthrosis are high. Due to the high load on the structure, even when fixing in situ (in a neutral position), no correction of the relationship of the vertebrae is performed during this operation, in order not to overload the structure. In addition, as a result of a laminectomy, an adhesions process in the spinal canal develops and the dural sac loses mechanical protection against accidental impacts.

The method of laminoplasty with titanium plates is known (Hida S, Naito M, Arimuzu J, Morishita Y, Nakamura A (2006). Eur Spine J 15: 1292- 1297), in which for access to the spinal canal make longitudinal through cuts arc on both sides of the spinous process, but medial to the inner edge of the articular processes. After dissection of the interstitial ligaments, the excised unit is removed, the main step is performed (for example, removal of an intradural tumor), and at the end of the main stage, the block is set back. Titanium plates are placed on the zones of the formed cuts and fixed with screws. The disadvantage of this method is the small width of the formed bone window (about 1.5 cm), which makes it impossible for bone decompression of the spinal cord roots and the implementation of interbody fusion.

The closest to the claimed method is the surgical treatment of VAT in the form of posterior interbody fusion with reduction and transpedicular fixation of the displaced vertebra (Suk SI, Lee CK, Kim WJ, et al. (1997) Adding posterior lumbar interbody fusion) decompression in spondylolytic spondylolisthesis (Spine 22: 210-219).

In a position on the abdomen, a linear incision of soft tissues along the line of the spinous processes is performed. An articulated vertebra (L5), an area of spondylolysis in the interarticular part of the arch, two interstitial spaces adjacent to the arc of an displaced vertebra on both sides are distinguished, articular and transverse processes on both sides. In the body of the displaced vertebra (L5) and in the body of the underlying vertebra (S1 sacrum), pedicle screws are installed through pedicules. Perform laminectomy and resection of the articular processes of the arculocestral joints on both sides. Spondylolysis area is resected on both sides. An audit of the L5 roots leaving the spinal canal in the region of the intervertebral openings L5-S1 is carried out on both sides. When compression is detected by their yellow ligament or the bottom of the lice, the final decompression is performed. On one side, the dural sac and spine are shifted to the midline. The opened fibrous annulus of the disk is dissected, and the disc is cured. Carry out the selection of height and wedge-shaped (4, 8 degrees) implants. The selection of the height of the implant is carried out by templates. In order to maximally restore the height of the intervertebral disk during the operation, always due to the “lost” disease, stretch the interbody space by bending the patient with the operating table and stretching the spinous processes of the operated segment with a special distractor. Thanks to these techniques, in the intervertebral gap can manage to enter the maximum possible height cage size. The cage selected with the help of templates is stuffed with crumb, is screwed onto the impactor pin and, with a hammer blow on the impactor handle, is hammered into the interbody space through a hole in the fibrous ring. Impactor retrieve. The methodically correctly established implant at this stage is tightly wedged in the interbody space between the bodies of adjacent vertebrae. After that, using similar actions, the interbody body implant is installed on the opposite side. The interstitial distractor is removed. The rods are laid in the heads of the screws. With the help of the patient's operating table, they unbend, i. they give it the necessary position of lordosis in the operated segment, while the screws are brought together by a special contractor. Thus, the angular correction of the position of the vertebrae in the segment. If, as a rule, the spontaneous linear reduction of the displaced vertebra arising during the operation and mobilization of the posterior structures is insufficient, then an additional “forwarding” of the upper (displaced) L5 vertebra by the Beale Reducer is carried out. Eliminate linear displacement within the limits specified by the elastic resistance of the tissues. Full linear reposition of the vertebra, as a rule, is not carried out. Since, for even indirect decompression of tensioned nerve structures, even a small linear correction is sufficient, and angular correction is decisive in shaping the correct balance of the spine. The rods in the heads of the screws tighten nuts. Conduct x-ray control.

This method provides the ability to perform adequate direct and indirect (due to the stretching of the intervertebral holes) decompression of nerve structures, angular correction in the segment in the sagittal plane, reduces the likelihood of implant development, nonunion, pseudoarthrosis.

The disadvantage of this method is that the free-lying arch of the displaced vertebra and the yellow ligaments adjacent to it above and below are removed. in fact, the entire posterior wall of the spinal canal. The dimensions of the defect in the posterior wall of the spinal canal can be approximately 5 × 5 cm. As a result: 1) the dura mater and roots (contents of the spinal canal) are in direct contact with the paravertebral muscles, an extensive scar-adhesions process is formed, 2) the dural sac and the roots , enclosed in it, are deprived of mechanical protection, which is important, given the proximity of the location of the dural sac to the surface of the body in the upper sacral region.

At the same time, the implementation of posterior interbody fusion through the interstitial access with preservation of part of the arc in patients with low dysplastic spondylolisthesis is impossible, due to their significant anatomical differences from patients without dysplasia. Firstly, due to the presence of a defect in the inter-articular part, the entire arch behind this defect, including the lower articular processes, the arc plate, the spinous process, remains in place while the vertebral body shifts forward and tilts down. As a result, the disk plane passes through the arc itself, and not through the interstice gap, as in patients with osteochondrosis. Secondly, the vertebral arch without normal fusion in the area of spondylolysis with the rest of the vertebra is a very mobile, “freely dangling structure”. Attempts to resect it partially make the remainder even more mobile and cause problems during subsequent stages, when, with a slight pushing off of the remaining part, it is unexpected and sometimes invisible for the surgeon to shift and cause compression of the nervous structures.

The task (technical result) of the present invention is to create a method of surgical treatment of low dysplastic spondylolisthesis, free from the disadvantages described above.

The task is solved by allocating the biased L5 vertebra, the spondylolysis zone in the inter-articular part of the bow, two inter-articular spaces adjacent to the displaced vertebra on both sides, the articular and transverse processes on both sides, the corpus callosum is decompressed L5, S1 on both sides and dural bag, perform disc kurettage, install interbody implants, correct the angular and linear displacement of the vertebra in the sagittal plane, fix the pants and pedicle screws. According to the invention, after the installation of pedicle screws, the yellow ligament is separated from the upper and lower edges of the arch, the inner surfaces of the arching joints, and the formed yellow flaps of the ligament are resected. Capsules of both arcuate gang joints are dissected along the articular fissure, spondylolysis fibro-cartilaginous formations are dissected to the right, the right side of the bow is raised. Rotate the handle to tear the fibrous tissue in the area of spondylolysis on the left, the bow is removed. Cartilage is scraped from the articular surfaces of the lower articular processes of the bow and the upper articular processes of the sacrum, and the cortical bone of the articular surfaces of the adjacent articular processes is treated until areas of uncovered spongy bone appear. Then, the decompression of the L5, S1 rootlets is performed and the extracted L5 shackle is put in its original place. On both sides, through the lower articular process of the bow in the upper articular process of the S1 vertebra (sacrum) perpendicular to the plane of the articular surfaces, a needle is held. A cannulated drill with a diameter of 2 mm forms a canal on the needle, a cannulated spongy screw 2.5 mm in diameter, 2 cm long, which tighten the articular process of the arch to the articular process of the sacrum is screwed on the spoke.

The proposed sequence of operations provides the possibility of a complete linear and angular reduction of the displaced vertebra, which creates favorable conditions for the formation of the bone block and improves the clinical outcome. During the operation, a wide bone window into the spinal canal is created, which allows adequate decompression of the spinal cord roots and a reliable interbody fusion without causing excessive trauma to the nerve roots. After the end of the manipulations in the spinal canal, the vertebral arch is placed on “its place” and closes the bone window. A barrier is created between the dural sac and the paravertebral muscles, which prevents the development of adhesions. The dural bag receives reliable mechanical protection against accidental impacts. This leads to a decrease in residual radicular and lumbar pain in the postoperative period, a decrease in the likelihood of neurological deficit with mechanical effects on the lumbar region and an improvement in the clinical outcome.

The invention is illustrated by the scheme of the operation, where figure 1 shows the rear view, in FIG. 2 - top view. FIG. 3 presents the results of the MSCT before the operation. FIG. 4-8 are the results of MSCT after the operation: FIG. 4 -sagittal section, FIG. 5 and 6 are axial sections; FIG. 7 - axial cut through spongy screws; 8 - cut through right spongy screw.

Below is an example of a specific implementation of the proposed method.

The patient is placed on the operating table on the abdomen. Perform a linear incision of soft tissue along the line of the spinous processes. Allocate the bow 1 displaced vertebra L5, zone 2 spondylolysis in the inter-articular part of the arch, two interjacent spaces adjacent to the arch 1 displaced vertebra on both sides, the articular 3, 4 and transverse processes on both sides. In the body 5 of the displaced vertebra L5 and in the body 6 of the underlying vertebra S1 (sacrum), transpedicular screws 7 are installed through the pedicles.

Raspar separates the yellow ligament 8 from the upper and lower edges of the bow 1, the inner surfaces of the arcuate-like joints. After this, the inner surface of the arcuate process joints L5-S1 becomes available for inspection. The capsule from the inner surface of one of the joints is removed with a raspator, after which the articular gap between the lower 3 articular process of the L5 vertebra, which lies superficially, and the upper 4 articular process of S1, which lies deeper, becomes visible. A flat racer is inserted into the joint space and the joint surfaces of the articular processes are pushed by 90 degrees. At the same time, the remnants of the joint capsule become tensioned and through them the joint gap in the lower and lateral parts of the joint becomes visible. Along the joint space finally cut through the joint capsule. In the same way cut through the capsule of the arcuate joint of the opposite side.

Separate adhesions between the ventral surface of the plate of the arch 1 and the dural bag. The surface fibro-cartilaginous formations of the zone of spondylolysis 2 are dissected to the right. After this, the bow 1 on the right remains fixed only deep in the zone of spondylolysis 2. The handle 1 for the spinous process is pulled upwards. The spondylolysis zone 2 on the right is stretched and its deep sections become visible. Deep fibro-cartilaginous formations of the spondylolysis zone 2 on the right are dissected and, thus, the shackle 1 on the right side is completely detached from the vertebra. The cleared side of the bow 1 is raised and, rotating, they achieve a rupture of fibrous tissues in the zone of spondylolysis 2 on the left. Shackle 1 is removed. However, it remains intact. The remaining soft tissue is scraped off. The cartilage from the articular surfaces of the lower articular processes 3 is also scraped off. The cortical bone of the articular surfaces of the lower articular processes 3 is treated until the appearance of blood dew, i.e. before the appearance of areas of uncovered spongy bone.

S1 rootlets are inspected, which exit from the dural sac at the level of the L5-S1 disc, lower at the rear upper corner of the 6 S1 vertebra body and bend through it and stretch, and lower at the level of the S1 vertebral roots, pass under the hypertrophied upper articular processes 4 S1 vertebra and compressed them. Hypertrophied, sprouting in the direction of the midline, the upper articular processes of the 4 S1 vertebra are resected from the medial side (medial fasteectomy is performed). This is achieved by decompression of the S1 roots in the lateral pockets. At the same time, the middle and lateral parts of the upper articular processes of the 4 S1 vertebra are left intact.

On one side, the dural sac and spine are shifted to the midline. The opened fibrous annulus of the disk is dissected, and the disc is cured. Carry out the selection of height and wedge shape (4, 8 degrees) of implants 9. Selection of the height of the implant 9 is carried out with standard templates. In order to maximally restore the height of the intervertebral disk during the operation, always due to the “lost” disease, stretch the interbody space by bending the patient with the operating table and stretching the spinous processes of the operated segment with a special distractor. Thanks to these techniques, it is possible to introduce an implant 9, the maximum possible height, into the intervertebral space. The cage selected with the help of templates is filled with autocodular chips, screwed onto the impactor pin and, with a hammer blow on the impactor handle, the resulting implant 9 is driven into the interbody space through a hole in the fibrous ring . Impactor retrieve. Methodically correctly installed implant 9 at this stage is tightly wedged in the interbody space between the bodies of adjacent vertebrae 5 and 6. After that, using similar actions, the interbody body implant 9 is installed on the opposite side. Interstate distractor clean. In the heads of the screws 7 stack rod. With the help of the patient's operating table, the patient is extended, i.e. give it the necessary position of lordosis in the operated segment, while screws 7 are brought together by a special contractor. Thus, the angular correction of the position of the vertebrae in the segment is carried out. If, as a rule, the spontaneous linear reduction of the displaced vertebra 5, which occurs during the operation and mobilization of the posterior structures, is insufficient, then the additional (displaced) L5 vertebra 5 is further reduced by the Beale reducer. The rods in the heads of the screws 7 are tightened with nuts. Conduct x-ray control. An audit of the L5 roots leaving the spinal canal in the region of the intervertebral holes L4-L5 on both sides is carried out. As a rule, at this point, the upper-lower dimensions (height) of the intervertebral foramen are significantly increased due to the distraction of the vertebrae and the use of implants 9 of maximum height, i.e. there is an indirect decompression of the roots. The posterior sections of the fibrous ring are tightened and compression of the nerves by the swelling disc is also eliminated. However, when residual compression of the nerves is detected with fragments of the yellow ligament 8, the lower part of the pedicles of the overlying vertebra resembles the compressing structures and the final decompression of the L5 roots.

From the articular surfaces of the upper articular processes of the 4 S1 vertebra, the cartilaginous plate is scraped off with a raspatory, and the remaining cortical layer is cleaned to blood dew. The previously extracted vertebral arch 1 is placed in the same place and pressed tightly. On one side, through the lower articular process 3, the arch 1 in the upper articular process 4 S1 of the vertebra perpendicular to the plane of the articular surfaces conduct a needle. In this case, the needle goes from the inside outwards, from top to bottom. The needle cannulated with a drill forms a channel with a length of 7-20 mm, depending on the anatomical features of the patient. The drill is removed, the cannulated spongy screw 10 is screwed along the spoke, which is used to carry out a tight and firm pulling of the articular process 3 of the arms 1 to the articular process 4 of the sacrum. In the same way, the spongy screw 10 is screwed into the articular pair on the other side. Perform radiological control.

Clinical example.

Patient A., born in 1994. Entered the FGBU "NIITO them. JL Tsivyan" Ministry of health of Russia in February 2018 with the following complaints: pain in the lumbar spine, on the back surface of both legs, aggravated when walking. At ease the pain pass.

After a comprehensive clinical and radiological examination, which included a specialist's examination, X-ray, MSCT (Fig. 3) and MRI, a clinical diagnosis was made: Low-dysplastic spondylolisthesis L5 Pet, radiculopathy S1 on both sides, functional insolvency syndrome of the lumbar spine. At MSCT, it can be seen that plane 11 of the disc passes through the arc itself, and not through the interstice gap, as in patients with osteochondrosis.

Decompression-stabilizing intervention was carried out: decompression of the spinal cord roots, transpedicular fixation of the L5-S1 vertebrae, posterior interbody wall fusion L5-S1.

The position of the patient on the operating table lying on his stomach on a special stand. Linear incision of soft tissue along the spinous processes. Displaced vertebra (L5), spondylolysis zone in the interarticular part of the arch, interstitial spaces L4-L5, and L5-S1 on both sides, articular and transverse processes on both sides were selected. The pedicle screws 6.5 × 45 mm were installed in the bodies of the L5 and S1 vertebrae through typical points.

The yellow ligament is separated along the lower edge of the bow of the L5 with a dissector from the front surface of the arc plate, then separated from the lower articular processes of the arc. After separation of adhesions between the ventral surface of the yellow ligament and the dural sac, the yellow ligament in the form of a single flap was folded downwards. In the area of attachment to the S1 plate, the yellow ligament is cut off with scissors and extracted with a single flap. The capsule from the inner surface of the right arcuate-gut joint is torn off with a raspator, the joint gap between the lower articular process of the L5 vertebra and the upper articular process of S1 is exposed. In the joint gap put flat raspator and the articular surfaces are apart. The articular gap in the lower and lateral parts of the joint is visualized through the stretched capsule. A joint capsule is dissected along the joint space. In the same way, the capsule of the left arculoplastic joint at the level of L5-S1 is dissected.

In the gap L4-L5, the yellow ligament is separated from the back surface of the upper edge of the bow L5 by the spreader The adhesions between the ventral surface of the yellow ligament and the dural sac are incised, the yellow ligament is resected with Kerrison nippers.

The adhesions between the ventral surface of the handle plate and the dural bag are broken by a nervous hook. Hoe handles are fixed for the spinous process pulled up. Scissors fibro-cartilaginous formations of the area of spondylolysis dissected to the right. The right side of the handle raised clamp, rotation of the fibrous tissue in the area of spondylolysis left broken. Shackle extracted. The cartilage from the articular surfaces of the lower articular processes of the handle scraped off. The cortical bone of the articular surfaces of the lower articular processes was processed until the areas of uncovered spongy bone appeared.

When revising the roots of S1, they were compressed with hypertrophied upper articular processes of the S1 vertebra on both sides. Medial fasciactomy was performed (resection of the medial parts of the upper articular processes of the S1 vertebra). Compression of the roots eliminated.

The dural sac and right spine are shifted to the midline. The opened fibrous ring of the disk is dissected, the disk is curetted. The operating table is bent. A distractor is installed between the spinous processes of the L4 and S1 vertebrae. The rear structures at the L4-S1 level are maximally stretched. Two cages of 12 × 25 mm at an angle of 8 degrees are stuffed with auto-bone chips. One cage is screwed onto the impactor pin and packed into the interbody space through a hole in the fibrous ring. Impactor removed.

The curettage of the disc and the installation of the cage on the left are similar. Interstate distractor removed. In the screw heads stacked rod. With the help of the operating table, the patient is unfolded, the contractor is given a compression on the screws. Achieved a corner correction in the segment. An additional linear correction was not performed. Rods in the heads of the screws tightened nuts. X-ray control - standing implants. An audit of the L5 rootlets-residual compression in the intervertebral holes was not detected.

The cartilaginous plates were scraped off the articular surfaces of the S1 vertebra facets, and the remaining cortical layer was trimmed with a diamond head of a high-speed drill to blood dew. The previously removed L5 shackle is laid in its place and tightly pressed. To the right, through the lower articular process of the handle, a needle is drawn to the upper joint process of the S1 vertebra perpendicular to the plane of the articular surfaces. A 2-mm-long canal was formed by a cannulated drill with a diameter of 2 mm. The drill was removed, a cannulated spongy screw 2.5 mm in diameter and 2 cm long were screwed onto the needle, which carried a tight pulling of the articular process of the bow to the articular process of the sacrum. In the same way, screw in the articular pair on the left. When you try to shake the handle for the spinous process, it is firmly fixed to the sacrum. X-ray control - screw positioning is correct. Hemostasis. The wound is washed with 1 liter of betadine. The wound is sutured in layers. Iodine. Ac. bandage. The patient is verticalized on the following day after surgery.

On the control MSCT after the operation (Fig. 4-8), the interbody body implants 9 in the interbody space with full safety of the arch 1 L5 vertebra in place, spongy screws 10, fixing the arch 1 passing through the articular processes 3 and 4 L5, S1 vertebrae are noted .

Claims (1)

  1. The method of surgical treatment of low dysplastic spondylolisthesis, which consists in distinguishing the bow of the displaced vertebra (L5), the area of spondylolysis in the inter-articular part of the bow, the yellow ligaments in the interjacent spaces adjacent to the bow of the displaced vertebra on both sides, the articular and transverse processes on both sides , transpedicular screws are installed in the bodies of the adjacent vertebrae, L5, S1 roots are decompressed on both sides and the dural sac, the disc is curetted, interbody implants are installed, and the corners are corrected The horizontal and vertical displacement in the sagittal plane of the vertebra fix rods in pedicle screws, characterized in that after installing the pedicle screws, the yellow ligament is separated from the upper and lower edges of the arch, the internal surfaces of the arculo-articular joints, the yellow ligaments of the yellow ligament are resected, and the capsules are cut along the joint gap. arcuate joints, spondylolysis fibrocartilage formations on the right are dissected, the right side of the arms is lifted, the rotation of the arms breaks fibrous tissues into the back not spondylolysis on the left, the arch is removed, the cartilage is scraped from the articular surfaces of the lower articular processes of the arch and the upper articular processes of the sacrum, the cortical bone of the articular surfaces of the adjacent articular processes is processed until areas of uncovered spongy bone appear, then decompression of the L5, S1 roots is performed, the bow is removed, and the arch is removed. to the former place, from both sides, through the lower articular process of the arch into the superior articular process of the S1 vertebra, perpendicular to the plane of the articular surfaces; A needle, a canal with a diameter of 2 mm form a canal through the needle, a cannulated spongy screw 2.5 mm in diameter and 2 cm long are screwed into the needle, and the articular process of the arch is tightly tightened to the articular process of the sacrum.
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Citations (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
RU2186541C2 (en) * 2000-05-03 2002-08-10 Самарский государственный медицинский университет Method for stabilizing the mobile vertebral segment in case of surgical correction of spondilolisthesis
US20080097438A1 (en) * 1999-10-22 2008-04-24 Reiley Mark A Facet Arthroplasty Devices and Methods
RU2356509C1 (en) * 2007-12-06 2009-05-27 Государственное учреждение Московский областной научно-исследовательский клинический институт им. М.Ф. Владимирского (МОНИКИ им. М.Ф. Владимирского) Spondylolisthesis surgery technique
RU2527150C1 (en) * 2013-05-24 2014-08-27 Государственное Бюджетное Образовательное Учреждение Высшего Профессионального Образования "Кубанский государственный медицинский университет" Минздрава России (ГБОУ ВПО КубГМУ Минздрава России) Method for lumbar spinal motion segment repair

Patent Citations (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US20080097438A1 (en) * 1999-10-22 2008-04-24 Reiley Mark A Facet Arthroplasty Devices and Methods
RU2186541C2 (en) * 2000-05-03 2002-08-10 Самарский государственный медицинский университет Method for stabilizing the mobile vertebral segment in case of surgical correction of spondilolisthesis
RU2356509C1 (en) * 2007-12-06 2009-05-27 Государственное учреждение Московский областной научно-исследовательский клинический институт им. М.Ф. Владимирского (МОНИКИ им. М.Ф. Владимирского) Spondylolisthesis surgery technique
RU2527150C1 (en) * 2013-05-24 2014-08-27 Государственное Бюджетное Образовательное Учреждение Высшего Профессионального Образования "Кубанский государственный медицинский университет" Минздрава России (ГБОУ ВПО КубГМУ Минздрава России) Method for lumbar spinal motion segment repair

Non-Patent Citations (2)

* Cited by examiner, † Cited by third party
Title
Suk SI et al. Adding posterior lumbar interbody fusion to pedicle screw fixation and posterolateral fusion after decompression in spondylolytic spondylolisthesis. Spine, 1997, V. 22, р. 210-219. *
Маркин С. П. и др., Способ хирургического лечения тяжелых форм дисплатического спондилодеза у взрослых. Хирургия позвоночника, 2014, N 4, с. 120-123. Grob D., et al., Direct pediculo-body fixation in cases of spondylolisthesis with advanced intervertebral disc degeneration // Eur Spine J. 1996. N 5. Р. 281-285. *

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