RU2789044C1 - A method for surgical ventral dynamic correction of spinal deformities in adult patients and children and a device for implementing a method for surgical ventral dynamic correction of spinal deformities in adult patients and children - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: inventions group relates to medicine, in particular to orthopedics and traumatology, and may be used for surgical ventral dynamic correction of spinal deformities in adult patients and children. The design consists of plates and fixing screws with placement of a flexible cord in the heads of the screws, which is led along the vertebrae and fixed in the heads of fixing screws with locking screws. Monoaxial fixation screws with an open tunnel head with internal thread are used, in which the head of the fixation screw is one piece with the cylindrical part and the external screw surface. Rectangular or square shaped plates are placed on the convex side of the deformity on the surface of each vertebra selected to suit the shape of the vertebra so that the edges of the plate do not extend beyond the vertebra surface. On one diagonal of the plate there are spikes on the end sections facing the vertebrae, and on the other diagonal there are two through holes for fixation screws. The upper and lower closure plates, the anterior edge of the body and the anterior edge of the vertebral canal of each vertebra are identified. A thread is cut in each vertebra and two fixation screws are screwed through the holes in the plate via a guide into the vertebra passing through both cortical layers so that they cross over in the vertebral body along the longitudinal axis and the ends of the screws extend outward from the vertebra. Flexible cords are inserted in the screw heads. One flexible cord runs along one side of the plates and the other runs along the opposite side of the plates. From the seventh thoracic vertebra and above, one flexible cord and one fixation screw are used. The spine is corrected by tensioning the flexible cords along the vertebrae and the degree of tension is controlled. After achieving proper correction results and correcting the spinal deformity, the flexible cords are fixed via alternative tightening with locking screws in the open heads of the fixation screws. The spatial visualisation of the affected spine is determined by multislice spiral computed tomography prior to surgical treatment. The surrounding soft tissue, vascular and nerve structures are evaluated using MRI. Vertebral levels are set for anteroposterior and lateral access after anaesthesia using intraoperative fluoroscopy with the patient in the lateral position with the convex side of the spinal deformity facing upwards. Palpation of the 12th rib is performed under EOC control. A thoracolumbar skin and subcutaneous fat incision and visualization of the lumbar aspect of the affected spine are performed with the incision extended in the direction of the external oblique abdominal muscle by 3-5 cm anteriorly with dissection of the parietal pleura along the entire length of the planned fixation over the vertebral bodies and discs. The lungs are taken off to the side. The anterolateral part of the vertebral bodies is skeletonised. The segmental vessels are identified. Coagulation and dissection preserving the collateral circulation between the segmental arteries in the intervertebral foramen are performed. For retroperitoneal access, the incision is extended caudally towards the muscle fibres of the external oblique abdominal muscles mobilising peritoneal from the quadriceps lumbar and iliac muscles and identifying and anteromedially mobilising the ureter in the posterior peritoneum. For retroperitoneal access, the incision is extended caudally towards the muscle fibres of the external oblique abdominal muscles mobilising peritoneal from the quadriceps lumbar and iliac muscles and identifying and anteromedially mobilising the ureter in the posterior peritoneum. The peritoneum is separated from the posterior and lateral abdominal wall and diaphragm, the internal oblique and transverse muscles are crosses, and the diaphragm is dissected to within 1 cm of its attachment excluding denervation of the descending diaphragmatic nerve. The lumbar muscle is withdrawn posteriorly exposing the segmental vessels located at the midpoint between the lumbar intervals, which are ligated to visualize and provide access for the lateral edge of the lumbar vertebral bodies and discs. Perform fluoroscopy of the spine in the anteroposterior and lateral projections after final fixation of the retaining screws in the fixation screws heads in order to confirm that the patient's spinal deformity has been corrected. Trim the ends of the flexible cord, leaving at least 2 cm at both ends. Place a pleural drain fitting over the diaphragm suture. The pleural cavity is irrigated with physiological solution, the lungs are inflated, and the wound is sutured layer by layer. The ends of the fixation screws are blunted to avoid damaging the organ and/or tissue. The process device contains square or rectangular shaped plates for attachment to vertebrae. The shape of the plate is selected to suit the vertebra so that the edges of the plate do not extend beyond the vertebra and the surface facing the vertebra matches the vertebra surface. On one diagonal of each plate there are spikes on the end sections for insertion into the vertebrae, and on the other side there are two through holes for open-headed screws with screw threads, in which either one flexible cord running along one side of the plates or two flexible cords, one running along one side of the plates and the other running along the opposite side of the plates are placed secured with locking screws.

EFFECT: invention provides for increasing the spinal deformities correction efficiency by reducing the surgery duration, blood loss and recovery period.

4 cl, 12 dwg

Description

The invention relates to medicine, in particular to orthopedics and traumatology, specifically to a method for surgical ventral dynamic correction of spinal deformities in adult patients and children and a device for its implementation, can be used in the surgical treatment of scoliotic spinal deformities in adults.

Scoliosis is a lateral curvature of the spine that most often occurs during a growth spurt just before puberty. Although scoliosis can be caused by conditions such as cerebral palsy and muscular dystrophy, the cause of most scoliosis is unknown. Most cases of scoliosis are mild, but some children develop spinal deformities that continue to get worse as they grow. Severe scoliosis can lead to disability. A particularly severe curvature of the spine can reduce the volume of the chest, making it difficult for the lungs to function properly.

Traditionally, scoliosis is treated with a posterior fusion. Spinal fusion involves techniques that mimic the normal healing process of broken bones. During a spinal fusion, a surgeon places bone or bone-like material into the space between two vertebrae. Metal plates, screws, and rods can be used to hold the vertebrae together so they can fuse together. Because spinal fusion surgery immobilizes parts of the spine, it changes the way the spine moves. This creates additional stress and strain on the vertebrae above and below the fused part and can increase the rate of degeneration of these areas of the spine. A known method of damper treatment of diseases of the spine, including mechanical fixation of the vertebrae, in which transosseous fixation of the spine is carried out by introducing into each vertebra a pair of fixation elements that are rigidly fixed on the plates, while the plane perpendicular to the midline of the spine, and in the plane perpendicular to the plane of fixation, create controlled elastic forces on a pair of vertebral fixation elements (Patent RU No. 2254080, 20.06.2005).

However, the known method is intended to create forces on the elements of fixation of the vertebrae when eliminating the S-shaped deformity of the spine is not intended to correct the C-shaped deformity of the spine due to the lack of the possibility of creating multidirectional forces in the frontal plane.

There is a known method of introducing screws into the vertebral arches through open access according to anatomical landmarks with the determination of places and directions of insertion based on the analysis of fluoroscopy data (Weber B.G., Magerl F.P. The extremal fixator. - Berlin: Springer-Verlag, 1985. - P.289-309. ).

However, this method is traumatic, associated with the development of intra- and postoperative complications, which adversely affects the results of treatment. In addition, with scoliotic deformity of the spinal column, due to hypoplasia and deformity of the anatomical structures, changes in the orientation of the pedicles of the vertebrae are observed. The consequence of this is the difficulty of their visualization in the thoracic spine during fluoroscopy, which also complicates the choice of the direction of insertion of fixators in the treatment of spinal deformity using external fixation devices.

From RU 2171645, 08/10/2001, a method for surgical correction of spinal deformity is known, which consists in the following. The soft tissues are cut along the spinous processes to the vertebral arches along the curvature arc. They skeletonize the transverse processes of the neutral vertebrae. One end of the elastic endocorrector is fixed to the upper neutral vertebra. An endocorrector is passed to the lower neutral vertebra with deformity correction. The second end is fixed to the lower neutral vertebra. Then the endocorrector is carried out in the opposite direction, stretched and fixed to the first or second vertebra lying above. Then they return in the caudal direction to the first or second apical vertebra lying below. Additionally stretch and fix. In the taut state, the parts of the endocorrector lying above and below the apical vertebra are sutured together. In case of kyphotic deformity, the endocorrector is carried out in the caudal direction after fixation to the first or second apical vertebra lying above, along the spinous processes. In the presence of a scoliotic component, the endocorrector, after fixation on the convex side of the curvature to the first or second apical vertebra lying above, is carried out in the caudal direction between the spinous processes on the concave side. The spinous processes of the vertebrae of the apex of the deformity are bent along the concave side and the endocorrector is brought out to the convex side of the deformity between the spinous processes of the vertebrae. The endocorrector is stretched and fixed on the convex side of the curvature. The endocorrector is fixed to the bone structures or hook-stops. As an endocorrector, a lavsan tape, or threads, or cords are used. The method allows to increase the possibility of correction and reliability of stabilization.

From RU 2432134, 27.10.2011, a method for the treatment of scoliosis is known, which is used in the surgical correction of the curvature of the spine in scoliosis, mainly in children. A corrector is fixed to the transverse processes. In this case, the first corrector tape is passed along the transverse processes on the convex side of the curvature from the upper neutral to the lower neutral vertebra and fixed. Through an incision above the spinous process of the apex of the deformity, the ends of the second tape are led behind the transverse process of the concave side of the apical vertebra, through the gaps between the spinous processes of adjacent vertebrae, and lead them to the convex side. Then the second tape is stretched and fixed to the tape of the convex side of the curvature. The technical result is to increase the corrective effect.

The methods of surgical treatment of idiopathic scoliosis also include the formation of a bone block using both dorsal and ventral access to the spine in patients with deformities of more than 40° according to Cobb.

However, almost 75% of patients with deformities up to 30° at the beginning of puberty, accompanied by accelerated growth and development, require surgical correction, even after brace treatment [Danielsson AJ, Romberg K, Nachemson AL. Spinal range of motion, muscle endurance, and back pain and function at least 20 years after fusion or brace treatment for adolescent idiopathic scoliosis: a case-control study. Spine. 2006;31:275 - 283. DOI: 10.1097/01.brs.0000197652.52890.71].

Nevertheless, rigid stabilization has a number of serious disadvantages: a radical limitation of the growth potential of the spine, the risk of developing an adjacent level syndrome in the future, and a complete lack of mobility of the spine in the fixation zone. Spinal fusion also affects the growth of the chest and lungs due to the close anatomical and physiological relationship between the chest and spine [Akbarnia BA. Management themes in early onset scoliosis. J Bone Joint Surg Am. 2007;89 Suppl 1:42-54. DOI: 10.2106/JBJS.F.01256]. A new approach is dynamic correction of the growing spine (Vertebral body tethering - VBT) in patients with existing growth potential. For adults, another term is used - "ventral dynamic correction of scoliosis" (Anterior Scoliosis Correction - ASC), since the principle of remodeling in this situation is impossible. ASC is the initial approach for correcting deformities in conditions of completed growth of the spine, which allows maintaining its flexibility. Before the introduction of this method into practice, studies on animal models for the biomechanical substantiation of growth modulation were published.

The experiments were carried out on mini pigs (mini pigs), which had a certain growth potential, and showed that a flexible cord placed between pedicle screws from the ventral access can change the morphology of the spine and lead to its deformity. There are also similar studies on other animal models: goats, cows and motion preservation. Spine. 2008;33:724-733. DOI: 10.1097/BRS.0b013e31816950a0; Braun JT, Ogilvie JW, Akyuz E, Brodke DS, Bachus KN. Creation of an experimental idiopathic-type scoliosis in an immature goat model using a flexible posterior asymmetric tether. Spine. 2006;31:1410-1414. DOI: 10.1097/01. brs.0000219869.01599.6b.].

These methods are not fully understood all over the world. There is very little information on long-term results of treatment, even among the pioneers of the use of this technique. The technique is based on the technology of transcorporeal implantation of titanium screws along the outer side of the main arc (arcs), into the heads of which a flexible (polyethylene terephthalate) cord is inserted and fixed. The main deformity correction maneuver is sequential compression with fixation of a strained cord using special tools. To install the system, open and endoscopic access is used in the thoracic region, and for the lumbar and thoracolumbar - only open using a small incision [Joshi V, Cassivi SD, Milbrandt TA, Larson AN. Video-assisted thoracoscopic anterior vertebral body tethering for the correction of adolescent idiopathic scoliosis of the spine. Eur J Cardiothorac Surg. 2018;54:1134-1136. DOI: 10.1093/ejcts/ezy200; Bonsignore-Opp L, Murphy J, Skaggs DL, Parent S, Samdani A, Hilaire TSt, Vitale M. Pediatric device regulation: the case of anterior vertebral body tethering. Spin Deform. 2019;7:1019-1020. DOI:10.1016/j.jspd.2019.09.006. 14. Padhye K, Soroceanu A, Russell D, El-Hawary R. Thoracoscopic anterior instrumentation and fusion as a treatment for adolescent idiopathic scoliosis: a systematic review of the literature. Spin Deform. 2018;6:384-390. DOI: 10.1016/j.jspd.2017.12.013] due to the anatomical features of this area.

B RU 2367374, 09/20/2009 describes an invention that relates to vertebrology. The technical result of the invention is the creation of optimal conditions for restoring the statics and dynamics of the kyphotic spine, simplifying the method of treatment due to the simplicity of the technical execution of the operation, minimal invasiveness and exclusion of the stage of external immobilization. Conduct ventral access to the anterolateral surface of the body of the wedge-shaped vertebra at the top of the deformity. The dorsal instrumentation is installed from the posterior access along the line of the spinous processes of the vertebrae. After the formation of the ventral access, an osteotomy of the lower edge of the vertebral body is performed at an angle open ventrally, starting from the anterior surface of the vertebral body and ending on the lower surface of the vertebral body, not reaching the posterior longitudinal ligament 5 mm. Then, a polysegmental endocorrector of the LSZ system is installed from the posterior approach, the fixing elements of which are attached to the arches of the vertebral bodies near the base of the spinous process from both sides.

In the patent RU 2436534, 20.11. 2011 describes a method for repositioning and fixing the spine in comminuted fractures. Preliminary, taking into account the results of computed tomography, a tap with a limiter is prepared, setting the latter at a distance from the threaded end of the tap, equal to the distance from the root of the arch to the anterior cortical plate of the damaged vertebra. Produce the introduction of transpedicular screws in adjacent from the damaged vertebrae through their roots of the arches. After that, a prepared tap is inserted through the Roy-Camille point into the damaged vertebra to the cortical plate of its ventral fragment. Carry out compression of the ventral fragment of the damaged vertebra by turning the tap around its longitudinal axis. Through the contralateral Roy-Camille point, a pedicle screw is inserted into the damaged vertebra, fixing its ventral fragment with it. Remove the stopper. A transpedicular screw is inserted into the channel formed by the tap. The installation of the pedicle system is completed by connecting all pedicle screws with modeled fixing rods. EFFECT: invention contributes to increasing the efficiency of the method while increasing the repositioning capabilities of the internal transpedicular system, reducing the rehabilitation period and reducing the risk of postoperative complications.

The principle of Vertebral body tethering - VBT is applied in patients with a certain growth potential. Candidates for surgery using this method have different types of deformities. Most of them suffer from idiopathic scoliosis (adolescent, juvenile or some other forms, such as syndromic on the background of genetic diseases: Marfan syndrome, Prader-Willi syndrome, etc. Each case is individually assessed and carefully considered. As a rule, these are patients older than 10 years , with possible growth potential and good mobility of the spine, having a thoracic, thoracolumbar or lumbar curve(s) of 30 to 80°.

US 10667845 (based on US 2019021768), 01/24/2019, describes a method and device for the treatment of spinal scoliosis, which includes anterior installation of vertebral fixation screws into the vertebrae of the spine in such a way that the first vertebra of the vertebrae receives the first vertebral fixation screw from the vertebral fixators screws, and the second vertebra of the vertebrae receives the second vertebral fixation screw of the vertebral screws; fixing the flexible cord to the first vertebral fixation screw; detachable connection of the first surgical instrument to the second vertebral fixing screw and to the flexible cord (cable, cord) at the same time; and manually actuating the actuating handle while the distal end portion of the cylinder is releasably connected to the second vertebral fixation screw and the flexible cord so that tension is applied to the cable between the first vertebral fixation screw and the tensile flexible cord. The first surgical instrument includes: a drive handle; a barrel extending from the drive handle, while the distal part of the cylinder tip is detachably connected to each of the vertebral screws separately; and a tension element movably connected to the distal end of the barrel. The tension member is configured to engage with the cable and apply tension to the cable in a first direction in response to manual actuation of the drive handle.

In some embodiments, the method also includes, by maintaining tension applied to the cable between the first vertebral screw and the tension member, rigidly attaching the cable to the second vertebral screw such that thereafter tension is maintained at the tether between the first vertebral screw and the second vertebral screw without the need for a tension element for creating tension in the part of the harness between the first vertebral screw and the second vertebral screw.

This document describes systems for the treatment of scoliosis and methods for their use. For example, this document describes systems for anterior fixation of the vertebral bodies and how to use them. Patient has a scoliotic spine, Patient 1 is treated with an anterior vertebral body fixation system in accordance with some of the embodiments described herein. The anterior fixation system of the vertebral body is placed anteriorly along the outer curvature of the spine. The operation to fix the vertebral body in the anterior part involves the introduction of vertebral fixing screws into the vertebrae affected by scoliosis. The surgeon attaches a flexible cord (cable or tether or cord) to each of the screws and then pulls and locks the cord segment by segment so that the vertebrae are pulled together on one side and expanded on the other to correct the curvature. This usually aligns the spine and gives the vertebrae room to grow properly. Designed for the treatment of moderate to severe scoliosis, an anterior vertebral body fixation system is generally recommended for adolescents in puberty who are still growing. Anterior vertebral body fixation surgery can be performed in a minimally invasive manner (eg, using video-assisted thoracoscopic surgical techniques).

The anterior vertebral body fixation system includes several vertebral fixation screws, several end caps (retaining screws) and a tether. Separate vertebral fixation screws are placed in the corresponding vertebra. A cord is passed between each vertebral fixation screw. Locking screws (end caps) are used to fix a flexible cord (cable, cord) on the heads of vertebral fixing screws. In the depicted configuration, one end of the cable is clamped in the vertebral fixation screw by the locking screw 120, with the cable firmly attached to the vertebral fixation screw, and the cord is not yet taut. In some embodiments, the vertebral fixation screws are one-piece non-cannulated screws made from stainless steel or titanium. Vertebral fixation screws can be 3D printed using titanium with variable porosity from a solid titanium central rod that borders the head and tip (which may have grooves for cutting into the bone), but with gradually increasing porosity towards the bone. The vertebral fixation screws can be scaled to any suitable length and diameter. For example, in some cases, the vertebral fixation screws 1 may have a length in the range of from about 20 mm to about 45 mm (without limitation). In some cases, the vertebral fixation screws 110 may have a diameter of from about 3.5 mm to about 6.0 mm (without limitation). In some embodiments, the implementation of the vertebral fixation screws have blunt ends at the ends, so that bicortical fixation is possible without damaging the anatomical structures on the far side of the vertebra. Vertebral screw heads may be tulip-shaped with female threads that can thread into male end caps (otherwise referred to as female tuning fork type open head lock screws).

A tuning fork (or, in other terminology, in the form of a tulip) support head allows a tether (cord) to pass laterally through slots formed in a tuning fork (or, in other terminology, in a tulip) support head. End caps (or locking screws) may be threaded into the open heads of tuning fork type vertebral fixation screws. End caps can be made from metallic materials such as stainless steel and titanium, or other materials including polymeric materials.

The tether (cord) is an elongated flexible element, in some cases the tether 130 is made of a polymeric material such as, but not limited to, polyethylene terephthalate (PET).

The principle behind this method is as follows.

A fixing screw is placed in each vertebra along the convex side of the spine. A cord (an extended cable) is inserted into the head of the first screw and wedged with a locking screw. After that, this cord is inserted into the head of the next screw installed on the next vertebra, and a special tool (tensioner) is installed into the head of the second screw, and this cord is tightened. Then the cord is fixed with a locking screw. There is a partial straightening of the spine, etc. to the end of the convex part of the spine. The cord is installed only on the convex side of the spine. When a child begins to walk, the spine begins to grow. Since the cord limits the growth of the spine only from the convex side, the spine grows more on the concave side (on the convex side, the spine grows more slowly and less). Due to different growth, the spine straightens as it grows.

In addition, the presence of a flexible cord does not restrict the movement of the patient (the spine can bend and the patient can bend). If there were not a cord, but a metal rod, then it would not allow the spine to bend, since the rod does not have the possibility of flexibility, it cannot bend and unbend). As a result of the described construction, children can bend. Children have a period of growth of the spine. The spine is considered to grow most intensively from 10 years to 18 years. And the surgeon can always calculate what the primary bend should be, so that with the gradual growth of the spine, it would fully straighten when it reaches the age at which the child and his spine stop growing.

An anchor (plate) is driven into the spine in the form of a ring with three spikes evenly spaced around the circumference. Spikes are driven into the spine. Each ring is set so that one spike looks forward. This reduces the risk that the screw being screwed into the ring will touch the spinal cord. The fixing screw passing through the ring is both a support element and an element that transmits force from the cord to the spine and vice versa.

The screw is a bicortical screw. This means that it passes through both cortical layers of the corresponding individual vertebra and exits on the other side of the vertebra. In order not to damage the internal organs and tissues, the screw is made blunt at the end.

A cord is inserted into the slot of the screw head with an internal thread. After that, the cord is fixed (clamped inside the slot of the screw head) by screwing the locking screw through the guide.

However, the known method and device is not intended for the use of surgical ventral dynamic correction of spinal deformities for adult patients, when significant forces can occur in the flexible cord, resulting in a risk of breaking the flexible cord.

The technical task of the claimed group of inventions is to develop an effective method and device for surgical ventral dynamic correction of spinal deformities in adult patients and children, expanding the arsenal of tools for the treatment of scoliosis.

The technical result achieved by the claimed group of inventions, in accordance with the stated technical task, is to increase the efficiency of the method and device for surgical ventral dynamic correction of spinal deformities in adult patients and children, to expand the arsenal of agents in the treatment of scoliosis, to reduce the duration of the operation, to reduce blood loss during surgical intervention, reduction in the period for rapid recovery with a low overall average duration of hospitalization.

The set technical task and the technical result are achieved by the claimed group of inventions, which includes a method for surgical ventral dynamic correction of spinal deformities in adult patients and children and a device for implementing the method.

Consider each of the variants of the claimed invention separately.

As noted above, the first object of the claimed invention is a method for surgical ventral dynamic correction of spinal deformities in adult patients and children using the installation on the vertebrae of an assembly of plates, fixing screws with an open head of a tuning fork type with an internal thread, with a flexible cord placed in them between the vertebrae, fixed by locking screws, and, according to the invention, before installation on the vertebrae, fixing screws with an open head of a tuning fork type with an internal thread are installed on the convex side of the spinal deformity on the surface of each vertebra of the plate, each of which has a four-sided shape, the surface of which corresponds to the surface of the vertebra, and the plate has one diagonal on the end sections on one side of the plate with spikes directed towards the vertebrae, and on the other diagonal, intersecting with the first diagonal, a pair of through holes on the end sections with the opposite on the other side of the plate for fixing screws, the upper and lower end plates, the anterior edge of the body and the anterior edge of the spinal canal of each vertebra are identified, a pair of fixing screws with an open head of the tuning fork type with an internal thread is bicortically screwed into both through holes of each plate, moreover, the mentioned screws screwed so that they cross into the bones of the vertebra for better connection, a pair of flexible cords of polyethylene terephthalate are inserted from the bottom up into the open heads of the tuning fork type with the internal thread of the fixing screws, with one flexible cord running along one side of the plates, and the other flexible cord running along the opposite side of the plates, using a pusher, the spine is corrected by tensioning the flexible cords between the vertebrae, while the degree of tension is controlled, after reaching the appropriate correction and eliminating the deformity of the spine, the flexible cords are fixed by tightening them alternately or sequentially from bottom to top with locking screws in the open heads of the locking screws.

This set of common essential features is the essence of the claimed object for the method. It is necessary and sufficient in all cases of its implementation.

EFFECT: invention makes it possible to increase the efficiency of the method for surgical ventral dynamic correction of spinal deformities in adult patients and children, to expand the arsenal of means in the treatment of scoliosis, to reduce the duration of the operation, to reduce blood loss during surgical intervention, to reduce the period for quick recovery with a low overall average duration of hospitalization. The claimed invention also makes it possible to expand the arsenal of means in the treatment of scoliosis in growing children, adolescents and adults, that is, it provides the possibility of treating not only adolescents, but also adults, when the spine almost does not grow with a fixed skeleton, and also reduces the trauma during surgery.

In addition, in relation to the claimed method, it is necessary to highlight the following developments and / or clarifications of the totality of its general essential features related to particular cases of using the method.

The Applicant considers it appropriate to carry out the operation in the following more specific manner.

Before performing surgical treatment, first, the spatial visualization of the affected spine is determined by the method of multilayer spiral computed tomography, then the condition of the surrounding soft tissues, vascular and nervous structures, which are not visualized when performing multilayer spiral computed tomography, is assessed using magnetic resonance imaging, after performing anesthesia using intraoperative fluoroscopy when the patient is positioned on the side with the convex side of the spinal deformity upward, the levels of the vertebrae are set to determine access in the anterior-posterior and lateral positions, then:

- under image intensifier control, palpation of the 12th rib is performed,

- perform a thoracolumbar incision of the skin and subcutaneous fat with visualization of the lumbar region of the affected spine of the patient with an extension of the incision in the direction of the external oblique muscle of the abdomen by 3-5 cm in front with a dissection of the parietal pleura along the entire length of the planned fixation over the vertebral bodies and discs,

- after dissection of the pleura, the lungs are abducted to the side,

- further skeletonize the anterolateral part of the vertebral bodies,

- identify segmental vessels, coagulate and dissect while maintaining collateral circulation between the segmental arteries in the intervertebral foramen,

- moreover, for retroperitoneal access, the incision is expanded caudally in the direction of the muscle fibers of the external oblique muscle of the abdomen with the mobilization of the peritoneum from the square lumbar and iliac muscles, as well as with the identification and anteromedial mobilization of the ureter in the posterior part of the peritoneum, for which

- separate the peritoneum from the posterior and lateral abdominal wall and diaphragm,

- cross the internal oblique and transverse muscles using electrocoagulation,

- cut the diaphragm at a distance of not more than 1 cm from its attachment with the exception of denervation of the descending phrenic nerve,

- the psoas muscle is retracted posteriorly with exposure of segmental vessels located at the midpoint between the lumbar spaces, which are tied up with visualization and access of the entire lateral edge of the bodies of the lumbar vertebrae and discs,

and after the final fixation of the locking screws in the heads of the fixing screws, a fluoroimaging of the spine is performed in the anteroposterior and lateral projections to confirm the elimination of the deformity of the patient's spine,

- cut off the excess ends of the flexible cord-cord, leaving at least 2 cm at both ends,

- install pleural drainage for thoracophrenolumbotomy of the lower part, suitable for the place of suturing the diaphragm,

- irrigate the pleural cavity with saline, inflate the lungs under visual control, carry out aero- and hemostasis, and the wound is sutured in layers.

It is important to note that when implementing the method of surgical ventral dynamic correction of spinal deformities in adult patients and children, a thread is cut with a tap in each vertebra and a pair of fixing screws with an open head of a tuning fork type with an internal thread is screwed through the guide through the guide into the vertebral bone through two cortical layers. each, wherein the fixation screws are monoaxial screws, each of which is characterized in that it has a single unit of the head of the fixation screw with a cylindrical portion with an outer helical surface, the screws being screwed so as to cross into the bones for better connection, and furthermore, the screws protrude outside.

When implementing the claimed method of surgical ventral dynamic correction of spinal deformities in adult patients and children, the ends of the fixing screws are blunted so as not to damage the organ and / or tissues, while, if you look along the axis of the spine, each pair of fixing screws pass through the vertebral body non-parallel to each other, and at an angle, crossing and being remote from the outer surface of the vertebra, thereby reducing the risk of cracking in the vertebral body or separation of a part of the vertebral body.

Moreover, in the claimed method of surgical ventral dynamic correction of spinal deformities in adult patients and children, the plates are made four-sided in terms of shape, for example, rectangular, in particular, square, that is, have a shape close to the anatomical shape of the surface of the vertebrae, so as not to "bulge" , and have a pair of through holes located at the ends of the diagonal.

At the same time, in the thoracic, thoracolumbar and lumbar spine, it is possible to install two cords each (up to the level of the Th7 vertebra, it is possible to routinely use two cords), and for the seventh thoracic vertebra and above, a continuation of one of the cords and one fixing screw are used due to the small size vertebral bodies.

The second object of the claimed invention is a device for implementing a method for surgical ventral dynamic correction of spinal deformities in adult patients and children, characterized in that it contains plates of a four-sided shape intended for attachment to the vertebrae, one diagonal of each of which is at the end sections on one side of the plate there are spikes intended for insertion into the vertebrae, and along the other diagonal, intersecting with the first diagonal, there are a pair of through holes in the end sections on the opposite side of the plate for fixing screws with open heads of the tuning fork type with screw threads, in which fixed with locking screws or one a flexible cord running along one side of the plates, or two flexible cords, one of which runs along one side of the plates, and the other flexible cord runs along the opposite side of the plates.

This set of common essential features is the essence of the claimed second object of the claimed invention.

It is necessary and sufficient in all cases of its implementation.

This technical solution has the following advantages compared to the prototype:

allows to increase the efficiency of surgical ventral dynamic correction of spinal deformities in adult patients and children, expand the arsenal of tools for the treatment of scoliosis, reduce the duration of the operation, reduce blood loss during surgery, reduce the period for rapid recovery with a low overall average length of hospitalization. The claimed invention also makes it possible to expand the arsenal of means in the treatment of scoliosis in growing children, adolescents and adults, that is, it provides the possibility of treating not only adolescents, but also adults, when the spine almost does not grow with a fixed skeleton, and also reduces the trauma during surgery.

The invention is illustrated in the following drawings.

Figure 1 shows a General view of the deformities of the spine;

Figure 2 shows a General view of the patient from the back after surgery;

In FIG. 3 shows a general side view of the patient after the operation;

Figure 4 shows the plate, plan view;

In FIG. 5 the same, isometry, side-top view;

In FIG. 6 the same, isometry, side-bottom view;

In FIG. 7 shows the fixing screw, side view;

In FIG. 8 shows a locking screw, side view, isometric view;

In FIG. 9 schematically shows the fixation of a flexible cord on one fixing screw using a guide at the initial stage of its installation;

In FIG. 10 schematically shows the fixation of the flexible cord on the same fixing screw using a guide and a screwdriver at the stage of bringing the locking screw to the flexible cord;

In FIG. 11 schematically shows the locking screws on a plate attached to a vertebra as viewed along the longitudinal axis of the spine (spike not shown) (spine shown as an outline);

In FIG. 12 - the same, if you look at them across the longitudinal axis of the spine (the spine is shown as a contour).

The following is a specific description of an embodiment of the claimed method and a device for its implementation.

On the curved section of the spine 1, vertebrae 2 are exposed, on one side of the spine, common to all vertebrae, plates 3 with spikes 4 are inserted into each vertebra 2 in this area (Fig. 1 - Fig. 6). The plates 3 have a rectangular shape in plan, corresponding to the surface of the vertebra 2. Each plate 3, in addition, has one diagonal at the end sections on one side of the plate 2 spikes 4 directed towards the vertebrae, and on the other diagonal, intersecting with the first diagonal, - a pair of through holes 5 without thread on the end sections on the opposite side of the plate for fixing screws. The central through hole 6 has an internal thread and is designed to install the plate 3 during the operation.

Next, take a holder (not shown in the figures, since it is not the subject of the invention and in order not to clutter up the figures) plate 3 and place it on the lateral surface of the upper vertebra 7, orienting it so that the spikes 4 are directed towards the vertebra 7, and plate 3 is driven in with spikes 4 into the vertebra 7, then using a holder (not shown) with an awl through the through holes 5 in the plate 3 pierce the first cortical layer of the bone of the vertebra 7 of the spine 1 and partially form a channel for further work.

Next, a thread is cut with a tap in the mentioned channels in the vertebra 7 and through the through holes 5 in the plate 3 a pair of fixing screws 8 with an open head 9 of the tuning fork type with an internal thread 10 (in other terminology, a tulip-shaped head) is screwed through the guide into the vertebral bone through two cortical layer each, and the fixation screws 8 are monoaxial screws, each of which is characterized in that it has a single unit of an open screw head 9 with a cylindrical part 11 of the fixation screw with an external helical surface, and the fixation screws 8 are screwed so as to cross into the bones 12 for better connection, and in addition, their ends 13 go out. The holder is removed from the installed plate with the fixing screws screwed in.

After that, other plates 3 are taken in turn with this holder (not shown in the figures, since it is not the subject of the invention and in order not to clutter up the figures), they are placed on the lateral surface of the following vertebrae 14, orienting so that the spikes 4 are directed towards the vertebrae 14, and drive plates 3 with spikes 4 into these vertebrae. Then, in a similar manner, the fixing screws 8 are screwed into the vertebrae 14.

After that, a pair of flexible cords 15, for example, made of polyethylene terephthalate, is inserted from bottom to top into the cavity 16 of open heads 9 of the tuning fork type with internal thread 10 fixing screws 8, with one flexible cord 15 running along one side of the plates, and the other flexible cord 15 running along opposite side of the plates 3.

On the open head 9 of the tuning fork type with an internal thread of each fixing screw 8 put on a counter-tensioner (not shown in the figures, because it is not the subject of the invention and not to load the figures), designed to keep the fixing screw 8 from rotating in a certain position during the subsequent operation, which consists in screwing the locking screw 17 (plug) into the open head 9 of the tuning fork type with an internal thread 10 of the fixing screw 8 provided with an internal thread 10 to fix the flexible cord 15 with the locking screw 17.

The flexible cord 15 is fixed (clamped inside the cavity 16 of the open head 9 of the fixing screw 8) by screwing the lock screw 17 through the cavity of the guide 18 with a screwdriver 19 into the internal thread 10 of the head 9 of the fixing screw 8.

It is important to note that cord installation techniques may have their own characteristics depending on specific circumstances.

For example, after installing a plate 2 on the upper vertebra 7 by means of spikes 4 and screwing a pair of fixing screws 8 into it, the same sequence of actions is repeated with the next vertebra 14 and so on until the last vertebra in the curved area, and in the second and subsequent vertebrae after inserting the flexible cord 15 into the cavity 16 of the open head 9 of the tuning fork type of the next fixing screw 8 the flexible cord 15 is tightened before tightening the locking screw 17 and only after that the flexible cord 15 is fixed with the locking screw 17 through the guide 18, as a result of which the spine 1 is partially straightened and then the whole sequence is repeated of the above actions, and the flexible cord 15 is installed only from the convex side of the spine with the formation along the curved section of the spine of two essentially parallel cords 15. The tensioner (in the simplest case, which is pliers) pulls the flexible cord with a certain force, for example, with a maximum of 40 kg.

As the material of the flexible cord 15, a fabric material made of a polymer, such as polyethylene terephthalate, is used.

The length of the flexible cord 15 is determined taking into account the possible growth of the patient and changes in the size of the vertebrae.

The method and device are intended for the treatment of scoliosis in adult patients. It can also be used for teenagers 8-18 years old.

So, the essential distinguishing features of the claimed invention from the above-mentioned US patent 10667845 are the use of two parallel flexible cords 15 located on the sides, which gives the following advantages:

- the possibility of treating not only adolescents, but also adults, when the spine almost does not grow with a fixed skeleton, but high loads on the flexible cord;

- install a pair of flexible cords 15, since the load is greater. One flexible cord 15 may break or overcorrection may occur when the spine becomes curved to the other side;

- the plates 3 are made not of a round shape, but of a square shape, that is, the shape of the surface of the vertebrae 2 close to the anatomical shape, so that the plates do not stick out, and the plates have a pair of through holes located at the ends of the diagonal of the plate;

- plates 3 have two spikes at the ends of opposite diagonals and each plate 3 is installed (introduced, hammered) on the side into the corresponding vertebra on the section of the spine curved by scoliosis.

The fixing screws 8 are screwed bicortically (through both cortical layers of the vertebra) with the end 13 coming out, and the end 13 of the fixing screw 8 is blunt so as not to damage the organ and/or tissues. In this case, the pair of fixing screws 8 on the common plate 3 are crossed for a better connection, and in addition, the screws come out. When viewed along the longitudinal axis 20 of the spine, this pair of fixation screws pass through the vertebral body not parallel to each other, but at an angle, crossing and located remotely from the outer surface of the vertebra (Fig. ). However, when viewed across the longitudinal axis 20 of the spine 1, the fixing screws 8 run parallel.

With such an arrangement of the fixing screws 8, they extend far from the outer surface of the vertebra, and as a result, the risk that the lateral part of the vertebra may come off or a crack is formed is reduced.

In addition, the pair of flexible cords 15 has the advantage of being more securely fastened (less risk of tearing), the spine can bend in different directions, relative to its longitudinal axis, since when a pair of flexible cords 15 is installed, it is more difficult for the spine to twist.

The peculiarity of the claimed method and device also lies in the fact that for the seventh thoracic vertebrae and above, the continuation of one of the flexible cords 15 and one fixing screw 8 are used due to the small size of the vertebral bodies.

So, with ventral dynamic correction by the claimed method and device to the level of the Th7 vertebra, a pair of flexible cords 15 and a pair of fixing screws 8 are used, which are screwed into the body of each vertebra. Above the seventh thoracic screw, due to the small size of the vertebral bodies, one fixation screw is used in the vertebral body and one flexible cord.

Using the method of dynamic correction in adults in the claimed method and not using growth modulation, we correct the deformity as much as possible using 2 flexible cords and 2 fixing screws in the body of each vertebra, which allows correcting the spinal deformity and maintaining spinal mobility due to cord extensibility. To improve the correction, it is possible to remove the pulpous nuclei at the top of the curvature while maintaining the end plates. This allows you to increase the percentage of correction.

When implementing the method and its implementing device according to the invention, it is possible to derotate the vertebrae at the apex of the curvature by inserting fixing screws at the apex of the curvature closer to the spinal canal, and on the end segments closer to the anterior surface of the vertebral bodies. The tension of the flexible cord contributes to the derotation maneuver.

In addition, the derotation maneuver can be performed by turning the vertebra with a special holder during the final tightening of the locking screws.

When implementing the method and its implementing device, it is possible to correct the sagittal profile when stretching the flexible cord. When the flexible cord is stretched on the fixing screws located closer to the anterior surface of the vertebral bodies, kyphosis intensifies; when stretched on the fixing screws located closer to the posterior surface of the vertebral bodies, lordosis increases.

As noted above, the invention of this application is intended for both adults who have almost stopped growth of the spine, and for growing children and adolescents during puberty and growth of the spine.

The claimed invention thus extends the range of application to people with already formed spines who no longer grow or grow very little.

The invention allows a person to twist, bend over when a metal rod is used.

When implementing the method and its implementing device, it is important to take into account that the child will still grow the spine for a maximum of 5-10 years.

And taking into account how the spine lengthens, they immediately calculate the angle by which the spine must first be straightened.

For adults, the spine is pulled together by tying the spine to a flexible cord 15, fixing the spine so as to stop its further bending and at the same time maintain mobility.

The operation can be performed both openly and through separate incisions through which plates with a flexible cord 15 are installed. This method has less blood loss, less infections affect tissues and organs, since the open area is smaller, and the operation is faster in time. In addition, there are fewer traces of sutured wounds on the patient's body, which is better from an aesthetic point of view.

Below is a more detailed description of the technology underlying the method of surgical ventral dynamic correction of spinal deformities of adult patients and children claimed as an invention.

A retrospective analysis of clinical and radiological data is carried out in 19 patients aged 13-44 years (18 women, 1 man) who underwent ventral dynamic correction of scoliotic spinal deformity.

The following indications were used: the magnitude of the arc (spinal deformity) is not more than 70°; spine mobility of at least 40% during functional tests; BMI less than 30; according to densitometry of the Ward zone of the femoral necks, the T-criterion is greater than -1.5 (no osteoporosis/osteopenia); the absence of pronounced degenerative changes in the intervertebral discs according to MRI (Pfirrmann I-II). All operations are performed in open access. At the planning stage of the study, patients with scoliosis of those types for which the number of observations was less than 4 were excluded from the analysis. These are types 2 and 6 (1 patient each). Thus, the number of patients decreased from the initial 21 to 19. Patients with type 4 scoliosis did not seek help during this period and, accordingly, were not included in the study. Patient groups were formed as follows: Lenke 1-8, Lenke 3-4, Lenke 5-7. A total of 19 patients were compared in pairs. The following indicators were selected for statistical analysis: age, Cobb curve size before and after surgery, correction angle, blood loss. The number of levels of fixation, the duration of the operation, the time spent in the hospital were studied. Functional status was assessed using the VAS and the SRS-22 questionnaire. Examinations were carried out at the following times: before surgery, after surgery, 4-6 weeks after surgery, 3, 6, 12 months. after operation.

The Mann-Whitney U test was applied. For statistical processing of SRS-22, VAS data, the Wilcoxon W-test was used.

Surgical technique.

The patient was laid in the position on the side and the convex side of the deformity was up. The levels of the vertebrae to determine the optimal approach were confirmed using intraoperative fluoroscopy in the anteroposterior and lateral positions. Standard thoracotomy is performed with rib resection, especially in operations where bone grafts are needed for interbody fusion. When performing this operation, thoracotomy at the same level without resection of the rib was performed if short fixation was noted with a small deformity arc with one cord. The principle of determining the upper and lower fixation points is the same as in standard rigid ventral stabilization of scoliotic deformity.

The choice of fixation points for both thoracic and lumbar deformities depended on the position of the neutral vertebrae of the main structural arch on the basis of the performed functional radiographs with inclinations in the patient's supine position. The distal level of fixation was determined by the position of the most caudal first expanding disk in direct projection on radiographs in the patient’s standing position and the disk through which the central sacral vertical line passes, as well as on functional radiographs with inclinations in the patient’s supine position. The choice of the proximal fixation point was determined by the position of the lower vertebra of the segment that deviated less than 10° during the bending test. In this case, the number of vertebrae of the distal lever should be at least two from the top of the deformity. To select the correct intercostal level, the 12th rib was palpated and image intensifier control was performed. For thoracolumbar access, the incision may be in the direction of the external oblique muscle of the abdomen approximately 3-5 cm anteriorly. The length of the incision depends on which part of the lumbar spine is to be visualized. After visualization of the top of the deformation, X-ray control of the levels is carried out. The parietal pleura was dissected along the entire length of the planned fixation over the vertebral bodies and discs. After dissection of the pleura, the lungs were taken aside, the anterolateral part of the vertebral bodies was skeletonized. Segmental vessels were identified, coagulated and dissected. No complications associated with dissection of segmental vessels are observed. The peculiarity is that this should be done in the middle of the vertebral bodies in order to maintain collateral circulation between the segmental arteries in the intervertebral foramen. For additional retroperitoneal access, the incision is expanded caudally in the direction of the muscle fibers of the external oblique muscle of the abdomen. Depending on the level of the lower thoracotomy, it may be necessary to cut the costal arch, followed by retroperitoneal access through the costochondral articulation.

Particular attention should be paid to mobilizing the peritoneum from the quadratus psoas and iliacus, and identifying the ureter in the posterior peritoneum from which it is mobilized anteromedially. Once the peritoneum is separated from the posterior and lateral abdominal walls and the diaphragm, the latter, then the internal oblique and transverse muscles can be transected by electrocoagulation. The diaphragm is dissected at a distance of no more than 1 cm from its attachment to avoid denervation of the descending phrenic nerve. The psoas muscle is retracted from behind, exposing segmental vessels located at the midpoint between the lumbar spaces, which can be ligated or coagulated and dissected, which allows additional mobilization of the psoas muscle to visualize the entire lateral edge of the lumbar vertebral bodies and discs.

After access is made, the upper and lower endplates, the anterior edge of the body, and the anterior edge of the spinal canal must be clearly identified for each vertebra before the fixing screws 8 are installed. Plates 3 with spikes 4 are used, which, in combination with the bicortical insertion of fixation screws 8, demonstrate a significantly more stable fixation compared to simple fixation with screws. Titanium fixing screws for transpedicular fixation are installed transcorporeally on the convex side of the spinal deformity, then a flexible cord 15 made of polyethylene terephthalate is passed from bottom to top through the heads of the fixing screws inserted into the vertebral bodies. In the next step, the guide 18 with a T-handle is placed alternately on the open heads 9 of the tuning fork type with an internal thread 10 of the fixing screws 8 (or, in other words, on the tulips of the fixing screws). Correction of the spine 1 occurs due to the tension of the flexible cord 15 between the vertebrae 2 and the translation of the vertebrae 2. The degree of tension is controlled visually and using a marker on the tensioner handle.

In the thoracic region, as a rule, one flexible cord 15 is used, in the thoracolumbar and lumbar - two each, up to the level of the Th7 vertebrae it is possible to routinely use a pair of flexible cords 15. Proximal is more difficult due to the small size of the vertebral bodies. The stop screw 17 on each fixing screw 8 is tightened after an appropriate correction has been achieved. With the help of alternate tension of the flexible cord 15 between the open heads 9 of the tuning fork type of the fixing screws 8, the deformation is eliminated. In patients with preserved axial growth, continued growth leads to further correction of the main arch. After all the locking screws 17 are finally fixed (tightened), fluoroimaging of the spine 1 is carried out both in the anteroposterior and in the lateral projection to confirm the correction of the deformity.

Then the excess sections of the flexible cord 15 are cut and left at least 2 cm at both ends. It is difficult to suture the pleura in the presence of implants, but this is not required, since it has a good regenerative capacity. Pleural drainage is installed during thoracophrenolumbotomy of the lower part, suitable for the site of suturing the diaphragm.

The pleural cavity is irrigated, the lung swells again under the control of vision, aero and hemostasis, the wound is sutured in layers.

We got the following results:

A total of 21 operations were performed in 19 patients, in two cases a two-stage surgical treatment was required with a second intervention from the contralateral side after 3 months. Three patients underwent two stages in one surgical session: a combination of traditional and dynamic fixation, and first - the dorsal selective correction of the thoracic region, then the patient was laid on his side for the ventral stage. This approach was chosen in patients with rigid thoracic deformities, for whom it was not possible to achieve satisfactory correction with dynamic fixation, and also because of the presence of hypercorkyphosis, which cannot be eliminated with flexible cords, 15. Of the eight patients with type 1 according to the classification Lenke underwent ventral fixation through thoracotomy in three cases, in the remaining five cases, thoracophrenolumbotomy was required due to the prolongation of fixation levels below L1, and in six cases double thoracotomy was required. The number of levels of dynamic fixation for all types ranged from 6 to 12; the full distribution of data on patients is presented in Table. The most proximal level of fixation is Th5, the most distal is L4. As a rule, with Lenke 5, the fixation zone was Th11-L4. In the lumbar and thoracolumbar regions, 2 flexible cords 15 were used in order to increase the strength of the structure and prevent its rupture. In the thoracic region, one cord is enough, since the rib cage creates additional stability and has less mobility compared to the lumbar region.

The small size of the vertebral bodies in the thoracic region limits the possibility of inserting two fixing screws 8, especially in young patients. When correcting double arches, one fixing screw is also installed at the level of the lower fixation point of the thoracic part and at the upper point of the lumbar fixation.

The average operation time for transthoracic access was 181 ± 28 min, for thoracophrenolumbotomy 198 ± 34 min. No abnormalities were detected during intraoperative neuromonitoring, as well as neurological deficit in the postoperative period. The average time spent in the hospital was 7.2 ± 1.5 days.

In all patients, except for two 13-year-olds who had a Risser test of 4, bone growth was completed. The Sanders test was not performed due to the predominant age of patients over 18 years of age.

When comparing the indicators of age, the average angle of deformity before and after surgery, the average angle of correction and blood loss between groups with Lenke 1 and 3, no statistically significant differences were found. Comparison of the same parameters in groups with scoliosis types according to Lenke 3 and 5 showed differences in deformity angles after the intervention (Lenke 3: 28.2° ± 7.2°; Lenke 5: 12.6° ± 9.5°) and the number fixed levels (Lenke 3: 9.5° ± 1.0°; Lenke 5: 6.4° ± 1.0°; p = 0.024 and p = 0.006, respectively). Since the differences for the initial deformity angle are not statistically significant (p > 0.05), it can be said that there may be different efficacy in the treatment of scoliosis types 1 and 3, but this requires further research on more clinical material. Thus, before the operation, no statistically significant differences were found among the considered parameters, but after the operation, differences appeared. Type 5 is expected to be more responsive to ASC treatment than type 3 and may have a significantly better prognosis. No statistical differences were found between types 1 and 5. Differences in angles before intervention between groups I and II, II and III, as well as angles of deformity after intervention between groups I and II at this stage do not carry sufficient statistical significance, however, they can be considered as potentially provable (0.05 < p < 0, 1) with an increase in the number of patients, including the addition of new observations to those already included in this study. There were no problems due to a break in the flexible cord 15, loss of correction, or due to overcorrection at the stages of observation, which may be due to a short observation period. Of the complications, in one case, pneumonia was noted on the side of the surgical access, which was stopped within two months after the operation. Despite the limited possibilities of derotation when using a flexible cord 15 in most cases, it was possible to achieve a satisfactory clinical result.

According to the rating scales, 3 months after surgery, the average SRS-22 for all patients was 4.00 ± 0.42 (from 3.00 to 4.95). VAS data before surgery: 6.9 ± 1.5 (4.0-9.0) and after 3 months. after surgery: 4.4 ± 1.6 (1.0-7.0). There is a significant improvement in indicators, which indicates the unconditional effectiveness of the surgical treatment, at least in the short term.

The claimed invention allows to delay or prevent the use of rigid stabilization in most patients, and in adults it is possible to achieve greater effectiveness in terms of better correction and a structure of complications comparable to the use of stable systems. This is due to the greater density of bone tissue, the anatomical dimensions of the vertebral bodies, which allows transcorporeal installation of two screws in each vertebra. To increase the stability of the fixing screws, especially the end screws, plates 3 were installed during the corrective maneuver. No resorption around the screws was found in our observations, which may be due to a short observation period.

According to the data obtained, the method is more preferable in the treatment of patients with lumbar and thoracolumbar deformities, which, of course, requires further research.

EFFECT: invention makes it possible to increase the efficiency of the method for surgical ventral dynamic correction of spinal deformities in adult patients and children, to expand the arsenal of means in the treatment of scoliosis, to reduce the duration of the operation, to reduce blood loss during surgical intervention, to reduce the period for quick recovery with a low overall average duration of hospitalization. The claimed invention also makes it possible to expand the arsenal of means in the treatment of scoliosis in growing children, adolescents and adults, that is, it provides the possibility of treating not only adolescents, but also adults, when the spine almost does not grow with a fixed skeleton, and also reduces the trauma during surgery.

Claims (17)

1. A method for surgical ventral dynamic correction of spinal deformities in adult patients and children using the installation on the vertebrae of a structure of plates, fixing screws with a flexible cord placed in the heads of the screws, drawn along the vertebrae and fixed in the heads of the fixing screws with locking screws, which consists in using monoaxial fixing screws with an open head of the tuning fork type with internal thread, in which the head of the fixing type is integral with the cylindrical part and with the outer screw surface; on the convex side of the spinal deformity, plates are installed on the surface of each vertebra, each of which has a rectangular or square shape, which is chosen taking into account the shape of the vertebra, so that the edges of the plate do not extend beyond the surface of the vertebra, and the plate has one diagonal at the end sections spikes directed towards the vertebrae, and on the other diagonal - two through holes in the end sections located on opposite sides of the plate for fixing screws, identify the upper and lower end plates, the front edge of the body and the front edge of the spinal canal of each vertebra, cut the thread into in each vertebra and through the through holes in the plate through the guide into the vertebra, two fixing screws are screwed, passing through both cortical layers, and the screws are screwed so that they cross in the vertebral body along the longitudinal axis, and the ends of the screws go outside the vertebra; flexible cords are inserted into the screw heads, with one flexible cord running along one side of the plates, and the other flexible cord running along the opposite side of the plates, and from the seventh thoracic vertebra and above, one flexible cord and one fixing screw are used; then, the spine is corrected by tensioning the flexible cords along the vertebrae, while the degree of tension is controlled, and after the appropriate correction is achieved and the spinal deformity is eliminated, the flexible cords are fixed by tightening them alternately with locking screws in the open heads of the fixing screws. 2. A method for surgical ventral dynamic correction of spinal deformities in adult patients and children according to claim 1, characterized in that, before performing surgical treatment, the spatial visualization of the affected spine is first determined using multilayer spiral computed tomography, then the condition of the surrounding soft tissues is assessed using magnetic resonance imaging, vascular and nervous structures that are not visualized when performing multilayer spiral computed tomography, after performing anesthesia with the use of intraoperative fluoroscopy, with the patient positioned on the side with the convex side of the spinal deformity up, the levels of the vertebrae are set to determine access in the anteroposterior and lateral positions, then: - under image intensifier control, palpation of the 12th rib is performed, - perform a thoracolumbar incision of the skin and subcutaneous fat with visualization of the lumbar region of the affected spine of the patient with an extension of the incision in the direction of the external oblique muscle of the abdomen by 3-5 cm in front with a dissection of the parietal pleura along the entire length of the planned fixation over the vertebral bodies and discs, - after dissection of the pleura, the lungs are abducted to the side, - further skeletonize the anterolateral part of the vertebral bodies, - identify segmental vessels, coagulate and dissect while maintaining collateral circulation between the segmental arteries in the intervertebral foramen, - moreover, for retroperitoneal access, the incision is expanded caudally in the direction of the muscle fibers of the external oblique muscle of the abdomen with the mobilization of the peritoneum from the square lumbar and iliac muscles, as well as with the identification and anteromedial mobilization of the ureter in the posterior part of the peritoneum, for which - separate the peritoneum from the posterior and lateral abdominal wall and diaphragm, - cross the internal oblique and transverse muscles using electrocoagulation, - cut the diaphragm at a distance of not more than 1 cm from its attachment with the exception of denervation of the descending phrenic nerve, - the psoas muscle is retracted posteriorly with exposure of the segmental vessels located at the midpoint between the lumbar spaces, which are tied up with visualization and access of the entire lateral edge of the bodies of the lumbar vertebrae and discs, and after the final fixation of the locking screws in the heads of the fixing screws, the spine is fluorovisualized in the anteroposterior and in lateral projections to confirm the elimination of the deformity of the patient's spine, - cut the ends of the flexible cord-cord, leaving at least 2 cm at both ends, - install pleural drainage for thoracophrenolumbotomy of the lower part, suitable for the place of suturing the diaphragm, - irrigate the pleural cavity with saline, inflate the lungs under visual control, carry out aero- and hemostasis, and the wound is sutured in layers. 3. The method of surgical ventral dynamic correction of spinal deformities in adult patients and children according to one of paragraphs. 1 or 2, characterized in that the ends of the fixing screws are blunt so as not to damage the organ and/or tissues. 4. A device for implementing the method of surgical ventral dynamic correction of spinal deformities in adult patients and children according to one of paragraphs. 1-3, characterized in that it contains square or rectangular plates intended for attachment to the vertebrae, each of which has a rectangular or square shape, which is chosen taking into account the shape of the vertebra, so that the edges of the plate do not extend beyond the surface of the vertebra, and the surface, facing the vertebra, should correspond to the surface of the vertebra, while one diagonal of each of which has spikes on the end sections on one side of the plate, designed to be inserted into the vertebrae, and on the other diagonal, intersecting with the first diagonal, a pair of through holes in the end sections with opposite side of the plate for fixing screws with open heads of tuning fork type with screw threads, in which either one flexible cord is fixed by locking screws, passing along one side of the plates, or two flexible cords, one of which runs along one side of the plates, and the other flexible cord runs along the opposite side of the plates.

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