RU2790783C1 - Method for discectomy for degenerative cervical spine disease - Google Patents

Abstract

FIELD: neurosurgery; traumatology.

SUBSTANCE: for simultaneous discectomy on two adjacent intervertebral discs, a fixed position of the cervical spine is achieved by moderately extending it by placing a pillow under the thoracic spine, placing a headrest under the occipital part of the head, and fixing the arms along the body. The access to the anterior surface of the cervical vertebrae is performed from a transverse skin incision located lateral to the midline to the outer edge of the sternocleidomastoid muscle. A radiological marker is placed over the vertebral body, which is the centre of the adjacent intervertebral discs to be operated on, and the two-staged discectomy is performed. At the first stage, discectomy is performed above the located intervertebral disc, for which the positions of the surgical table and the surgery microscope are changed so that the patient's legs are higher than the head and direct visualization of the working channel and anatomical corridor to the intervertebral disc located higher is achieved. At the second stage, discectomy is performed below the located intervertebral disc, for which the positions of the surgical table and the surgery microscope are changed so that the patient's legs are lower than the head and direct visualization of the working channel and anatomical corridor to the intervertebral disc located lower is achieved.

EFFECT: method provides reduction of pain syndrome, effective visualization of intervertebral discs of adjacent segments and the spinal canal in the area of surgical intervention without expanding access for implant installation, the possibility of using a standard set of surgical instruments due to the shortest trajectory from the skin incision to the anterior surface of the cervical spine and a standard interbody cervical retractor due to the absence of wide dissection and gross damage to the superficial fascia of the neck and paravertebral muscles, changing the angle of the surgical table and surgery microscope.

1 cl, 7 dwg, 5 tbl

Description

The present invention relates to the field of medicine, namely to neurosurgery and traumatology, and can be used in the surgical treatment of multilevel degenerative compression lesions of the cervical spine for minimally traumatic access to the spinal column.

It is known that the main causes of the development of radicular syndrome in the cervical spine are narrowing of the spinal canal and intervertebral foramen, mainly due to herniated intervertebral discs [1,2]. In order to eliminate discogenic compression of neural structures at the cervical level, the posterior approach, lateral approach, and anterolateral approach are currently used [3,4].

There is a known method of traditional access to the anterior-lateral surface of the cervical spine with a multilevel degenerative lesion [5], including a longitudinal incision of the skin and superficial fascia of the neck along the inner edge of the sternocleidomastoid muscle 8-10 cm long, discectomy with fixation of the affected segments with an autograft.

The disadvantages of the known method of access in the surgical treatment of multilevel degenerative diseases in the cervical spine are:

- significant damage to the superficial fascia of the neck and sternocleidomastoid muscle, a significant amount of blood loss and infection risks associated with wide exposure of tissues during access;

- pronounced postoperative pain syndrome due to a large skin incision and extensive mobilization of soft tissues;

- a long recovery period associated with persistent pain and low physical activity;

- an increased risk of adjacent level degeneration associated with the lack of recovery of cervical lordosis and non-physiological redistribution of the axial load on the operated segments.

Closest to the present invention is a discectomy method, including access to the anterolateral surface of the cervical spine, described by I.N. Shevelev. and Gushcha A.O. [6]. The method of spinal canal discectomy in case of degenerative disease of the cervical spine consists in the fact that the patient is placed on the operating table in the supine position with extension of the cervical spine by placing a small pillow under the shoulders, ventral repharyngeal access to the anterior surface of the cervical spine is performed, why a transverse skin incision is made taking into account anatomical landmarks, after dissection of the superficial fascia of the neck, access to the intervertebral disc is made in a blunt way, while the neurovascular bundle is retracted laterally, and the esophagus with the trachea medially. Subsequently, discectomy, resection of the posterior osteophytes and the installation of an interbody implant are performed.

The known method of discectomy in the surgical treatment of degenerative diseases in the cervical spine has significant disadvantages:

- the method is effective mainly in the treatment of single-level degenerative diseases and is difficult to implement in two-level surgical procedures, when projection access to two segments at once is required without expanding the skin incision;

- an error in the level of the operation is possible when using only anatomical landmarks during access, which also makes it doubtful the possibility of performing two-level surgical procedures;

- there is no adequate visualization of the spinal cord and spinal roots when working on two adjacent intervertebral discs;

- the position of the pillow under the neck and shoulders does not fully correct the cervical lordosis.

The invention is aimed at solving the problem of expanding the functionality of the method while reducing trauma due to :

- performing surgical manipulations on adjacent segments while maintaining external aesthetics, less damage to the paravertebral muscles due to the use of one access to the anterior surface of the cervical spine;

- providing more gentle access to the spinal column while maintaining the integrity of the superficial fascia of the neck when performing a transverse skin incision with less traction of the sternocleidomastoid muscle;

- use of standard surgical instruments due to a modified transverse approach and maintaining the stability of a standard interbody cervical retractor in the muscular anatomical corridor, which is impossible when performing multilevel surgical procedures from a longitudinal approach and requires the use of more aggressive retractor systems with greater dissection of paravertebral tissues;

- reduction of postoperative pain syndrome by reducing the length of the skin incision and manipulations with the muscular-fascial complex;

- reducing the risk of degeneration of the adjacent level of the spine by restoring the physiological configuration of the cervical spine.

The technical result of the invention is to provide access to the spinal canal in case of a two-level degenerative disease of the cervical spine using one transverse ventral repharyngeal access to the anterior surface of the cervical spine, which allows for a phased two-level discectomy with the installation of interbody implants at adjacent levels.

The essence of the invention lies in the fact that in the method of discectomy of the spinal canal in a degenerative disease of the cervical spine, in which the patient is placed on the operating table in the supine position in a fixed position of the cervical region, marking is made with the release of a radiological mark, ventral repharyngeal access to the anterior surface is performed of the cervical spine and perform discectomy with the installation of interbody implants, according to the invention, it is proposed for simultaneous discectomy on two adjacent intervertebral discs to achieve a fixed position of the cervical spine by moderately extending it by placing a pillow under the thoracic spine, positioning the headrest under the occipital part of the head and fixing arms along the body, access to the anterior surface of the cervical vertebrae is performed from a transverse skin incision located lateral to the midline to the outer edge of the group dino-cleidomastoid muscle, while the radiographic mark is placed above the vertebral body, which is the center of the adjacent intervertebral discs undergoing surgery, and the discectomy is performed in two stages, and at the first stage, discectomy is performed above the located intervertebral disc, for which the position of the operating table and the operating room are changed. microscope so that the patient's legs are higher than the head and direct visualization of the working channel and the anatomical corridor to the higher intervertebral disc is achieved, and at the second stage, discectomy is performed below the located intervertebral disc, for which the positions of the operating table and the operating microscope are changed so that the patient's legs are below the head and direct visualization of the working canal and the anatomical corridor to the underlying intervertebral disc was achieved.

Positioning the patient in a position of moderate hyperextension in the cervical spine allows for a physiological lordotic configuration for the operated segments.

X-ray marking of the skin access to the anterior surface of the cervical spine using a metal mark located above the vertebra, which is the center of adjacent intervertebral discs, ensures correct planning of the skin incision without the need to expand the latter.

Carrying out one modified transverse approach to two adjacent cervical segments makes it possible to reduce the size of the skin incision, reduce the damaging factor on the superficial fascia of the neck and the sternocleidomastoid muscle.

Access to the anterior surface of the cervical spine lateral to the midline to the outer edge of the sternocleidomastoid muscle creates the possibility of adequate visualization during all stages of surgical intervention at the level of adjacent segments.

Modified transverse access to two adjacent cervical segments also makes it possible to use a set of surgical instruments of standard length and contributes to stable fixation of a standard interbody cervical retractor in the intermuscular space.

Carrying out surgical manipulations by tilting the surgical table and operating microscope for direct visualization of the working channel and the anatomical corridor, the first stage at the overlying level, the second at the underlying level, provides a gradual dosed restoration of the physiological lordotic configuration of the cervical spine.

After the clinical application of the proposed method of access and analysis of the results obtained, the authors found that improved surgical techniques made it possible to restore morpho-functional disorders of the spine less traumatically and maintain the aesthetics of the postoperative appearance. Based on the analysis of the clinical application of the proposed method of discectomy for a two-level degenerative disease of the cervical spine, the authors established the following advantages:

- decrease in the severity of the pain syndrome due to the absence of a wide dissection and gross damage to the superficial fascia of the neck and paravertebral muscles;

- the possibility of effective visualization of the intervertebral discs of adjacent segments and the spinal canal in the area of surgical intervention without expanding access for implant installation, including by changing the angle of the surgical table and operating microscope;

- the possibility of using a standard set of surgical instruments due to the shortest trajectory from the skin incision to the anterior surface of the cervical spine and a standard interbody cervical retractor due to its stable fixation in the intermuscular space;

- absence of ischemia of the skin flap and rapid wound healing due to the shorter length of the incision and the reduction in the duration of the surgical intervention;

- maximum preservation of external aesthetics due to the transverse location of the incision along the skin fold and a decrease in the length of the skin incision;

- restoration of natural biomechanics in the operated spinal motion segments due to effective correction of cervical lordosis during preoperative planning of the patient's position and stage-by-stage installation of interbody implants.

The method is illustrated with illustrations.

On FIG. Figure 1 shows the results of MRI of the cervical spine of patient A. before surgery: a – sagittal projection; b – axial projection in segment C _V -C _VI ; c – axial projection in segment C _VI -C _VII .

On FIG. 2 shows a schematic representation of the positioning of the patient and the marking of the anterior-lateral access to the cervical spine in the area of surgical treatment, and Fig. 3.4 shows a schematic representation of the patient on the operating table, taking into account the change in the angle of its inclination and the trajectory of access to the overlying intervertebral disc and to the underlying intervertebral disc, respectively, where:

1 - a pillow located under the thoracic spine;

2 - headrest in the form of a rubber ring;

3 - fixation of both hands, for example, with adhesive tape;

4 - surgical access;

5 - operating microscope;

6 - surgical table.

On FIG. 5 shows a photo of a sutured postoperative wound.

On FIG. Figure 6 shows the results of cervical spondylography of patient A. after surgery at the level of C _V -C _VI , C _VI -C _VII : a – lateral projection, b – direct projection.

On FIG. Figure 7 shows the results of MRI of the cervical spine of patient A. after surgery at the level of C _V -C _VI , C _VI -C _VII : a – sagittal projection; b – axial projection in segment C _V -C _VI ; c – axial projection in segment C _VI -C _VII .

The method is carried out as follows. After laying the patient on his back, pillow 1 is placed in the form of a roller under the thoracic spine for moderate overextension in the cervical spine. The fixation of the arms along the body is carried out, for example, with adhesive plaster 3. A pillow in the form of a headrest 2 is placed under the head, which can be used, for example, as a rubber ring. X-ray marking of skin access to the anterior surface of the cervical spine is performed using a metal label located above the vertebra, which is the center of adjacent intervertebral discs. Through one modified transverse incision located along the skin fold lateral to the midline to the outer edge of the sternocleidomastoid muscle, projection access 4 to the anterior surface of the cervical spine is performed. The superficial fascia of the neck is cut in a similar way to the skin access with the possibility of its subsequent plastic closure. Using a standard set of surgical instruments and a standard interbody cervical retractor, the first stage, by tilting the surgical table 6 and operating microscope 5 for direct visualization of the working channel and the anatomical corridor, as well as stable fixation of the cervical retractor in the intermuscular space, discectomy and stabilization of the overlying level are performed, the second - underlying.

After treatment of the surgical field with an antiseptic solution, under intravenous anesthesia using artificial lung ventilation, the patient is placed in the supine position, with a roller placed under the thoracic spine for moderate hyperextension of the cervical spine. After x-ray marking, a modified transverse incision is made along the skin fold lateral to the midline to the outer edge of the sternocleidomastoid muscle and the projection line located above the vertebra, which is the center of adjacent intervertebral discs. The superficial fascia of the neck is cut transversely and mobilized upward and downward. After the neurovascular bundle is retracted laterally and the trachea and esophagus medially by adjusting the angle of the surgical table and the operating microscope, necessary for direct visualization of the working channel and the anatomical corridor, using a standard set of surgical instruments and a standard interbody cervical retractor, the first stage is discectomy, resection posterior osteophytes, removal of the posterior longitudinal ligament and interbody implantation at the overlying level, the second - at the underlying level. This access allows for adequate visualization and revision of the dural sac and spinal roots from both sides and eliminates the cause of compression of the neural structures. The wound is washed with an antiseptic solution, the wound is sutured in layers and an aseptic bandage is applied.

The essence of the proposed method is illustrated by the following example.

Patient A., born in 1960, was hospitalized at the Center for Neurosurgery at the Clinical Hospital “RZD-Medicine”, Irkutsk, with complaints of severe pain in the cervical spine, radiating to the left shoulder, forearm along the external-lateral surface, in all fingers of the left hand, numbness in the area of pain.

From the anamnesis it was found out that periodic pains in the cervical spine have been disturbing for 7 years. Repeatedly received courses of conservative treatment with a positive effect. Over the past six months, he began to notice an increase in pain in his left hand, the appearance of numbness. Two months ago, the pain intensified significantly. The patient was referred to the Neurosurgery Center of the Clinical Hospital RZD-Medicine in Irkutsk to resolve the issue of surgical treatment.

Neurological examination showed that the cranial nerves were intact. Movements in the cervical spine are painful and limited. Defense of the paravertebral muscles III st. Reflexes from the biceps D => S, from the triceps D => S, carporadial D => S, live. Percussion of the thoracic spine is painless. Lumbar lordosis is preserved. Movements in the lumbar spine are painless. Knee reflexes D = S, Achilles reflexes D = S are reduced. There are no signs of tension. There are no pathological reflexes. Muscle tone in the upper and lower limbs is physiological. Strength in arms and legs 5 points. Sensitivity disorders of the radicular type in dermatomes C6, C7 on the left. There are no pelvic disorders. The level of pain syndrome according to the visual analog scale (VAS) was 84 mm in the cervical spine and 97 mm in the left upper limb. The value of the index of restriction of movements in the cervical spine according to the Neck Disability Index (NDI) is 42 points.

Performed cervical spondylography with functional tests: osteochondrosis of the cervical spine was detected, signs of instability were not detected. According to the results of MRI of the cervical spine, osteochondrosis is determined, left-sided hernia of the intervertebral discs at the level of C _V -C _VI , C _VI -C _VI with compression of the spinal cord roots, as shown in Fig. 1. Electroneuromyography of the upper and lower extremities was performed: stimulation myography revealed diffuse changes in the axonal type with a predominance of a decrease in the f-wave and M-response in the left upper limb. A detailed study of the clinical data and the results of additional research methods made a clinical diagnosis: Dorsopathy. Osteochondrosis of the cervical spine. Herniated discs at the level of C _V -C _VI , C _VI -C _VI . Radiculoneuritis C6, C7 on the left. Pronounced pain and muscular-tonic syndromes.

Taking into account the data of the clinical and neurological examination, the results of additional research methods, severe pain syndrome, resistant to conservative therapy, the patient is shown surgical treatment in the amount of two-segment discectomy C _V -C _VI and C _VI -C _VI .

Due to the two-level nature of the degenerative disease of the cervical spine, in order to minimize the surgical trauma during access, it was decided to perform surgical manipulations on adjacent segments according to the proposed method.

On January 15, 2020, in accordance with the proposed access method, minimally invasive C _V -C _VI microdiscectomy with interbody fusion and C _VI -C _VI microdiscectomy with total arthroplasty, meningoradiculolysis, foraminotomy for C6, C7 roots on both sides were performed.

Under intravenous anesthesia using artificial lung ventilation, in the position of the patient "on the back" with a pillow in the form of a roller 1 under the thoracic spine for moderate hyperextension of the cervical spine and a rubber headrest 2 in the form of a ring under the occipital part of the head and fixing 3 arms along the body adhesive plaster. The patient was positioned and X-ray marking of the projection line over the body of the C _VI vertebra was carried out as shown in Fig. 2. After treatment of the surgical field with an antiseptic solution, surgical access 4 was performed, for which a modified transverse incision was made along the skin fold lateral to the midline to the outer edge of the sternocleidomastoid muscle. A transverse incision was made in the superficial fascia of the neck with its mobilization upwards and downwards, after which the neurovascular bundle was retracted laterally, and the trachea with the esophagus medially. A cervical retractor Caspar (Ulrich, Germany) was fixed in the bodies of the C _V and C _VI vertebrae. By tilting the surgical table 6 and the operating microscope 5, a direct visualization of the working channel and the anatomical corridor to the intervertebral disc C _V -C _VI is provided, Fig. 3. With the help of conchotomes, total discectomy C _V -C _VI was performed, resection of the posterior osteophytes, removal of the posterior longitudinal ligament, revision of the dural sac and foraminotomy for C6 roots on both sides were performed using pistol nippers. Subsequently, an interbody cage was implanted. By changing the angle of attack of the microscope 5 through the same surgical access wound 4 and the anatomical corridor, the cervical retractor Caspar (Ulrich, Germany) was reinstalled with its fixation in the bodies of the C _VI and C _VII vertebrae, the bone canal in the body of the C _V vertebra was treated with bone wax. By tilting the surgical table 6 and the operating microscope 5, a direct visualization of the working channel and the anatomical corridor to the underlying intervertebral disc C _VI -C _VII is provided, Fig. 4. With the help of conchotomes, total discectomy C _VI -C _VII was performed, resection of posterior osteophytes, removal of the posterior longitudinal ligament, revision of the dural sac and foraminotomy for C7 roots on both sides were performed using pistol nippers. Subsequently, with the use of appropriate instruments, an artificial disc prosthesis was implanted. The cervical retractor Caspar (Ulrich, Germany) was dismantled, the bone canals in the bodies of C _VI and C _VII vertebrae were treated with bone wax. Implants were visualized on adjacent segments. The wound was washed with an antiseptic solution. Made layer-by-layer suturing of the wound, imposed aseptic bandage. The length of the postoperative wound was 3.5 cm as shown in FIG. 5.

In the postoperative period, it was carried out: antibacterial, symptomatic, vasoactive, vitamin therapy, exercise therapy, massage, dressings.

At discharge on the 8th day after surgery, the patient's condition was satisfactory. In the neurological status, there was a decrease in the severity of pain in the cervical spine and no pain in the left upper limb. The level of pain according to VAS was 3 mm in the cervical spine and 0 mm in the left upper limb. The value of the index of restriction of movements in the cervical spine according to NDI was set to 4 points.

1.5 months after the operation, the control objective and clinical examinations did not reveal any neurological deficit, there was no pain syndrome, working capacity and quality of life were restored. The patient returned to his previous work activity.

According to the results of control studies, the radiography of the cervical spine is shown in Fig. 6, after 3 months, no signs of implant instability were detected at the level of the surgical intervention in segments C _V -C _VII , cervical lordosis was preserved. According to the results of MRI of the cervical spine, shown in Fig. 7, 6 months after the operation, no degeneration of adjacent segments was registered.

Using the proposed method, operated on 16 patients with two-level degenerative compression lesions of the cervical spine (I group). A comparative analysis of the results of surgical treatment was performed with patients operated on for similar indications using a longitudinal approach to the anterolateral surface of the cervical spine and two-level interbody fusion in the supine position with a roll placed under the shoulders (Group II, n=25).

Table 1 reflects general information about the patients of the studied groups according to anthropometric data, gender parameters. It was found that the analyzed groups were comparable in terms of these characteristics (p>0.05).

Table 2 presents the results of the technical features of interventions and parameters of postoperative management of patients. It was established that the indicators of the duration of the operation, the volume of blood loss, the intraoperative amount of opioid drugs and the duration of inpatient treatment were significantly longer in group II (p<0.05). At the same time, there was no intergroup difference in activation time.

When comparing the degree of pain in the area of surgical intervention according to VAS, a statically significantly lower level was found in group I during the period of hospitalization until discharge from the department (p<0.05), as well as a significantly lower need for postoperative analgesia during hospitalization (p= 0.002). In this connection, in patients of group I in the early postoperative period there was no need for the introduction of painkillers, while in group II, injections of narcotic (morphine 1.0), non-narcotic analgesics (tramadol 2) were used to relieve pain in the area of the postoperative wound. .0) and non-steroidal anti-inflammatory drugs (ketonal 2.0). It was also found that 11 patients (68.7%) of group I did not need pain relief from 5 postoperative days of observation.

Table 3 shows that on the 1st-3rd day of the postoperative period, a statistically significantly lower level of glycemia was detected in group I compared with group II, which characterizes a lower level of local pain in response to "surgical stress".

Table 4 shows that an intergroup comparison of the number of postoperative surgical complications found a significantly lower number in group II (p=0.003).

Table 5 shows the dynamics of radiological parameters. It was found that 87.5% of patients in group I (n=14) after surgery had a physiological lordotic configuration of the cervical region and 40% (n=14) in group II (p=0.004).

The patients operated according to the proposed method returned to their previous work activities on average 35 (31;44) days after the operation, while in group II, 54 (42;67) days after the operation (p=0.02).

Thus, the proposed invention achieves a technical result, which consists in providing access to the spinal canal in case of a two-level degenerative disease of the cervical spine using one transverse ventral repharyngeal access to the anterior surface of the cervical spine, which allows for a phased two-level discectomy with the installation of interbody implants at adjacent levels . Due to this, the invention allows to solve the problem and expand the functionality of the method while reducing its trauma, allows, with minimal surgical trauma, to create maximum conditions for performing the necessary manipulations on adjacent intervertebral discs and neural structures in case of a two-level degenerative disease of the cervical segments, to use a set of surgical instruments standard length and a standard interbody cervical retractor, reduce the duration of surgery and intraoperative use of narcotic drugs, effectively reduce local pain and the need for postoperative pain relief, minimize the number of perioperative surgical complications, reduce the duration of postoperative inpatient treatment, conduct labor and social rehabilitation of patients as soon as possible , restore physiological spatial relationships in operated segments. In the late postoperative period, there was no need for additional decompressive or decompressive-stabilizing interventions on the operated and adjacent segments.

Table 1

Baseline Patient Data

Criteria Group I (n=16) Group II (n=25) R Age (years), Me (25; 75) 37 (31;50) 39 (34;55) 0.19 Gender [(male/female), % male] 11/5 (68.7) 18/7 (72) 0.26 BMI (kg / m ² ) 25.2 (23.7; 26.1) 25.5 (23.9; 26.3) 0.61

Note: BMI - body mass index; р – level of statistical significance

table 2

Perioperative characteristics of surgical interventions

Criteria Group I (n=16) Group II (n=25) R Operation duration (min), Me (25; 75) 110 (98;145) 150 (115;170) 0.01 Volume of blood loss (ml), Me (25; 75) 15 (10;20) 40 (20;60) <0.001 Number of anesthetic drugs administered (fentanyl 0.005%/mL/case) 12 (9.5;16) 16.5 (13.5;19) 0.014 Activation time (days), Me (25; 75) 1 (0;1) 1 (1;2) 0.05 Terms of hospitalization (days), Me (25; 75) 7 (6;7) 9 (9;10) 0.03

Note: p is the level of statistical significance

Table 3

Dynamics of blood glucose levels in patients

Criteria Study Group The value of the analyzed parameter during the measurement
at various stages Before surgery 1st day 2nd day 3rd day Glucose,
mmol/l
(Me: 25; 75%) Group I (n=16) 4.9 (4.4; 5.6) 6.4 (5.8; 6.9) ^* 6.6 (5.9; 7.0) ^* 6.0 (5.5; 6.8) ^* Group II (n=25) 4.8 (4.5; 5.4) 9.8 (9.3; 10.5) 9.8 (8.8;10.1) 9.1 (8.3; 9.9)

^* - reliability of differences between groups at the same stages of the study

Table 4

Postoperative complications in overweight patients

sign Group I (n=16) Group II (n=25) Formation of intermuscular hematomas, n, % - 2 (8) Surgical area infection 1 (6.25) 3 (12) Revision Interventions - 2 (8) Total amount , n, % 1 (6.25) 7 (28)

Table 5

Change in the sagittal profile of the cervical spine

Configuration before surgery Before surgery, n, % After surgery, n, % Group I (n=16) lordotic 9 (56.25) 14 (87.5) straight 5 (31.25) 2 (12.5) kyphotic 2 (12.5) 0 (0) Group II (n=25) lordotic 12 (48) 10 (40) straight 10 (40) 14 (56) kyphotic 3 (12) 14)

Sources of information taken into account:

1. Byvaltsev V.A., Sorokovikov V.A., Kalinin A.A., Belykh E.G. Analysis of the results of anterior cervical fusion using a hybrid RSV Evolution cage over a two-year period. N.N. Burdenko. - 2013. - No. 1. - P. 37-45.

2. Hirai T., Yoshii T., Arai Y., Sakai K., Torigoe I., Maehara H., Tomori M., Taniyama T., Sato H., Okawa A. A Comparative Study of Anterior Decompression With Fusion and Posterior Decompression With Laminoplasty for the Treatment of Cervical Spondylotic Myelopathy Patients With Large Anterior Compression of the Spinal Cord // Clin Spine Surg. - 2017. - Vol. 30. - No. 8. - R. E1137-E1142.

3. Byvaltsev V.A., Kalinin A.A., Aliev M.A., Shepelev V.V., Yusupov B.R., Aglakov B.M. Development of differentiated surgical tactics in the treatment of patients with multilevel degenerative diseases of the cervical spine. Innovative medicine of Kuban. - 2019. - T. 16. - No. 4. - S. 47-54.

4. Zhang L., Chen J., Cao C., Zhang Y.Z., Shi L.F., Zhai J.S., Huang T., Li X.C. Anterior versus posterior approach for the therapy of multilevel cervical spondylotic myelopathy: a meta-analysis and systematic review. Arch Orthop Trauma Surg. - 2019. - Vol. 139. - No. 6. - R. 735-742.

5. Bailey R.W., Badgley C.E. Stabilization of the cervical spine by anterior fusion // J Bone Joint Surg Am. - 1960. - Vol. 42-A. - P. 565-594.

6. Degenerative-dystrophic diseases of the cervical spine / I.N. Shevelev, A.O. Guscha - M .: ABV-press, 2008. - 176 p. – S. 93-95.

Claims (1)

A method for discectomy in a degenerative disease of the cervical spine, in which the patient is placed on the operating table in the supine position in a fixed position of the cervical spine, marking is made with the release of a radiographic mark, ventral repharyngeal access is performed to the anterior surface of the cervical spine and discectomy is performed with the installation of interbody implants, characterized in that for simultaneous discectomy on two adjacent intervertebral discs, a fixed position of the cervical spine is achieved by moderately extending it by placing a pillow under the thoracic spine, placing the headrest under the occipital part of the head and fixing the arms along the body, access to the anterior surface of the cervical vertebrae is performed from a transverse skin incision located lateral to the midline to the outer edge of the sternocleidomastoid muscle, with a radiological mark placed above the vertebral body, which is the center of adjacent intervertebral discs undergoing surgery, and discectomy is carried out in two stages, and at the first stage discectomy is performed above the located intervertebral disc, for which the positions of the operating table and the operating microscope are changed so that the patient's legs are higher than the head and achieved direct visualization of the working channel and the anatomical corridor to the above located intervertebral disc, and at the second stage discectomy is performed below the located intervertebral disc, for which the positions of the operating table and the operating microscope are changed so that the patient's legs are lower than the head and direct visualization of the working channel and the anatomical corridor is achieved to the underlying intervertebral disc.

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