METHOD OF POSTERIOR-TRANSFORAMINAL INTERBODY SPINAL FUSION ACCOMPANIED BY DECOMPRESSOR-STABILIZING OPERATIONS ON LUMBAR SPINE Russian patent published in 2020 - IPC A61B17/70 

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to spinal surgery, and can be used for posterior-transforaminal interbody fusion accompanied by decompression-stabilizing surgical interventions on the lumbar spine. Non-invasive examination of the injured vertebral-motor segment is performed. Possible sizes of planned for implant installation in given anatomical conditions are estimated. Bone screws of the transpedicular fixation system are implanted in the vertebrae, decompression is provided. In an oblique direction – at an angle to the sagittal plane – a corridor is formed, which is intended for further introduction of the implant into the interbody body. That is ensured by facetectomy, resection of the arch of the upper fixable vertebra to the base of the spinous process, resection of the yellow ligament throughout the segment to the contralateral side, mobilization of the dural sac. After imaging, medially at value from 1/3 to 1/2 of the width of the spinal canal, an opening is made in an interbody spacing, a posterior longitudinal ligament and a fibrous ring. Discectomy is performed with treatment of vertebral closing plates. Autobone resulting from vertebral processing is preserved and used as an osteoconductive material. Implant is formed. For this purpose, the cage is filled with autobone, the implant is inserted into the interbody space, implant is brought along a corridor with due allowance for a skewed trajectory of introduction; transpedicular helical fixation of vertebras is performed by mounting elements of a metal structure of a transpedicular system in a compression mode. Non-invasive examination of the injured vertebral-motor segment is performed by multi-helical computed tomography. Transpedicular helical fixation is performed on the opposite side from the side of the implant installation, performing the implantation of bone screws and erection of the metal structure with supporting compression. Cage is used with width of 16 to 22 mm and length of 30 to 35 mm, height of 10 to 12 mm, made by additive technology, by selective layer-by-layer laser melting of titanium powder BT-6, made personally for a specific patient. When forming a corridor intended for insertion of an implant, a volume of intervertebral disc larger than that of the implant is removed, during implantation, the implant is turned, placing its long side in the frontal plane, filling the cavities with autobone. Access is performed through median incision or paravertebrally by Wiltse to perform skeletonization of posterior structures of stabilized vertebras.

EFFECT: method provides fusion of vertebrae with reduced risk of developing pseudoarthrosis, reduced time of surgical intervention and reduced aggressiveness of surgical intervention by increasing the area of contact of the implant and reducing tissue injuries.

7 cl, 12 dwg