METHOD FOR REVISION SURGICAL INTERVENTION ON THE LUMBAR SPINE Russian patent published in 2021 - IPC A61B17/70 

FIELD: medicine.

SUBSTANCE: invention can be used in medicine, namely in neurosurgery, and can be used for revision surgical intervention on the lumbar spine. Guide wires are installed in the superjacent and subjacent vertebral bodies through the roots of the arches, then an incision of the skin, subcutaneous fat and thoracolumbal fascia is made between the wires on the side contralateral to the primary surgical intervention at a step of 3.5 to 4 cm from the middle line. The multifidus muscle up to the zygapophysial joint is divided by blunt dissection, a tubular retractor is installed, an interlaminar gap is isolated. The base of the spinous process is resected, the free fragment whereof together with the soft tissues is mobilised contralateral to the access. An interlaminar access to the spinal canal is provided and a semi-arch is resected. After visualising the unaltered dura mater, a view of the part of the spinal canal and intervertebral foramen is performed on the side contralateral to the access. Meningoradiculolysis is performed in the scar area, and the semi-arch contralateral to the access, scar tissue, hypertrophied ligamenta flava over the isolated area of dura mater are resected. In the course of resection of the bone tissue, the retractor blades are spread, the soft tissues and scar are mobilised to the cuff of the root on the side contralateral to the access and up to the intervertebral foramen. The dural sac is displaced, the peridural spaces are revised, the compressing substrate is removed, and a foraminotomy contralateral to the access is performed. Also, the disk cavity is curetted and an interbody cage is installed. Upon completing the decompression transpedicular screws are installed on the side of the access under X-ray control through the previously installed guide wires through the roots of the arches. Transcutaneous transpedicular stabilisation is performed on the side contralateral to the access.

EFFECT: method provides a reduction in the trauma rate, duration of surgery, and volume of blood loss due to a safe approach from the side of unaltered tissues, adequate visualisation of the neural structures, and preserved integrity of the multifidus lumbar muscle.

4 cl, 4 dwg, 1 ex