METHOD FOR SURGICAL CORRECTIVE SPONDYLODESIS ON THE LUMBAR SPINE Russian patent published in 2022 - IPC A61B17/56 A61B17/70 

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to traumatology and orthopedics, and can be used for surgical corrective fusion in the lumbar spine. In the preoperative period, the spatial visualization of the affected structures of the lumbar spine with the determination of kyphotic, shear and rotational deformity in the lumbar spine is determined by the method for multilayer spiral computed tomography and radiography, the condition of the surrounding soft tissues, vascular and nervous structures is assessed using magnetic resonance imaging. The patient is positioned on the surgical table on the ridges located under the chest and under the area of ​​the hip joints, the posterior median approach is performed, the elements of the posterior support columns are skeletonized, if any, after the previous surgical intervention of the transpedicular structure, leaving the transpedicular screws. Laminectomy and bilateral facetectomy, removal of the yellow ligament and meningoradiculolysis at the level of corrective spondylodesis are performed. Alternately, the dural sac is displaced medially to the left and right, the posterior longitudinal ligament and the dorsal part of the fibrous ring in the visual control zone are dissected with a scalpel, the nucleus pulposus, hyaline cartilage of the endplates are removed to "blood dew". Two temporary rods are placed in the heads of the transpedicular screws on the left and on the right, which are preliminarily fixed in the heads of the screws. Distraction is performed using a distractor by the heads of the screws of the interbody space, and in this position, temporary mounting of the transpedicular structure is performed. Through the interbody space under image intensifier control, a rupture of the lateral and anterior parts of the annulus fibrosus is performed using a flat chisel, with the chisel exit limiting to no more than 5 mm beyond the contour of the vertebral body. After a complete rupture of the fibrous ring, the nuts of the transpedicular structure are loosened and additional distraction of the interbody space is carried out by the heads of the transpedicular structure to install the required size of the interbody implant. An interbody implant is installed in the anterior third of the interbody space, bone autocrumbs from the resected posterior structures are placed in the posterior 2/3 of the interbody space, the structure is loosened by giving the patient an extension in the lumbar spine. Due to the extension of the surgical table, the deformity is corrected in all planes until the edges of the resection wedge close. Alternately, on the left and right, temporary rods are replaced with rods bent in accordance with the planned correction. The contraction for the heads of the pedicle screws and the final assembly of the structure are performed. EOP control is carried out, revision of the position of the dural sac and spinal roots, the wound is washed with saline and drainage is performed. The wound is sutured in layers and an aseptic bandage is applied.

EFFECT: method makes it possible to use the ventral support column under conditions of previously performed transpedicular fixation and rigid deformity, eliminates the risk of trauma to intracanal neurovascular formations, provides the possibility of performing the necessary rupture of the fibrous ring along the entire perimeter of the intervertebral disc, the possibility of segmental distraction of the interbody space simultaneously behind the heads of the transpedicular structure on the right and left, as well as the elimination of kyphotic, shear and rotational deformities in the spinal motion segment due to the implementation of method techniques.

2 cl, 3 ex