METHOD FOR TREATING PATIENTS WITH FORAMINAL LIGAMENTARY STENOSIS OF THE LUMBAR SPINE Russian patent published in 2023 - IPC A61B17/00 A61B17/56 

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to traumatology and orthopedics, neurosurgery, and can be used to treat patients with foraminal ligamentary stenosis of the lumbar spine. If a patient has confirmed foraminal ligamentary stenosis, which is expressed in the relief of pain after foraminal blockade of the proposed zone with 1 ml of 2% lidocaine solution under X-ray control, endoscopic transforaminal decompression is performed. After determining the position of the iliac crest, the puncture zone of the instruments is marked at a distance of 12 cm from the spinous processes at the level of L5-S1, 10 cm from the spinous processes at the level of L4-L5 and 8 cm from the spinous processes at the level of L3-4 and L2-L1. The location of the injection point is controlled radiographically in frontal and lateral projections, performing navigation markings. A skin incision 8 mm long is made. After the conductor is installed along the puncture needle, the first tubular dilator is passed through it so that, during X-ray control in the lateral projection, its end reaches the ventrolateral edge of the superior articular process and the upper medial edge of the pedicle of the arch of the underlying vertebra, and in direct projection it is located in the spinal canal in the subarticular zone along the medial pedicular line. Tubular dilators are sequentially carried out with an increase in their diameter and an emphasis on their ends in the bone structures; a crown cutter is passed along the conductor, corresponding to the diameter of the last tubular dilator, rotating it counterclockwise until it comes into contact with the bone structures. By changing the direction of rotation of the cutter, the ventrolateral edge of the superior articular process and the upper medial edge of the pedicle of the arch of the underlying vertebra and the transforaminal ligaments attached to them are resected. The cutter and the complex of removed tissues are removed. A guide with a central hole is passed along the conductor so that, during X-ray control in a direct projection, the end of the guide reaches the medial pedicular line. The conductor is removed and the endoscope port is passed along the guide; with insufficient decompression of the roots, the resection zone is expanded, hypertrophied structures are removed.

EFFECT: method provides relief of pain syndrome intensity, excludes migration of instruments from the area of interest, reduces the operation time, simplifies it and allows one-stage resection of a complex of tissues without changing the direction of the cutter due to the foraminal blockade, the use of one cutter and the direction of its rotation.

1 cl, 4 dwg, 2 ex