METHOD OF PERFORMING SURGICAL TREATMENT OF PATIENTS WITH LUMBAR INTERVERTEBRAL HERNIAS USING POLYMER FIXATION CAGE Russian patent published in 2023 - IPC A61B17/70 A61F2/28 

FIELD: medicine; traumatology; orthopedics; neurosurgery.

SUBSTANCE: invention can be used to perform surgical treatment of patients with lumbar intervertebral hernias using a polymer fixing cage. When diagnosing a patient with stage II–III intervertebral disc degeneration according to Pfirrmann, protrusive type of intervertebral hernia, changes in the red bone marrow and endplates of adjacent vertebral bodies according to Modic I type, intervertebral disc height index more than 0.3, range of motion in the spinal motion segment more than 10°, the angle of lumbar lordosis less than 40°, preoperative planning and subsequent surgical treatment of lumbar intervertebral hernia are carried out, during which an incision is made in the skin and subcutaneous fat in the projection of the affected spinal motion segment, the spinous processes, arches and facet joints are skeletonized to the transverse processes. Transpedicular screws are installed in the pedicles of adjacent vertebrae on the right and left, which are fixed with rods on the left and right. The ligamentum flavum and facet joint are removed from the side of the hernia. The part of the intervertebral disc, nucleus pulposus, and hyaline cartilage of the endplates that prolapses into the spinal canal is removed. A polymer interbody cage, banana-shaped in the axial plane and rectangular in the frontal plane, measuring 10×28 mm and height from 7 to 14 mm with an internal cavity filled with osteoinductive material is installed in the anterior 1/3 of the formed bed of the intervertebral space. The polymer cage is made of polyaryletherketone, selected from the group polyetheretherketone, or polyetheretherketone, or polyetherketoneketone, or polyetheretherketoneketone, or polyetherketoneetherketoneketone. The posterior 2/3 of the formed bed of the intervertebral space is filled with osteoinductive material. The correct placement of transpedicular screws and interbody cage is assessed using image intensifier control. The position of the dural sac and spinal roots is inspected. The wounds are washed with saline solution with drainage, and the wounds are sutured layer by layer. The T-PAL De Puy Synthes cage is used as a polymer banana-shaped interbody cage. Herewith, granules of a complex alloplastic preparation based on hydroxyapatite containing 60 % wt collagen, or granules of bone-plastic biological material based on bone tissue or autologous bone crumb are used as osteoinductive material. Transpedicular screws and fixing rods are made of titanium alloy VT6.

EFFECT: method eliminates the risk of compression of the nerve roots along with the accompanying artery, provides the possibility of restoring the height of the interbody space, reliable restoration of the sagittal profile of the patient’s lumbar spine while maintaining the physiological load on the overlying adjacent spinal motion segment, as well as a significant increase in the patient’s quality of life due to the features execution of the method.

4 cl, 5 ex