METHOD OF PERFORMING SURGICAL TREATMENT OF PATIENTS WITH LUMBAR INTERVERTEBRAL HERNIAS USING A POLYMER FIXATION CAGE WITH OSTEOINDUCTIVE MATERIAL IMPREGNATED WITH TOBRAMYCIN AND/OR AMIKACIN Russian patent published in 2023 - IPC A61B17/70 A61F2/44 

FIELD: medicine; traumatology; orthopedics; neurosurgery.

SUBSTANCE: invention can be used to perform surgical treatment of patients with lumbar intervertebral hernias. In the preoperative period, the index of the height of the affected intervertebral disc, the range of motion in the affected lumbar-motor segment, and also the angle of lumbar lordosis are determined using radiography; the stage of degeneration of the intervertebral disc according to Pfirrmann, the type of intervertebral hernia, and the nature of changes in the red bone marrow are determined using magnetic resonance imaging. and endplates of adjacent vertebral bodies according to the Modic type. 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 >0.3, range of motion in the spinal motor segment >10°, angle of lumbar lordosis <40°, the surgical treatment of lumbar intervertebral hernia is carried out. During the treatment an incision is made into the skin and subcutaneous fat, and the projections of the affected spinal motion segment are skeletonized from the spinous processes, arches and facet joints to the transverse processes. Transpedicular screws are installed in the pedicles of adjacent vertebrae on the right and left fixed with rods on the left and right. Next, the yellow ligament and facet joint are removed from the side of the hernia, and 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 by 28 mm with a height of 7–14 mm with an internal cavity filled with osteoinductive material impregnated with aqueous solutions of tobramycin with a concentration of 30–50 mg/ml and/or aqueous solutions of amikacin with a concentration of 35–55 mg/ml used an antibacterial agent is installed in the anterior 1/3 of the formed bed of the intervertebral space. The polymer interbody cage is made of polyarylene ether ketone, selected from the group polyether ether ketone, or polyether ether ketone, or polyether ketone ketone, or polyether ether ketone ketone, or polyether ether ketone ketone, or polyether ether ketone ketone, or polyether ether ketone ketone, or polyether ether ketone ketone, the rear 2/3 of the formed bed of the intervertebral space is filled with osteoinductive material, impregnated with aqueous solutions of tobramycin with a concentration 30–50 mg/ml and/or aqueous solutions of amikacin with a concentration of 35–55 mg/ml as an antibacterial agent. Using image intensifier control, the correct placement of transpedicular screws and interbody cages is assessed, the position of the dural sac and spinal roots is inspected, and the wounds are washed with saline solution with drainage. The wounds are sutured. 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. Herewith, the content of an aqueous solution of ceftobiprol antibacterial drug in its mixture with an aqueous solution of dalbavancin antibacterial drug was chosen from 20 to 80% by volume.

EFFECT: method eliminates the risk of compression of the nerve roots along with the accompanying artery, restores the height of the interbody space, restores the sagittal profile of the patient's lumbar spine while maintaining the physiological load on the overlying adjacent spinal motion segment, ensures the absence of infectious lesions of surrounding tissues, while maintaining blood supply and innervation tissues, as well as improving the patient’s quality of life by performing surgical treatment of patients with lumbar intervertebral hernias using a polymer fixation cage with osteoinductive material impregnated with tobramycin and/or amikacin.

5 cl, 5 ex