METHOD OF SURGICAL MOBILIZATION OF THE MAIN CURVE OF SCOLIOTIC DEFORMITY OF LUMBAR SPINE DURING ANTERIOR DYNAMIC CORRECTION Russian patent published in 2023 - IPC A61B17/00 A61B17/70 

FIELD: traumatology and orthopedics.

SUBSTANCE: invention can be used for surgical mobilization of the main arc of scoliotic deformity of the thoracic spine during ventral dynamic correction. After performing anesthesia using intraoperative fluoroscopy with the patient positioned on his side with the convex side of the spinal deformity upward, vertebral levels are established. Under image intensifier control, palpation of the 12th rib is performed, a thoracolumbar incision is made in the skin and subcutaneous fat with visualization of the lumbar region of the affected spine of the patient with an extension of the incision in the direction of the external oblique abdominal muscle by 3-5 cm in front with dissection of the parietal pleura along the entire length of planned fixation. The anterolateral part of the vertebral bodies is skeletonized. Segmental vessels are identified, coagulated and dissected while maintaining collateral circulation between the segmental arteries in the intervertebral foramen. With the expansion of access caudally in the direction of the muscle fibers of the external oblique abdominal muscle with mobilization of the peritoneum from the quadratus lumborum and iliacus muscles, separation of the peritoneum from the posterior and lateral abdominal wall and diaphragm, followed by the intersection of the internal oblique and transverse muscles. Dissection of the diaphragm at a distance of 0.8-1 cm from the site of its attachment. After access to the lateral surfaces of the vertebral bodies of the deformed lumbar spine and intervertebral discs, the spinal motion segments are mobilized by dissecting the fibrous ring of the disc for 1-1.5 cm on each disc of the deformed lumbar spine using a scalpel, followed by partial removal of the nucleus pulposus on the convex side of the spinal deformity. Rectangular or square plates are placed on the surface of each vertebra so that the edges of the plate do not extend beyond the surface of the vertebra. The plate has spikes along one diagonal at the end sections directed towards the vertebrae, and along the other diagonal there are two through holes at the end sections located on opposite sides of the plate for fixing screws. A thread is cut in each vertebra with a tap and two fixing screws with blunt ends are screwed into the vertebra through the through holes in the plate through the guide, passing through both cortical layers, and the screws are screwed in so that they intersect in the vertebral body along the longitudinal axis, and the ends of the screws come out vertebra. Moreover, mono-axial fixing screws with an open head of the tuning fork type with an internal thread are used, in which the fixing type head is integral with the cylindrical part and with the outer screw surface. Flexible cords running along each side of the plates are inserted into the screw heads. The spine is corrected by tensioning the flexible cords along the vertebrae. The flexible cords are fixed by tightening them alternately with locking screws in the open heads of the fixing screws, and after the final fixation of the locking screws in the heads of the fixing screws, fluorovisualization of the spine is performed in the anteroposterior and lateral projections. Cut the ends of the flexible cord, leaving 2-2.4 cm at the ends. A pleural drainage is installed, the pleural cavity is irrigated with saline solution, the lungs are inflated, and aero- and hemostasis are performed. The wound is closed in layers. In this case, the flexible cord is made of polyethylene terephthalate, and the plates and screws are made of titanium alloy.

EFFECT: method ensures reliable anatomical restoration of frontal and sagittal balance, mobility of spinal motion segments, adequate derotation of the scoliotic arch of the deformed spine, achieving maximum cosmetic effect, ensuring the possibility of use in the treatment of patients with rigid deformities, as well as ensuring early social rehabilitation of the patient while simultaneously improving quality of life due to the peculiarities of the correction.

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