METHOD OF PERFORMING SURGICAL TREATMENT OF PATIENTS WITH LUMBAR INTERVERTEBRAL HERNIAS USING A POLYMER FIXATION CAGE WITH OSTEOINDUCTIVE MATERIAL IMPREGNATED WITH VANCOMYCIN AND/OR GENTAMICIN Russian patent published in 2024 - IPC A61B17/70 A61F2/44 A61K31/7042 A61K31/7036 A61P19/02 

FIELD: medicine; traumatology; orthopaedics; neurosurgery.

SUBSTANCE: invention can be used for surgical treatment of patients with lumbar intervertebral hernias using a metal fixing cage with osteoinductive material impregnated with vancomycin and/or gentamicin. 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 metal fixing interbody cage, banana-shaped in the axial plane and rectangular in the frontal plane, measuring 10–28 mm with the height from 7 to 14 mm is installed in the anterior 1/3 of the formed bed of the intervertebral space. The space formed after the removal of the intervertebral disc is filled with osteoinductive material impregnated as an antibacterial agent with aqueous solutions of tobramycin at a concentration of 20–40 mg/ml and/or gentamicin at a concentration of 25–50 mg/ml. Using image intensifier control, the correct placement of transpedicular screws and a metal fixing interbody cage is assessed, and the position of the dural sac and spinal roots is reviewed. The wounds are washed with saline solution with drainage. The wounds are sutured layer by layer. The BBraun TSPACE cage is used as a metal fixing interbody banana-shaped 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, fixing rods and a metal cage are made of VT6 titanium alloy. 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: eliminating the risk of compression of the nerve roots along with the accompanying artery, restoring the height of the interbody space and the sagittal profile of the patient's lumbar spine while maintaining the physiological load on the overlying adjacent spinal motion segment, the absence of infectious lesions of surrounding tissues and the prevention of the occurrence of purulent-inflammatory processes with simultaneous preservation of blood supply and innervation of tissues due to the peculiarities of implementation.

5 cl, 5 ex