METHOD FOR SURGICAL CORRECTION OF MAIN ARCH OF SCOLIOTIC DEFORMATION OF THORACOLUMBAR SPINE USING POLYMER CAGE WITH VENTRAL DYNAMIC CORRECTION Russian patent published in 2024 - IPC A61B17/00 A61B17/70 A61F2/44 

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to traumatology and orthopaedics, and can be used for correction of the main arch of scoliotic deformation of the thoracolumbar spine using a polymer cage for ventral dynamic correction. Thoracolumbar incision of the skin and subcutaneous fat is performed with visualization of the thoracolumbar portion with an extension of the incision in the direction of the external oblique muscle of abdomen by 3–5 cm from the front with dissection of the parietal pleura along the length of the planned fixation. Anterolateral part of the vertebral bodies is skeletonized, the segmental vessels are identified, coagulated and dissected while preserving the collateral circulation between the segmental arteries in the intervertebral foramen, with extension of access caudally in direction of muscle fibres of external oblique muscle of abdomen with mobilization of peritoneum from quadratus lumborum muscle and iliac muscle, separation of peritoneum from posterior and lateral abdominal wall and diaphragm with subsequent intersection of internal oblique and transverse muscles. Diaphragm is dissected at distance of 0.8–1 cm from its attachment point. Spinal motion segments are mobilized by dissecting a fibrous ring of the disc on each disc of the deformed lumbar spine for 1–1.5 cm, followed by removal of a nucleus pulposus on the convex side of the spinal deformity. On the surface of each vertebra, plates are installed, each of which has a rectangular or square shape, which is selected so that the edges of the plate do not extend beyond the surface of the vertebra. Plate has on one diagonal on the end sections the studs directed towards the vertebrae, and on the other – two through holes on the end sections located on the opposite sides of the plate for the fixing screws, upper and lower end plates, front edge of body and front edge of spinal canal of each vertebra are identified. Thread is cut in each vertebra, and two fixing screws with blunt ends passing through both cortical layers are screwed through the through holes in the plate through the guide into the vertebra. Screws are screwed in so that they intersect in the vertebral body along the longitudinal axis, and the ends of the screws protrude outside the vertebra. Monoaxial fixing screws with an open head of a tuning-fork type with an internal thread are used, in which the fixing type head is an integral part with a cylindrical part and with an external screw surface. Flexible cords are inserted into screw heads. One flexible cord passes along one lateral side of the plates, and the other flexible cord passes along the opposite lateral side of the plates. One flexible cord and one fixing screw are used from the seventh thoracic vertebra and higher. Spinal correction is performed by stretching flexible cords along vertebrae. After adequate correction and elimination of spinal deformation, flexible cords are fixed by tightening them in turn with locking screws in open heads of fixing screws. Spinal fluorimaging is performed in anteroposterior and lateral projections. Ends of flexible cord are cut. Pleural drainage is installed during thoracotomy. Pleural cavity is irrigated with normal saline, and the lungs are inflated. Aero- and haemostasis is performed, the wound is closed in layers. Flexible cord is made from polyethylene terephthalate, and the studded plates, monoaxial fixing screws and locking screws are made from titanium alloy.

EFFECT: method provides the reliable anatomical restoration of the frontal and sagittal balance, mobility of the spinal motion segments by increasing the degree of correction and performing the adequate derotation of the scoliotic arch of the deformed spine.

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