Anterior fusion for spondylolisthesis

Spinal spondylolisthesis is used for the surgical treatment of spondylolisthesis in children. Children with spondylolisthesis are displaced forward or backward by the vertebral arch due to rupture of the vertebral arch. The forward shifter is called the anterior spine slip; even if the shift is backward, it is called posterior spine slip; if there is no shift, the pedicle is cracked. The cause of the disease is thought to be related to factors such as congenital lamina isthral defect, trauma and isthmus developmental disorders. Children with spondylolisthesis occur mostly after the age of 10 and are most common at 14 years old. When the spine is slipped, it can often directly compress the spinal nerves or cause disc herniation, muscle spasm and ligament damage. It occurs in L5, which accounts for about 90%, sometimes in L3 to L4, and occasionally in C5 to C6. Lumbar spine slippery manifestations of trunk shortening, lumbar lordosis increased significantly, may have low back pain, severe cases may occur sciatica, skin sensory disturbances, limited bending activities, straight leg elevation test positive, knee and Achilles tendon The reflection is weakened or disappeared, and even the incontinence is incontinent, and the lower limbs are incomplete. Occurred in the cervical spine may have neck pain, muscle spasm, torticollis, restricted neck activity, and even difficulty swallowing. According to the X-ray film, according to the severity of the upper vertebral body relative to the lower vertebral body slip, the spondylolisthesis can be divided into I, II, III, IV, V degrees. The I degree slippery vertebral body is displaced forward to less than 25% of the anteroposterior diameter of the lower vertebral body, the second degree is 25% to 50%, the third degree is 50% to 75%, the IV degree is >75%, and the V degree is (the spine). Advance) is the complete separation of the superior vertebral body from the lower vertebral body (Fig. 12.29.5.2.1-0-1). In the choice of treatment, for those who are not obvious, and the X-ray film is only shifted by one degree, non-surgical treatment is adopted, including restricting patient activity, back muscle massage, traction and brace fixation therapy. About 20% of patients with symptomatic spondylolisthesis need surgery. For patients with painful spondylolisthesis, the younger the patient, the more certain the indications for surgery and the better the surgical outcome. Sciatica is often the cause of surgical treatment in this type of patient. Spinal fusion, spinal fusion, internal fixation plus spinal fusion can be used according to different conditions. Treatment of diseases: lumbar spondylolisthesis Indication Spinal scapular anterior fusion is suitable for: 1. The L5 vertebral body is severely displaced, and the L5 and S1 lamina gap cannot be revealed and scraped from the posterior approach of the spine. 2. Loss after post-spinal fusion. Contraindications 1. The general condition is poor and there are important organ diseases. 2. There are infected lesions in the skin near the surgical area. Preoperative preparation 1. Take a full lateral spine of the spine to determine the extent and extent of spondylolisthesis. 2. Electrophysiological examination. 3, blood chemical examination. 4. Application of antibiotics. Surgical procedure 1. Incision A midline longitudinal incision was made from the 2cm to the pubic symphysis on the umbilicus. 2, revealing lumbar vertebrae Cut the skin along the direction of the incision, cut a small gap between the umbilical cord and the pubic symphysis, lift the white line on both sides of the abdomen, use the tissue scissors to cut the white line of the abdomen, and separate the extraperitoneal fat. The peritoneum was cut with a knife and the peritoneum was cut up and down, respectively. Use the saline gauze pad to push the small intestine and the large intestine to the sides, fully reveal the posterior peritoneum, and find the bifurcation of the abdominal aorta as a sign to further identify the iliac crest, vein and ureter. Cut the posterior peritoneum longitudinally at the iliac crest and extend it up and down. Find and cut, ligature the iliac crest, vein, and peel the posterior peritoneum to the two sides, and then suture the posterior peritoneum and the peri-perimembranous periphery to fix several needles to separate the surgical field from the abdominal viscera. The displacement of the L5 and S1 vertebral bodies was touched by hand and compared with those seen by the X-ray films. Then, the anterior longitudinal ligament and periosteum in front of L4 to S1 were cut from the bifurcation of the abdominal aorta. 3, bone graft Under fluoroscopy, the upper edge of the L5 vertebral body was drilled obliquely between the S1 vertebral bodies. Due to the patient's supine position, the direction of the rough drill bit is roughly perpendicular to the ground. When the drill bit passes between L5 and S1, there is a feeling of falling. When entering the S1 vertebral body, there is a sense of resistance until the drill bit enters the thickness of the S1 vertebral body. So far. Then the bone strip with cortical bone is taken from the humerus and embedded in the borehole, and L5 is fixed on the S1 vertebral body. 4, close the incision Thoroughly stop bleeding, rinse with saline, remove the temporarily fixed anterior and posterior peritoneal sutures, suture the periosteum and anterior longitudinal ligament, and then suture the peritoneal incision to close the layers of the abdominal wall. complication Abdominal cavity, pelvic organ injury, general iliac crest, venous injury.

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