bilateral lateral spine fusion

Spiral bilateral lateral fusion 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 shift) is the complete separation of the superior vertebral body from the lower vertebral body. 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: waist isthmus cracking and spondylolisthesis Indication Bilateral lateral fusion of the spine is suitable for: 1, the spine slips II degree or more, and there are lower back, buttocks and thigh pain. 2, there are symptoms of sciatica. 3, there are hamstring tendons. 4. Although there are no obvious symptoms, the spine slips off III degree or above. Contraindications 1, the spine slips off I degree, and asymptomatic. 2. The symptoms are not aggravated after non-surgical treatment. Preoperative preparation 1. Take the X-ray positive lateral radiograph of the whole spine to determine the type and extent of spondylolisthesis. In addition, conventional myelography or CT or MRI examination to understand the compression of the spinal canal and nerve roots. 2, electrophysiological examination to understand whether the spinal nerve root is damaged, and as a follow-up comparison. 3, blood biochemical examination blood CPK and liver and kidney function check, to understand the basic conditions of the body. 4, traction for 2 weeks before spinal traction, so that the paravertebral muscles, ligaments and small joints relax, is conducive to intraoperative reduction. 5, the application of antibiotics 24 hours before surgery to give a sufficient amount of broad-spectrum antibiotics. Surgical procedure 1. Incision A median skin incision is made between the superior and inferior vertebral spinous processes of the vertebral body, and the subcutaneous tissue is separated to both sides. 2, revealing the fusion zone The deep fascia was cut at the width of the two fingers outside the midline and the incision was exposed to reveal the fusion zone. The blunt dissection of the paravertebral muscle reveals the intervertebral joint capsule. Continue to separate the transverse processes that are to be fused. Submucosal removal of muscle tissue reveals transverse and intertransverse ligaments. Subperiosteal detachment of the fascia of the facet joint and all other tissues. Peel the fascia and tissue around the isthmus. Do the same for the opposite side. Do not remove the upper articular surface of the uppermost spine to be fused. 3, take the autogenous humerus Reveal the posterior superior iliac spine, sharply or use an electric knife to cut the fascia on the iliac crest, continue to peel from the posterior superior iliac spine to the outside, reveal a sputum of 3 to 4 cm, and peel the gluteal muscle outside the iliac crest. The exposed iliac crested the cortical-cancellous bone from the outside to the inner plate. The wound is placed with a negative pressure drainage tube to close the wound. 4, bone grafting When implanting bone in the recipient area, the cortical-cancellous bone strip is placed under the transverse process to bridge the transverse intersegmental ligament, and the cortical surface is oriented toward the ligament. The articular cartilage to be fused is completely removed, and the cancellous bone is placed between the joints. All exposed bones are subjected to deboned cortex, including the humeral wing, transverse process, and revealed isthmus. The remaining bone is carefully filled from the inside to the outside in the groove between the bilateral isthmus and the transverse process tip. 5, close the incision Thoroughly stop bleeding, flush the wound with saline, suture the incision layer by layer, and place a negative pressure drainage tube under the skin. complication 1, the formation of false joints, increased slip. 2. Damage to the cauda equina and nerve roots.

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