SPONDYLODESIS (spondylodesis; Greek spondylos vertebra + desis binding; synonym osteosynthesis of a backbone) — the operation directed to immobilization of any segment or department of a backbone by creation of the uniform bone block, a conglomerate of group of vertebrae is more often by means of osteoplastic methods. A large number of names is applied to designation of operation: substitution of defect of bodies of vertebrae, substitution of bodies of vertebrae, front plastics of a backbone, front korporodez, etc. Most of them means only special cases of S. or does not correspond to problems of this operation in this connection their use cannot be considered as lawful.
One of the first options C. is operation of Olbi (1911) — the osteoplastic fixing of back departments of a backbone offered for immobilization of the affected vertebras at tubercular: spondylitis (see), without intervention on the center of defeat. In 1931 D. Chaklin for the first time executed osteoplastic fixing of front departments of a backbone. Approximately at the same time irrespective of it this operation was carried out in Japan by Ito, Tsutiya, Experts (H. Ito, J. Tsu-chiya, G. Asami).
Indications to S. — disturbances of an oporosposobnost, stability of a backbone, it patol. mobility in any department as a result of damages, dystrophic or destructive processes in it, and also owing to the nek-ry inborn or general diseases leading to deformation of a backbone and disturbance of its oporosposobnost. Indications to S. can arise after the nek-ry operative measures on a backbone breaking its oporosposobnost, anatomic integrity, napr after corrective vertebrotomiya, beliefs-tebrektomy (see. Backbone, operations ), sometimes later laminectomies (see).
The page can be independent operation or supplement other intervention, making with it a uniform complex. So, in combination with radical operations at a tubercular spondylitis of S. makes uniform radical recovery intervention.
Basic contraindication to S. — a serious general condition of the patient. It is connected with the fact that S. — operation very traumatic, is followed by considerable blood loss and threat of emergence of operational shock. As well as all osteoplastic operations, S. is contraindicated at purulent processes irrespective of their localization, except for fistular forms of a tubercular spondylitis.
Pages carry out usually in a planned order; carry out urgently at nek-ry spinal fractures with disturbance of its stability less often that, in turn, threatens with a secondary injury of a spinal cord and nearby large vessels.
Training of patients for operation does not differ in any specific features. An optimum type of anesthesia — an intubation anesthesia with the managed breath (see. Artificial respiration ). Operation can be made by means of usual orthopedic tools (see). In recent years quite often apply special chisels, mills, tools to ultrasonic cutting of fabrics that provides the performance which was more sparing it, reduces danger of injury of a spinal cord.
Fixing of bodies of vertebrae demands the good review in the depth of a wound and performance of all manipulations under control of sight. Therefore use of lobbies and perednebokovy quick accesses to bodies of vertebrae — transthoracic, retroperitoneal, etc. is most justified (see. Lumbotomy , Backbone ).
Fixing of back departments of a backbone is carried out usually back median access with a section over acanthas of vertebrae and the subsequent skeletonization of these shoots and semi-handles of vertebrae.
Distinguish front and back C. The front S. (which is quite often called korporodezy) provides an ankidozirovaniye of bodies of vertebrae among themselves, and back (quite often called by osteoplastic fixing of a backbone) — their shoots and semi-arches. Back S. includes group of the various operations on the equipment combined by the general net result — a spayaniye of back departments of vertebrae in the uniform bone block of hl. obr. due to use of bone transplants. At the same time vertebrae, but also up to one-two healthy vertebras above and below struck are blocked not only struck (or damaged).
Operation of Olbi consists in implementation in the split acanthas of the linear bone autograft taken from a tibial bone (fig., a). Modification of this operation on P. G. Kornev differs in a form of a transplant (in the form of a bracket), edges is reasonable for fixing kyphotically of the deformed backbone at a tubercular spondylitis (fig., b).
Bigger distribution was gained by those types of back S., at to-rykh bone transplants stack on the parties from skeletirovanny acanthas or on a semi-handle of vertebrae, napr, on Genle's way — Uitmena. For fixing of lumbosacral department of a backbone of Meyerding (H. W. Me-yerding) recommended to stack bone filling brick about the lower ends of transplants. A. A. Kozlowski's modification consists in use of a P-shaped integral transplant (fig., c). Across Bosuort (V. M. of Bosworth), the H-shaped transplant is stacked on the spongy bone opening after a resection of acanthas and a back plate of compact substance of arches of vertebrae (fig., d). Back S. across Chaklin at scoliosis (see) carry out by means of the long bone transplants fixing the most part of chest and lumbar departments of a backbone.
Back S. without use of bone transplants is made more often on Gibbs's way. It includes a resection of intervertebral joints (dugootrostchaty joints, T.), connection of arches of vertebrae the bone shavings taken from the same handles unbent up and from top to bottom and also cutting and a nadlamyvaniye of acanthas from top to bottom before contact of each of them with the basis underlying (a so-called spinozoplastik according to Gibbs).
Sometimes fixing of back departments of a backbone is carried out by means of metal plates, couplers, a wire, silk, etc. (fig., e). These operations should be considered as back S.'s options though they also differ on the equipment from its typical methods. Holds a specific place among different types of back S. oktsipitospondilodez, applied at nek-ry fractures and dislocation-fractures of upper cervical vertebras. At the same time acanthas of cervical vertebrae block with an occipital bone by means of bone transplants, a wire, etc. For unloading of lumbosacral department of a backbone it is sometimes reasonable iliospondilodez — connection by means of bone transplants of acanthas of lumbar vertebrae with ileal bones.
In recent years back S. in many cases gave way front that is explained by bigger efficiency of the last. At back S. the bone transplant (or transplants) is exposed generally to load of a bend and therefore not fully provides stability of a backbone, especially in the presence of a hump. Much more successfully this problem is solved with front S.'s help, at Krom the transplant in essence replaces defect in bodies of vertebrae and is exposed to load of compression. During front S.'s operation in some cases it is possible «to wedge» the deformed vertebrae by means of a bone transplant and by that to reduce kyphotic or scoliotic deformation of a backbone, napr, at a spondylitis.
Front S.'s equipment is defined by features patol. process and extent of deformation of a backbone. In the absence of destructive changes (e.g., at osteochondrosis of a backbone) the transplant is densely implemented in specially created groove in bodies of vertebrae. At destruction of bodies of vertebrae (e.g., at a spondylitis) the transplant can be implemented between the remains of the affected bodies of vertebrae or the ends immerse it in next with struck intact bodies of vertebrae. In the latter case struck iozvon-@ not only are immobilized, but also are substantially exempted from loading that is especially important at a spondylitis (see fig. 29 to St. Backbone ). Has the features and front S.'s technician at spondylolisthesis (see).
At S. apply bone auto-and allotransplants. Autografts in some cases use with preservation of the vascular and muscular leg feeding them. In chest department of a backbone such transplants create of edges, in lumbar — of a crest of an ileal bone. Allotransplants can be prepared practically any necessary form and size and in it their main advantage, however their assimilation demands rather bigger time, than assimilation of autografts (see. Bone plastics ).
Maintaining the postoperative period, except its usual elements, includes a long immobilization of patients for the purpose of the prevention of shift of transplants and creation of conditions for their union. After front S. patients are stacked usually on a back with the bent hips (so-called situation across Chaklin), sometimes — semi-sitting, the head end of a bed is raised. At the same time the backbone is bent, and transplants are strongly fixed between bodies of vertebrae. After back S. patients to a removal of sutures lie at first on a stomach more often, then on spin, usually in a plaster bed (see. Plaster equipment). Duration of an immobilization is various (up to several months) and is defined by features patol. process, level of damage of a backbone, age of the patient, etc. So, after S. executed concerning a spondylitis, a bed rest much longer than after S. concerning osteochondrosis. Patients start walking in a corset (see. Orthoses ). Duration of its carrying is defined by the same factors, as duration of a bed rest.
As a result of S. the bone block of group of vertebrae is formed, the basis to-rogo is made by the bone transplant (or transplants) reconstructed and assimilated by the recipient. Blocking of vertebrae prevents increase in deformation of a backbone, infringement of roots of spinal nerves, recovers an oporosposobnost, liquidates mobility of the affected vertebras, W. h pathological. It must be kept in mind, however, that lack of mobility of group of vertebrae leads to compensatory increase in mobility in the next departments of a backbone and to an overload of these departments that is fraught with development in them spondylosis (see) and osteochondrosis (see).
The main complications of S. — suppuration of an operational wound with rejection of transplants, their neprizhi-vleniye, shift. The unsuccessful outcome of S. leads to increase in deformation of a backbone, to its functional inferiority. The most dangerous complication during S. is the injury spinal cord (see) with the corresponding disturbances of an innervation.
Bibliography: Kazmin A. I. Two-stage operational treatment of scoliosis, M., 1968, bibliogr.; To about in and l e N to about D. G. K to a question of a plastic surgery of a backbone at a tubercular spondylitis, Owls. medical, No. 7, page 47, 1968, bibliogr.; M about in sh about in and the p I. And. and P and I. A c. Radiodiagnosis and principles of treatment of scoliosis, M., 1969, bibliogr.; N of IS and y G. A. Radical plastic surgery of a tubercular spondylitis, Alma-Ata, 1975; it, Quick accesses and anesthesia in a radical plastic surgery of a tubercular spondylitis, Methodical recommendations, Alma-Ata, 1976; D and in I am Ya. L. Hirurgiya's N of a backbone, M., 1966, bibliogr.; it, Injuries of a backbone, M., 1971, bibliogr.; it, Operational treatment of humps, M., 1973, bibliogr.; H and to l and V. D's N. Fundamentals of operational orthopedics and traumatology, M., 1964; G about 1 M. K. e Vertebral osteotomy for correction of fixed flexion deformity of the spine, J. Bone Jt Surg., v. 50-A, p. 287, 1968.
AA. P. Mathis.