METHOD FOR DECOMPRESSION OF CAUDA EQUINA RADICLESS IN LUMBAR-SACRAL VERTEBRAL DEPARTMENT DUE TO ANTERIOR SUPRAPUBIC RETROPERITONEAL ACCESS

摘要

FIELD: medicine, neurosurgery. SUBSTANCE: at patient's back lying position with roller under lumbarsacral vertebral department one should carry out cutaneous marking of incision line. At the middle distance between right and left superior anterior spine of ilium point 1 is marked, point 2 - at the center of superior edge of pubic articulation. At the border between superior and average third of distance between points 1 and 2 one should mark point 3 to mark semioval line with convexity downwards and 5-6 cm towards the right and left sides. Ends of this line do not come above the middle distance between points 1 and 3. Head end of operational table is descended for 10-15 deg. that favors to replace inner organs upwards. By marked line one should perform tissue incision up to aponeurosis. The latter is resected cross-sectionally being 2 cm rightwards and leftwards against white line of stomach to bluntly separate it against underlying rectus muscles of stomach. After that, aponeurosis dissection is continued by semioval incision rightwards and leftwards in accordance to the line of cutaneous incision by coming under cutaneous fragment 3-4 cm vertically upwards. Acutely aponeurosis is dissected along middle line of stomach against cross-sectional fascia by developing a wedge with rounded end and foundation at 2-3 cm below umbilical ring. One should bluntly exfoliate rectus muscle of stomach from the right or from the left against white line of stomach and underlying cross-sectional fascia upwards and downwards together with epigastric artery and vein to tighten them laterally and to the front. Towards lateral iliac departments one should reach lateral departments of iliac fossa, bluntly open fibers of cross-sectional fascia to enter retroperitoneal space. By orienting towards anterior-medial edge of large lumbar muscle and external iliac artery and vein one should come nearer to lumbar-sacral vertebral department. Parietal peritoneum is exfoliated by middle line and together with ureter and rectum it should be medially replaced, spermatic funiculus in men and round ligament in women are replaced downwards and medially. Intraperitoneal fascia and fatty fiber are exfoliated between right and left general iliac arteries and veins up to anterior longitudinal vertebral ligament. In projection of L5-S1 disk one should dissect anterior longitudinal ligament along vertebral axis, separate it against vertebral bodies to the sides and lance vertebral channel by drilling L5-S1 disk with adjacent halves of bodies of L5 and S1 vertebra. Direct angle of inclination of operative action and not deep wound enable to remove compressing substrate out of vertebral channel, carry out valuable revision followed by spondylodesis. EFFECT: decreased traumaticity level of operation, shortened terms of therapy. 1 dwg, 1 tbl