Apparatus and method for stereotaxic lateral extradural disc puncture
First Claim
1. Apparatus for lateral extradural disc puncture comprising a frame for fixation to a patient,an offset index,a needle angle guide connected to said offset index at a predetermined angle,first means adjustably positioning said offset index relative to said frame to determine the position of said needle angle guide both from the midsaggital plane of the patient and longitudinally relative to the intervertebral discs of said patient,a heading guide,second means adjustably positioning said heading guide relative to said frame longitudinally relative to said patient,and plumb line establishing means on said heading guide positioned to hang down the back of the patient into proximity to said needle angle guide.
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Abstract
Apparatus consists of a stereotaxic fixture made up of a needle angle guide attached to an offset index, a parallel heading guide with plumb line chain attached, and a frame which provides fixation for the guides, allowing rapid and secure position readjustment, and which provides retention of orientation between the guides and the lumbar spine of the patient. The patient is positioned for the operation, preferably in full lateral (side lying) orientation of the spine, confirmed by the radiographic. image made preferably in posteroanterior projection. The midsaggital plane of the body is located at the skin surface by placing a first radiopaque marker corresponding to the center of the spine image. A second radiopaque skin marker is located at the side of the body of the patient for monitoring spine position while viewing profile radiographic image. The first marker provides a starting point from which to measure offset distance. The frame and heading guide are adjusted in position and secured in place, the heading guide radiographic image being superimposed on a line bisecting the angle between the adjacent vertebral end plates. The offset index is adjusted on the frame by means of the chain and its offset from the midsaggital plane (established from pre-operative radiograph) adjusted. A multiple needle technique puncture using the needle angle guide attached to the offset index to locate the site of skin puncture and the preferred 45° angle of penetration is utilized to allow gentle isolation of the nerve root crossing the disc in the target area of lateral approach, gentle enough to permit anesthesia under the semiconscious state of neuroleptanalgesia, supplemented by local anesthesia. Diagnostic and treatment drugs are injected in the nucleus pulposus through the lumen of the puncturing needle.
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Citations
32 Claims
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1. Apparatus for lateral extradural disc puncture comprising a frame for fixation to a patient,
an offset index, a needle angle guide connected to said offset index at a predetermined angle, first means adjustably positioning said offset index relative to said frame to determine the position of said needle angle guide both from the midsaggital plane of the patient and longitudinally relative to the intervertebral discs of said patient, a heading guide, second means adjustably positioning said heading guide relative to said frame longitudinally relative to said patient, and plumb line establishing means on said heading guide positioned to hang down the back of the patient into proximity to said needle angle guide.
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22. Apparatus for lateral extradural lumbar disc puncture comprising
an elongated index guide adapted to be secured to the back of the patient extending longitudinally relative to the lumbar vertebrae in fixed relation to the spinous processes of said vertebrae, a needle angle guide having guide means and an extension arm at an angle to said guide means, first means for securing said arm to said index guide in a plurality of positions of adjustment longitudinally and transversely, a heading guide, second means supporting said heading guide relative to said index guide, said heading guide having a radiologically visible portion and a depending portion in proximity to said guide means to assist the surgeon in directing a needle projected through said guide means into docking contact with a disc while avoiding nerve root damage.
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25. A method for stereotaxic extradural disc puncture comprising the steps of:
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first making a radiographic image in vertical projection and determining from said image the depth from the skin surface of the intervertebral disc into which a pharmaceutical is to be injected; second, making a radiographic image in vertical projection and determining a heading along a line viewed in vertical projection bisecting the angle between the end plates of the vertebrae to either side of said disc; third, locating the site of skin puncture by measuring vertically from the midsaggital plane a distance calculated from the tangent of the desired angle of needle penetration and said depth in the vertical plane of said heading; fourth, inserting a needle into the patient at said site at said angle of penetration and radiographically monitoring penetration of said needle on said heading until said disc is penetrated inward of the facet joint adjacent said disc; and injecting a pharmaceutical through said needle into said disc. - View Dependent Claims (26, 27, 28, 29, 30, 31, 32)
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Specification