Angled Ultrasonic Bone Curette‐Assisted Circumferential Decompression for Thoracic Myelopathy Caused by Severely Anterior Ossification

Abstract

Objective Thoracic myelopathy caused by severe anterior ossification is often progressive and fails to respond to conservative treatment. Removal of the compressing ossification is the most effective method but is hard to operate. In this study, we describe a novel one‐stage posterior circumferential decompressive procedure assisted by an angled ultrasonic bone curette (UBC) for thoracic myelopathy caused by severe anterior ossification and evaluate its safety and efficacy. Methods The current study enrolled 15 consecutive patients (five men and 10 women) with thoracic myelopathy caused by severely anterior ossification between January 2017 and December 2019. All patients underwent posterior circumferential decompression assisted by angled UBC and segmental instrumentation with interbody fusion. At the time of surgery, the average age was 58.6 ± 6.3 years (47–70 years). Before and after surgery, the patient data, clinical manifestation, operative levels, blood loss, operative time, perioperative complications, Japanese Orthopaedic Association (JOA) score were recorded and analyzed retrospectively. Results All patients had successful one‐stage posterior circumferential decompression to remove anterior ossifications directly. There were 12 cases of OPLL, two cases of a calcified giant herniated disc, and one case of osteophyte. The average operation time was 153.4 ± 53.4 min (77–242 min), with a mean blood loss of 463.5 ± 155.8 mL (240–780 mL). The average length of stay in the hospital was 14.3 ± 4.7 days (9–25 days) and the mean follow‐up duration was 20.8 ± 8.8 months (12–39 months). Almost all patients had subjective improvement in motor power and gait. The average preoperative JOA score was 4.5 ± 1.6, which improved to 9.0 ± 1.8 at the final follow‐up. Postoperative differences in the overall JOA scores showed significant improvement (F = 105.446, p < 0.01). The overall recovery rate at the final examination scored 70.9% ± 25.0%. According to Hirabayashi's classification, eight cases were rated as excellent, four as good, two as fair, and one as unchanged. No patient was graded as deteriorated. Two patients (13.3%) experienced intraoperative cerebrospinal fluid leakage, while two cases (13.3%) experienced unilateral intercostal neuralgia, and only one (6.7%) encountered acute neurological deterioration. All these patients were treated conservatively and their neurological function improved significantly. At the follow‐up, there was no evidence of neurological deterioration. Conclusion Circumferential decompression assisted by angled UBC can preserve more posterior elements of the involved levels, maintaining an intact pleura and reducing the operation time and blood loss for thoracic myelopathy caused by severe anterior ossification. It is a safe, effective, and technically feasible method to provide surgeons with a new option for thoracic spinal circumferential decompression.

The efficacy and safety of ultrasonic bone scalpel for removing retrovertebral osteophytes in anterior cervical discectomy and fusion: A retrospective study

“…In our study, we first compared the clinical characteristics of the use of the UBS for the removal of large cervical retrovertebral osteophytes to that of the traditional HSD. Consistent with previous studies, the use of UBS can save operation time 11 , 12 , 20 – 27 . Several reasons contribute to the reduction in operation time, aside from the method used in our study of removing the entire posterior osteophytes.…”

Application of Piezosurgery in Revision Surgery through Posterior Approach for Infection after Percutaneous Vertebral Augmentation: Technique Note with Case Series

“…The technical advantages of a piezosurgery device—such as a self‐irrigating cooling mechanism, no rolling motion, and less tip bone contact force—have made it an effective instrument for performing procedures near the dura mater and other neural tissues without excessive mechanical and thermal injury 10–12 . Some researchers reported the application of piezosurgery in spinal surgeries can preserve more posterior elements of the involved levels, maintaining an intact, reducing the operation time and blood loss, and avoiding injuring the dura mater and nerves 12–14 . However, few studies have focused on the use of piezosurgery for cement removal in PSVA, and the safety and feasibility of this technique have not yet been systematically evaluated.…”

“… 10 , 11 , 12 Some researchers reported the application of piezosurgery in spinal surgeries can preserve more posterior elements of the involved levels, maintaining an intact, reducing the operation time and blood loss, and avoiding injuring the dura mater and nerves. 12 , 13 , 14 However, few studies have focused on the use of piezosurgery for cement removal in PSVA, and the safety and feasibility of this technique have not yet been systematically evaluated. The present study aimed: (i) to introduce the application of piezosurgery in revision surgery; (ii) to report the preliminary outcomes; and (iii) and to evaluate its feasibility and safety.…”

Design and optimization of a half-wavelength ultrasonic bone scalpel

“…To solve these problems, ultrasonic surgical equipment appeared and developed in the 1950s. As a kind of ultrasonic surgical equipment for cutting bone, the UBS has been widely used in oral and maxillofacial surgery, spinal surgery and other surgery [1][2][3][4]. It uses high-frequency mechanical vibration and cavitation effect to cut bone materials [5][6][7].…”