Efficacy and Safety Analysis of Ultrasonic Bone Curette in the Treatment of Thoracic Spinal Stenosis

Abstract

ObjectiveTo investigate the efficacy and safety of ultrasonic bone curette in treating thoracic spinal stenosis.MethodsA total of 30 patients of thoracic spinal stenosis who underwent posterior thoracic decompression in the hospital from December 2015 to 2017 were enrolled. Of these, 18 patients (group A) underwent posterior thoracic decompression using ultrasonic bone curette; and 12 patients underwent the treatment using a high‐speed drill (group B). The time of laminectomy, amount of intraoperative blood loss, presence or absence of cerebrospinal fluid leakage, and nerve root injury were recorded. All patients underwent X‐ray, computed tomography with three‐dimensional reconstruction, and magnetic resonance imaging before and after surgery. The Frankel classification and the Japanese Orthopaedic Association (JOA) scores were used to assess the neurological function and neurological recovery in patients. The measured data were statistically processed and analyzed using SPSS21.0 software, and the measurement data were expressed as mean ± SD.ResultsIn groups A and B, the average time for single‐segment laminectomy was 3.3 ± 1.2 min and 6.0 ± 1.8 min and the mean bleeding volume was 105.5 ± 43.3 mL and 177.4 ± 54.7 mL, respectively, with a statistically significant difference between the groups. The difference in JOA scores before and after surgery in groups A and B was statistically significant. No significant difference was found between the groups, in group A, the improvement rate of nerve function at the last follow‐up was 71% and in group B, the improvement rate at the last follow‐up was 70%. In group A, at last follow‐up, two patients had Frankel grade B injury, one had grade C injury, seven had grade D injury, and eight had grade E injury. In group B, at last follow‐up, one patient had Frankel grade B injury, one had grade C injury, five had grade D injury, and five had grade E injury. The Frankel classification of both groups A and B significantly improved. Four patients experienced cerebrospinal fluid leakage in group A and five in group B, with no significant difference between the groups. There was no nerve root injury in both groups, and no complications, such as pulmonary infection and urinary tract infection, occurred after operation.ConclusionsWith the use of ultrasonic bone curette in posterior thoracic decompression, the decompression surgery could be completed relatively safely and quickly. It effectively reduced the amount of intraoperative blood loss.

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

“…The ultrasonic bone curette (UBC) is a relatively novel orthopaedic surgical device, primarily utilizing different ultrasonic frequencies to selectively cut hard tissues while the dural mater and blood vessels are left intact. Advantages of this device, such as precision safety, self‐irrigation cooling system, soft tissue protection, and better hemostasia, make it a useful instrument for treating various spinal disorders without causing excessive mechanical and thermal injury 20 , 21 . Especially for patients with thoracic myelopathy caused by severely anterior ossification, the application of UBC could effectively reduce the probability of spinal cord injury after circumferential decompression and improve the recovery rate of spinal cord function in comparison with conventional instruments 16 , 22 .…”

Unplanned hospital readmission after surgical treatment for thoracic spinal stenosis: incidence and causative factors

“…Firstly, for patients that are at high risk of dural tear in the preoperative evaluation, such as dura ossification, floating method should be recommended as the primary surgical method, instead of slitting dura procedure. Secondly, try to prevent dural tear by improving surgical instrumentation, it has been reported that the decompression surgery could be completed safely and quickly when use of ultrasonic bone curette in posterior thoracic decompression [ 24 ]. Thirdly, try to repair dural tear directly if possible using fibrin glue, gelfoam and artificial dura, and anaesthetists should ask the patient to perform a few Valsalva manoeuvres to confirm absence of CSF leakage.…”

Ultrasonic bone scalpel for thoracic spinal decompression: case series and technical note

“…Otherwise, intraoperative blood loss is expected to be reduced due to reduced operating procedures and the clotting effect of UBS. Lu et al [ 17 ] compared the efficacy and safety of UBS with high-speed drill for TSS decompression and found that UBS effectively reduced the operation time and blood loss. In this study, the mean blood loss was 108.3 ± 47.3 ml, and the operation time was 3.0 ± 1.4 min for single-segments laminectomy.…”