Efficacy and Safety of the Ultrasonic Bone Scalpel in Lumbar Laminectomies

Steinle, Anthony M.; Chen, Jeffrey; O’Brien, Alexander G.; Vaughan, Wilson E.; Croft, Andrew J.; Waddell, W. Hunter; Vickery, Justin; Elrod, Robert W.; Chanbour, Hani; Lugo-Pico, Julian; Zuckerman, Scott L.; Abtahi, Amir M.; Stephens, Byron F.

doi:10.22603/ssrr.2022-0138

Cited by 1 publication

(1 citation statement)

References 28 publications

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“…on the occurrence of durotomy. The ultrasonic cutting tool has been reported to have a decreased associated risk of durotomy in small series, including that of Bydon et al [25] and Steinle et al [26], though this association has been inconsistent [27]. Some authors [19] advocate against the use of this tool in the context of epidural scars, as they believe it actually increases the risk of durotomy.…”

Section: Ultrasonic Bone Curette and The Influence Of Osteotomy Toolsmentioning

confidence: 99%

The Predictors of Incidental Durotomy in Patients Undergoing Pedicle Subtraction Osteotomy for the Correction of Adult Spinal Deformity

Hamouda,

Pennington,

Astudillo Potes

et al. 2024

JCM

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Background: Pedicle subtraction osteotomy (PSO) is a powerful tool for sagittal plane correction in patients with rigid adult spinal deformity (ASD); however, it is associated with high intraoperative blood loss and the increased risk of durotomy. The objective of the present study was to identify intraoperative techniques and baseline patient factors capable of predicting intraoperative durotomy. Methods: A tri-institutional database was retrospectively queried for all patients who underwent PSO for ASD. Data on baseline comorbidities, surgical history, surgeon characteristics and intraoperative maneuvers were gathered. PSO aggressiveness was defined as conventional (Schwab 3 PSO) or an extended PSO (Schwab type 4). The primary outcome of the study was the occurrence of durotomy intraoperatively. Univariable analyses were performed with Mann–Whitney U tests, Chi-squared analyses, and Fisher’s exact tests. Statistical significance was defined by p < 0.05. Results: One hundred and sixteen patients were identified (mean age 61.9 ± 12.6 yr; 44.8% male), of whom 51 (44.0%) experienced intraoperative durotomy. There were no significant differences in baseline comorbidities between those who did and did not experience durotomy, with the exception that baseline weight and body mass index were higher in patients who did not suffer durotomy. Prior surgery (OR 2.73; 95% CI [1.13, 6.58]; p = 0.03) and, more specifically, prior decompression at the PSO level (OR 4.23; 95% CI [1.92, 9.34]; p < 0.001) was predictive of durotomy. A comparison of surgeon training showed no statistically significant difference in durotomy rate between fellowship and non-fellowship trained surgeons, or between orthopedic surgeons and neurosurgeons. The PSO level, PSO aggressiveness, the presence of stenosis at the PSO level, nor the surgical instrument used predicted the odds of durotomy occurrence. Those experiencing durotomy had similar hospitalization durations, rates of reoperation and rates of nonroutine discharge. Conclusions: In this large multisite series, a history of prior decompression at the PSO level was associated with a four-fold increase in intraoperative durotomy risk. Notably the use of extended (versus) standard PSO, surgical technique, nor baseline patient characteristics predicted durotomy. Durotomies occurred in 44% of patients and may prolong operative times. Additional prospective investigations are merited.

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Section: Ultrasonic Bone Curette and The Influence Of Osteotomy Toolsmentioning

confidence: 99%

The Predictors of Incidental Durotomy in Patients Undergoing Pedicle Subtraction Osteotomy for the Correction of Adult Spinal Deformity

Hamouda,

Pennington,

Astudillo Potes

et al. 2024

JCM

View full text Add to dashboard Cite

show abstract

Efficacy and Safety of the Ultrasonic Bone Scalpel in Lumbar Laminectomies

Abstract: were responsible for the acquisition of data. Jeffrey Chen and Hani Chanbour were responsible for the analysis. Anthony Steinle, Wilson Vaughan, and Andrew Croft were responsible for the acquisition and interpretation of data for the submitted work.

Cited by 1 publication

References 28 publications

The Predictors of Incidental Durotomy in Patients Undergoing Pedicle Subtraction Osteotomy for the Correction of Adult Spinal Deformity

The Predictors of Incidental Durotomy in Patients Undergoing Pedicle Subtraction Osteotomy for the Correction of Adult Spinal Deformity

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