The Effectiveness and Safety of Ultrasonic Bone Scalpel Versus Conventional Method in Cervical Laminectomy: A Retrospective Study of 311 Patients

Abstract

Study Design: Retrospective cohort study. Objectives: The aim of this study was to compare the results of cervical laminectomy (CL) performed with ultrasonic bone scalpel (UBS) or conventional method (CM). Method: This study comprised 311 CL performed by a single surgeon between January 2004 and December 2017. Group A (GpA) comprised 124 cases of CL performed using UBS, while Group B (GpB) comprised 187 cases of CL performed using CM. These 2 groups were compared in terms of demographic characteristics of patients, duration of surgery, estimated blood loss, and surgical complications. Results: GpA included 112 males and 12 females, mean age being 61.18 years. GpB comprised 166 males and 21 females, mean age being 62.04 years. Mean duration of surgery, estimated blood loss, and length of hospital stay was 65.52/70.87 minutes, 90.24/98.40 mL, and 4.80/4.87 days in GpA and GpB, respectively. Six patients were reported to have dural injuries in each group. In GpA, 2 cases of C5 palsy and 1 nerve root injury was observed, while in GpB, 3 cases of C5 palsy and no nerve root injury was reported. One patient had developed transient neurological deterioration postsurgery in GpA as against 11 patients in GpB. Conclusion: Neurological complications observed in CM leads to intensive care unit admission, additional morbidity, and additional expenditure, whereas UBS provides a safe, rapid, and effective means of performing CL, thereby decreasing the rate of surgical complications and postoperative morbidity.

Efficacy and Safety of the Ultrasonic Bone Scalpel in Lumbar Laminectomies

“…This benefit is attributable to a variety of features unique to the UBS. Longitudinal micromovements are produced by the UBS at a frequency of 22.5 kHz 13 . The recurrent impacts that result from these high-frequency oscillations tend to pulverize noncompliant crystalline structures, such as bone, because such structures do not bend or deviate in position and thus absorb a large portion of the instrument's energy at the point of contact 13,17 .…”

“…Ultrasonic devices are utilized as an assistive tool for osteotomy in various spine surgeries. The ultrasonic bone scalpel (UBS) is a tool that uses high-frequency oscillation to create localized tissue disruption 13 . By vibrating at high frequency, micromovements of the blade surface preferentially cut through hard surfaces such as bone 14 .…”

“…This preferential cutting occurs because the higher natural elasticity of soft tissue structures such as the dura mater allows greater tolerance of vibratory strain 15 . Subsequently, the UBS can be used to cut through bone with specificity and precision 13 . This technology has been shown to both improve speed and reduce intraoperative complications in laminectomies for cervical and thoracic spondylotic myelopathy when compared to traditional methods 16,17 .…”

Ultrasonic Bone Scalpel and Its Role In Spine Surgeries : A Article Review

“…The conventional method (CM) is to use the Kerrison punch and Leksell Rongeur to remove laminae piecemeal or to make troughs on both sides of laminae using Kerrison punch and then remove laminae en bloc. Dave et al [15] had studied the effectiveness and safety of UBS versus CM. It was a retrospective analysis of 311 patients who were divided into two groups.…”

Expanded Indications of Full Endoscopic Spine Sugery

“…In addition the system is relatively easy for beginners and can compensate the area for the lack of technical expertise 251) . This system is a game changer in open surgeries and will be equally effective in FESS too 152,252) , XMRI (intraoperative MR scan) alleviates major concern with FESS i.e. the risk that revision surgery will be required due to the possibility of remnant DH fragments.…”