The H Laminectomy: Technical Description and Clinical Experience From the First 85 Patients

Abstract

Background: Over the years, lumbar laminectomy has been widely employed by spinal surgeons for many purposes throughout the spinal canal. The Misonix BoneScalpel relies on ultrasonic energy and allows the surgeon to make precise osteotomies while protecting collateral or adjacent soft tissue structures. Amplification of electric impulses allows the blade in the BoneScalpel to oscillate at very high frequencies, which thus allow it to cut bone with immense amounts of heat, which are then tempered with copious irrigation to prevent overheating. The purpose of this study is to outline and detail an innovative technique while providing insight into the technique's clinical application in a variety of spine surgeries.Methods: Data were retrospectively collected from medical charts and surgical reports from February 2018 to July 2021 for each surgery in which the ultrasonic scalpel was used to perform the H laminectomy. Baseline demographic information was recorded, including age, gender, laminectomy indication, and the number of levels of laminectomy.Results: A total of 85 patients (64 women, 21 men) were included in this study. The mean age of the patients was 63.7 years. Of those patients, 42.4% underwent H laminectomy for degenerative stenosis without instrumentation, 31.8% for degenerative stenosis with instrumentation, 9.4% for traumatic injuries, and 7.1% for revision surgery with instrumentation. Approximately 55% of patients underwent laminectomy of 2 or more levels, while the rest underwent single-level laminectomy. No patients had a dural tear or cerebrospinal fluid (CSF) leak as a result of the BoneScalpel.Conclusions: The H laminectomy is another safe and effective way to perform a lumbar laminectomy. The technique has not been previously reported in the literature. No patients experienced a dural tear or CSF leak from the BoneScalpel using the H laminectomy technique. This technique affords the surgeon enhanced control of the dura-ligamentum interface. Even if the surgeon is not very experienced with the BoneScalpel, this technique provides an inherent safety mechanism with constant visualization/tactile feedback of the tip of the instrument and osteotome.

Handheld Osteotome Laminectomy in Cadavers and a Case Study

“…Decompressive laminectomies are common in spine surgery, benefiting from advancements like rongeurs, high-speed drills, and ultrasonic osteotomes, which provide precision and protect soft tissues [4]. Our technique involves two vertical cuts on the lamina and two oblique cuts at the pars interarticularis, differing from the H laminectomy method [5]. The cut across the lamina in the ultrasonic H laminectomy technique to free the lamina from its bony attachments can be dangerous because the spinal cord is directly underneath without the ligamentum flavum as a buffer.…”

“…The constant visualization and tactile feedback of the tip of the instrument and osteotome provided an inherent safety mechanism and allowed enhanced control of the dura-ligamentum interface, even for nonexperienced surgeons. They concluded that the H laminectomy is a safe and effective way to perform a lumbar laminectomy [5].…”