The incidence of nerve root injury by high-speed drill can be reduced by chilled saline irrigation in a rabbit model

Tamai, Katsuto; Suzuki, Akinobu; Takahashi, Shinji; Akhgar, Javid; Rahmani, Mohammad Suhrab; Hayashi, Kôichi; Ohyama, Shoichiro; Nakamura, Hiroaki

doi:10.1302/0301-620x.99b4.bjj-2016-0841.r1

Cited by 12 publications

(9 citation statements)

References 19 publications

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“…The use of these irrigation fluids may help to maintain the field of view and to secure the workspace. Furthermore, the use of normal saline, as a medium, could reduce thermal nerve root injury when drilling the bone around the nerve tissue with the high-speed diamond drill during laminotomy [ 17 ]. Another merit of performing a surgery under continuous fluid irrigation is that it allows the use of an advanced energy-based surgical dissection device, called bRFA.…”

Section: Discussionmentioning

confidence: 99%

Clinical outcome of biportal endoscopic revisional lumbar discectomy for recurrent lumbar disc herniation

et al. 2020

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Background Although literature provides evidence regarding the superiority of surgery over conservative treatment in patients with lumbar disc herniation, recurrent lumbar disc herniation (RLDH) was the indication for reoperation in 62% of the cases. The major problem with revisional lumbar discectomy (RLD) is that the epidural scar tissue is not clearly isolated from the boundaries of the dura matter and nerve roots; therefore, unintended durotomy and nerve root injury may occur. The biportal endoscopic (BE) technique is a newly emerging minimally invasive spine surgical modality. However, clinical evidence regarding BE-RLD remains limited. We aimed to compare the clinical outcomes after performing open microscopic (OM)-RLD and BE-RLD to evaluate the feasibility of BE-RLD. Methods This retrospective study included 36 patients who were diagnosed with RLDH and underwent OM-RLD and BE-RLD. RLDH is defined as the presence of herniated disc material at the level previously operated upon in patients who have experienced a pain-free phase for more than 6 months. BE-RLD was performed as follows: two independent surgical ports were made inside the medial pedicular line of the target segment and on the intact upper and lower laminas. Peeling off the soft tissue from the vertebral lamina helps to easily identify the traversing nerve root and the recurrent disc material without dealing with the fibrotic scar tissue. Clinical outcomes were obtained using a visual analog scale (VAS) and the modified Macnab criteria before and at 2 days, 2 and 6 weeks, and 3, 6, and 12 months after surgery. Results The data of 20 and 16 patients who underwent OM-RLD and BE-RLD, respectively, were evaluated. The demographic and perioperative data were comparable between the groups. During the year following the surgery, in the BE-RLD group, the VAS scores at each point were significantly improved over the baseline and remained improved up to 2 weeks after surgery (p < 0.05); however, no statistical difference between the two groups was observed after 6 weeks of surgery (p > 0.05). According to the modified Macnab criteria on the follow-up, the excellent or good satisfaction rates reported at 2 weeks, 6 weeks, 6 months, and 12 months after surgery were 81.25%, 81.25%, 75%, and 81.25%, respectively, in the BE-RLD group, and 50%, 75%, 75%, and 80%, respectively, in the OM-RLD group. Conclusion BE-RLD yielded similar outcomes to OM-RLD, including pain improvement, functional improvement, and patient satisfaction, at 1 year after surgery. However, faster pain relief, earlier functional recovery, and better patient satisfaction were observed when applying BE-LRD. Trial registration Retrospectively registered

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Section: Discussionmentioning

confidence: 99%

Clinical outcome of biportal endoscopic revisional lumbar discectomy for recurrent lumbar disc herniation

et al. 2020

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“…As a treatment that uses thermal energy, high-frequency hyperthermic coagulation therapy is used to treat pain such as chronic low back pain [ 22 , 23 , 24 ]. C5 palsy after cervical spine surgery is well-known as a complication as a neurological disorder caused by thermal damage associated with drilling [ 25 , 26 , 27 ]. Unmyelinated fibers were immediately destroyed at 58 °C [ 28 ].…”

Section: Discussionmentioning

confidence: 99%

Fluid Lubrication and Cooling Effects in Diamond Grinding of Human Iliac Bone

et al. 2021

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Background and Objectives: Although there have been research on bone cutting, there have been few research on bone grinding. This study reports the measurement results of the experimental system that simulated partial laminectomy in microscopic spine surgery. The purpose of this study was to examine the fluid lubrication and cooling in bone grinding, histological characteristics of workpieces, and differences in grinding between manual and milling machines. Materials and Methods: Thiel-fixed human iliac bones were used as workpieces. A neurosurgical microdrill was used as a drill system. The workpieces were fixed to a 4-component piezo-electric dynamometer and fixtures, which was used to measure the triaxial power during bone grinding. Grinding tasks were performed by manual activity and a small milling machine with or without water. Results: In bone grinding with 4-mm diameter diamond burs and water, reduction in the number of sudden increases in grinding resistance and cooling effect of over 100 °C were confirmed. Conclusion: Manual grinding may enable the control of the grinding speed and cutting depth while giving top priority to uniform torque on the work piece applied by tools. Observing the drill tip using a triaxial dynamometer in the quantification of surgery may provide useful data for the development of safety mechanisms to prevent a sudden deviation of the drill tip.

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“…Previous studies have reported that cooled saline might be more effective for minimizing temperature elevations during drilling. 15,31 The present study however did not evaluate effect of different irrigation saline temperatures in order to limit the number of variables in the study. Bur type, rotation speed, and applied pressure are all factors that have been reported to influence temperature elevation during drilling.…”

Section: Discussionmentioning

confidence: 99%

“…9,10 Temperature elevation in nervous tissue and resultant thermal injury has been extensively investigated with ex vivo studies, experimental animal models, and in vivo studies. [10][11][12][13][14][15][16][17][18][19][20][21] Uchiyama and others evaluated the effect of temperatures ranging from 43 to 47 C for 30 min duration on canine spinal cords using spinal cord evoked potentials and histopathology. 22 The main findings of their study were: (1) full functional recovery with no histologic changes was noted at 44 C for 30 min, (2) at 45 C for 30 min, although all dogs had a full functional recovery histological changes (pigment exudation, vacuolation, and hemorrhage) were noted, and (3) temperature ≥46 C for 30 min caused tissue destruction in all dogs with incomplete to no functional recovery.…”

Section: Introductionmentioning

confidence: 99%

“…Drilling generates frictional heat, which puts adjacent spinal cord and nerve roots at risk of thermal injury 9,10 . Temperature elevation in nervous tissue and resultant thermal injury has been extensively investigated with ex vivo studies, experimental animal models, and in vivo studies 10‐21 . Uchiyama and others evaluated the effect of temperatures ranging from 43 to 47°C for 30 min duration on canine spinal cords using spinal cord evoked potentials and histopathology 22 .…”

Section: Introductionmentioning

confidence: 99%

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Effect of irrigation technique on the vertebral canal temperature during thoracolumbar hemilaminectomy in dogs: An ex vivo study

Dongaonkar

Aoki

Zwueste³

et al. 2021

Veterinary Surgery

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Objective: To determine the influence of continuous and intermittent bolus irrigation on vertebral canal temperature during thoracolumbar hemilaminectomy. Study Design: Ex vivo study. Sample Population: Ten canine cadavers.Methods: Six consecutive thoracolumbar hemilaminectomies starting at T12-13 with alternating left-or right-side selection, and alternating continuous or intermittent bolus irrigation were performed in each dog resulting in 30 hemilaminectomies per irrigation technique. Drilling was performed for 15 s followed by a 10-s pause and resumed until completion of hemilaminectomy.Continuous irrigation consisted of saline delivered at 15 ml/min during drilling. Bolus irrigation consisted of manual delivery of 10 ml saline during the pause. Temperatures were recorded with two sensors placed within the vertebral canal adjacent to target hemilaminectomy site and compared between techniques with a linear mixed model. Results: Intermittent bolus irrigation was associated with lower peak vertebral canal temperatures (mean 15.7 C; range 9.4-23.3 C) than continuous irrigation (mean 16.7 C; range 9.6-27.6 C, p = .003) (mean difference of 1.1 C, p = .006). Similarly, mean vertebral canal temperatures remained lower when hemilaminectomies were performed under intermittent rather than continuous irrigation (mean difference of 0.48 C, p = .006, linear mixed model). Conclusion:Lower vertebral canal temperatures were maintained during hemilaminectomy with intermittent bolus rather than continuous irrigation. Clinical Significance: Both intermittent bolus and continuous irrigation are suitable to prevent elevations in canine vertebral canal temperature during hemilaminectomy.

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The incidence of nerve root injury by high-speed drill can be reduced by chilled saline irrigation in a rabbit model

Abstract: Frictional heat caused by a high-speed drill can cause histological nerve root injury. Chilled saline irrigation had a more prominent effect than RT in reducing the incidence of the thermal injury during extended drilling. Cite this article: 2017;99-B:554-60.

Cited by 12 publications

References 19 publications

Clinical outcome of biportal endoscopic revisional lumbar discectomy for recurrent lumbar disc herniation

Clinical outcome of biportal endoscopic revisional lumbar discectomy for recurrent lumbar disc herniation

Fluid Lubrication and Cooling Effects in Diamond Grinding of Human Iliac Bone

Effect of irrigation technique on the vertebral canal temperature during thoracolumbar hemilaminectomy in dogs: An ex vivo study

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