Ultrasonic bone scalpel: utility in cervical corpectomy. A technical note

Background: Thoracic kyphosis is not so uncommon, which presents with devastating myelopathy. In the past, the surgical treatment for it had been somewhat controversial. Traditionally, it had been addressed by open decompression and stabilization with significant dissection and disruption of normal tissues and complications. Main body: Recently, correction techniques have evolved as the standard of care. A substantial body of evidence now supports the benefits of correction but can be questioned in view of the fact that upper dorsal kyphosis is never a cosmetic concern in our part of the world. New technique has reduced complications, but it is not solely due to the technique but due to accessory gadgets like O-arm, navigation, and IONM making it safer. We describe a method of 360°decompression alone with the use of an Ultrasonic Bone Scalpel (UBS) that preserves maximum bony stability and achieves an optimum bone sculpting that negates the need for correction. Conclusion: This technique of ventral sculpting decompression in the thoracic spine may be more utilized in the future to be applied for more wider indications.

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“…Less bleeding increases visibility and decreases the time consumed. Also, this not being a rotatory instrument is safer [12,13].…”

Section: Discussionmentioning

confidence: 99%

“…Presently, burr is the standard instrument used for anterior decompression through posterior-only approaches as described in the literature [10]. Also, sparse literature is available about the use of UBS for osteotomy procedures [12][13][14].…”

Section: Introductionmentioning

confidence: 99%

Ventral sculpting decompression: a novel bone scalpel-based technique in thoracic ventral stenosis/kyphosis with myelopathy

et al. 2020

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“…Prior investigations have reported on the safety of UBS in spinal surgery (23)(24)(25). Use of UBS in adult cervical spondylotic myelopathy, adult cervical corpectomy, and adolescent posterior instrumented fusion for idiopathic scoliosis have all been associated with lower blood loss (26)(27)(28). Other potential advantages include higher precision, lower rates of durotomies, and decreased operative times (22,26,27).…”

Section: Discussionmentioning

confidence: 99%

“…Use of UBS in adult cervical spondylotic myelopathy, adult cervical corpectomy, and adolescent posterior instrumented fusion for idiopathic scoliosis have all been associated with lower blood loss (26)(27)(28). Other potential advantages include higher precision, lower rates of durotomies, and decreased operative times (22,26,27). We feel these potential advantages of using an UBS in bone dissection distinguish it from manual osteotomes, which require malleting to achieve bone cuts and are non-hemostatic in their cutting action, and high-speed drills, which are less precise and can be associated with high temperatures if inadequate irrigation is used (29,30).…”

Section: Discussionmentioning

confidence: 99%

Use of image-guided bone scalpel for resection of spine tumors: technical note

Towner¹,

Piper²,

Schoeniger³

et al. 2018

AME Case Rep

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In the literature, the use of navigation for spine tumor surgery has largely centered on implant placement. We describe the cases of two patients with spinal tumors on whom we utilized our resection technique of registering an ultrasonic bone scalpel (UBS) to a navigation system. In both cases, we achieved a satisfactory tumor resection with negative margins and excellent neurologic outcomes. We feel that using the navigation-registered UBS is a valuable tool to increase the operator's ability to achieve desired resections while minimizing the neurologic deficits and operative morbidity associated with these challenging surgical cases.

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“…Using ultrasonic bone scalpel reduced blood loss while performing corpectomy [8]. Dave et al [19] performed cervical corpectomy using ultrasonic bone scalpel. After exposing the vertebral level to be removed and clearing the disc cartilage, UBS was used for removing the vertebra until the posterior cortex and remaining was removed using rongeur.…”

Section: Corpectomymentioning

confidence: 99%

Role of Ultrasonic Bone Scalpel in Spine Surgery: a Review Article

Kumar

Neradi

Salaria

et al. 2020

SN Compr. Clin. Med.

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During the last 20 years, there have been remarkable advances in the field of spine surgery. Ultrasonic bone scalpel is one of the most impactful advances. It is a unique surgical device which offers a controlled osteotomy which slices the hard bone while the soft tissues remain largely unaffected. The major benefits of using this modern instrument are the soft tissue sparing, controlled cutting, reduced bleeding, and thereby increasing the effectiveness. There are widespread studies in the literature propagating its use in various surgeries like thoracoplasties, osteotomies, vertebral column resections, laminectomies, corpectomies, laminotomy, facetectomy and scoliotic surgeries. It is one of the precise and finest instruments available for bone cutting which can be of great value while working near the vicinity of spinal cord, dura and nerve roots. Although not 100%, it can significantly minimise the risk of ripping the tissues as compared with osteotomes, Kerrison and the high-speed rotating burrs. It also has a distinct advantage of minimizing the thermal damage due to its attached irrigation component. Various studies have proven its efficiency in decreasing the operating time, increased fusion rates and decreasing the blood loss. Although it is a relatively easy technique to master on, a very basic training is required initially. So, we can safely say that ultrasonic bone scalpel is indispensable in the armamentarium of today's spine surgeon where minimally invasive surgeries are swiping in.

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Ultrasonic bone scalpel: utility in cervical corpectomy. A technical note

Abstract: Use of UBS is likely to provide a safe, rapid, and effective surgery when compared to conventional rongeurs and high-speed burr. The advantages such as lower blood loss and lower intra-operative incidental dural tears were noted with the use of UBS.

Cited by 16 publications

References 36 publications

Ventral sculpting decompression: a novel bone scalpel-based technique in thoracic ventral stenosis/kyphosis with myelopathy

Ventral sculpting decompression: a novel bone scalpel-based technique in thoracic ventral stenosis/kyphosis with myelopathy

Use of image-guided bone scalpel for resection of spine tumors: technical note

Role of Ultrasonic Bone Scalpel in Spine Surgery: a Review Article

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