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Ou C, Tong Y, Liu J, Shan Z, Chen Y, Huang B, Zhang X, Chen Y, Zhao F. Improving C1 Pedicle Screw Placement for Atlantoaxial Instability with Ultrasonic Bone Burr Assistance. World Neurosurg 2024:S1878-8750(24)01577-8. [PMID: 39270794 DOI: 10.1016/j.wneu.2024.09.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2024] [Accepted: 09/05/2024] [Indexed: 09/15/2024]
Abstract
OBJECTIVE This study aims to evaluate the safety and efficacy of the ultrasonic bone burr (UBB) in facilitating C1 pedicle screw placement for atlantoaxial instability treatment, compared to the conventional high-speed drill (HSD) technique. METHODS A retrospective analysis was conducted on patients undergoing posterior screw-rod fixation for atlantoaxial instability between December 2017 and July 2023. The patients were divided into 2 groups based on the tools used for screw placement: UBB and HSD. Data on surgical duration, estimated blood loss, spinal cord and arterial injury incidence, screw placement accuracy, neurological status measured by the Japanese Orthopedic Association score, and fusion rates were collected and analyzed. RESULTS Thirteen patients received C1 pedicle screw placement via UBB facilitation, while 8 were treated using the HSD approach. The UBB group showed a significant reduction in blood loss and operation time compared to the HSD group (P = 0.002 and P < 0.001, respectively). No spinal cord or arterial injuries occurred in either group. Optimal screw placement was confirmed in all UBB cases versus 87.5% in the HSD group (P = 0.139). Both groups demonstrated significant improvements in Japanese Orthopedic Association scores with no intergroup difference. The fusion rate was 100% in the UBB group and 87.5% in the HSD group, not statistically different (P = 0.381). CONCLUSIONS UBB is a viable alternative for C1 pedicle screw placement, associated with reduced blood loss and shorter operation time, while achieving comparable clinical outcomes to the conventional HSD method. Nevertheless, further research with a larger sample size is needed.
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Affiliation(s)
- Changjiang Ou
- Department of Neurosurgery, The Fourth Affiliated Hospital of School of Medicine, and International School of Medicine, International Institutes of Medicine, Zhejiang University, Yiwu, China; Department of Orthopaedics, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yongjun Tong
- Department of Orthopaedics, Zhejiang Hospital, Hangzhou, China
| | - Junhui Liu
- Department of Orthopaedics, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Zhi Shan
- Department of Orthopaedics, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yilei Chen
- Department of Orthopaedics, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Bao Huang
- Department of Orthopaedics, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Xuyang Zhang
- Department of Orthopaedics, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yili Chen
- Department of Neurosurgery, The Fourth Affiliated Hospital of School of Medicine, and International School of Medicine, International Institutes of Medicine, Zhejiang University, Yiwu, China
| | - Fengdong Zhao
- Department of Orthopaedics, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
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Luan H, Peng C, Jia H, Deng Q. Efficacy and safety of ultrasonic bone curette and high-speed drill in cervical expansive open-door laminoplasty: A systematic review and meta-analysis. Asian J Surg 2024; 47:2646-2648. [PMID: 38508890 DOI: 10.1016/j.asjsur.2024.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 03/01/2024] [Indexed: 03/22/2024] Open
Affiliation(s)
- Haopeng Luan
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, 830054, China
| | - Cong Peng
- Department of Spine Surgery, The Sixth Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Honglin Jia
- The Fourth Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Qiang Deng
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, 830054, China.
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Lyutenski S, Lieder A, Bloching M. Piezoelectric ear surgery: a systematic review. HNO 2023; 71:10-18. [PMID: 36205754 DOI: 10.1007/s00106-022-01211-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND The piezoelectric instrument (PEI) offers a novel technique for bone removal in ear surgery with a combination of micro-oscillation and cavitation. The aim of this review is to explore the advantages, disadvantages, and limitations of this instrument in comparison to the drill. MATERIALS AND METHODS We conducted a search of PubMed/MEDLINE and Google Scholar in accordance with the PRISMA recommendations. The primary selection included all studies reporting on the use of PEI in ear surgery or its effect on the inner ear. Only studies with a control group were included in the secondary selection. RESULTS The first search identified 49 studies between 2003 and 2022. These reported on a total of 1162 ear operations, during which PEI was used for various indications. Most data were based on uncontrolled retrospective studies or case reports (76%). Only one of the five controlled clinical studies was prospective and randomized. The advantages of PEI weighed against its limitations and disadvantages were critically analyzed in comparison to the drill. CONCLUSION Piezoelectric surgery is an innovative and promising surgical technique in the temporal bone. PEI appears to enable safer and more precise bone removal in close proximity to soft tissue when compared to the drill. The slower bone removal and cost factors represent current limitations to its wider use in ear surgery.
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Affiliation(s)
- Stefan Lyutenski
- Department of Otorhinolaryngology, Helios Hospital Berlin-Buch, Schwanebecker Chaussee 50, 13125, Berlin, Germany.
| | - Anja Lieder
- Department of Otorhinolaryngology, Helios Hospital Berlin-Buch, Schwanebecker Chaussee 50, 13125, Berlin, Germany
| | - Marc Bloching
- Department of Otorhinolaryngology, Helios Hospital Berlin-Buch, Schwanebecker Chaussee 50, 13125, Berlin, Germany
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Maldonado J, Porto E, Revuelta Barbero JM, Tello I, Rodas A, Vivas EX, Mattox DE, Solares CA, Garzon Muvdi T, Pradilla G. Thermal Analysis of an Ultrasonic Aspirator Micro Claw Tool Compared With Standard High-Speed Drilling During Internal Auditory Canal Opening in a Cadaveric Model. Oper Neurosurg (Hagerstown) 2023; 25:183-189. [PMID: 37083749 DOI: 10.1227/ons.0000000000000721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 02/16/2023] [Indexed: 04/22/2023] Open
Abstract
BACKGROUND The ultrasonic aspirator micro claw tool (UAmCT) can be used to remove the bone of the internal auditory canal (IAC) during vestibular schwannoma resection via the retrosigmoid approach (RSA) without the risk of a spinning drill shaft. However, the thermal profile of the UAmCT during IAC removal has not been reported. OBJECTIVE To compare the thermal profile of the UAmCT during access of the IAC to that of a conventional high-speed drill (HSD) and to present an illustrative case of this application. METHODS IAC opening via RSA was performed in 5 embalmed cadaveric specimens using the UAmCT with 3, 8, and 15 mL/min irrigation on the left and the HSD at 75 000 revolutions per minute and 0%, 14%, and 22% irrigation on the right. Peak bone surface temperatures were measured 4 times in 20-second intervals, and statistical analyses were performed using SPSS software. An illustrative case of a vestibular schwannoma resected via an RSA using the UAmCT to access the IAC is presented. RESULTS The IAC was opened in all 5 specimens using both the UAmCT and HSD without complication. The mean peak bone surface temperatures were significantly lower with the UAmCT compared with the HSD ( P < .001). The UAmCT did not meaningfully prolong the operating time in the illustrative case, and the IAC was accessed without complication. CONCLUSION The UAmCT may be a safe and effective alternative to HSD for IAC opening during vestibular schwannoma resection via the RSA. Larger studies under clinical conditions are required to further validate these findings.
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Affiliation(s)
- Justin Maldonado
- Department of Neurosurgery, Emory University, Atlanta, Georgia, USA
| | - Edoardo Porto
- Department of Neurosurgery, Emory University, Atlanta, Georgia, USA
| | - J Manuel Revuelta Barbero
- Department of Neurosurgery, Emory University, Atlanta, Georgia, USA
- Department of Neurosurgery, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
| | - Isaac Tello
- Department of Neurosurgery, Instituto Nacional de Neurología y Neurocirugía Manuel V. Suárez, Mexico City, Mexico
| | - Alejandra Rodas
- Department of Otolaryngology, Emory University, Atlanta, Georgia, USA
| | - Esther X Vivas
- Department of Otolaryngology, Emory University, Atlanta, Georgia, USA
| | - Douglas E Mattox
- Department of Otolaryngology, Emory University, Atlanta, Georgia, USA
| | - C Arturo Solares
- Department of Otolaryngology, Emory University, Atlanta, Georgia, USA
| | | | - Gustavo Pradilla
- Department of Neurosurgery, Emory University, Atlanta, Georgia, USA
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Liu J, Kong Q, Feng P, Zhang B, Ma J, Hu Y. Analysis of the curative effect of cervical spondylotic radiculopathy with osseous foraminal stenosis using ultrasonic osteotome in anterior cervical surgery. BMC Musculoskelet Disord 2023; 24:81. [PMID: 36721172 PMCID: PMC9887743 DOI: 10.1186/s12891-022-06083-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 12/12/2022] [Indexed: 02/01/2023] Open
Abstract
PURPOSE To explore the clinical efficacy and operation points of cervical radiculopathy with osseous foraminal stenosis treated with ultrasonic osteotome in anterior cervical surgery. METHODS From January 2018 to June 2021,a retrospective analysis of 23 patients with cervical radiculopathy with bony foraminal stenosis during this period was retrospectively analyzed. Anterior Cervical Discectomy and Fusion (ACDF) was used for all cases in this group. Intraoperative use of ultrasonic osteotome to decompress the nerve in the intervertebral foramina. The operation time, intraoperative blood loss and complication rate were recorded in this group of patients. Interbody fusion was evaluated using Brantigan criteria. The IC-PACS imaging system was used to measure the intervertebral foramen area (IFA) before and after surgery to evaluate the range of decompression. The VAS (Visual Analogue Scale, VAS) score and NDI (Neck Disability Index, NDI) score before and after surgery were recorded to evaluate the clinical efficacy. RESULTS All enrolled patients were followed up regularly for 1 year or more. The mean operative time was 61.5 ± 8.0 minutes. The average intraoperative blood loss was 88.3 ± 12.8 ml, and the average hospital stay was 8.1 ± 1.7d. Twenty one cases of successful fusion were followed up 1 year after operation, and the fusion rate was 91.3%. IFA expanded from 25.1 ± 4.0 mm2 before operation to 57.9 ± 3.4 mm2 at 1 year after operation, and the difference was statistically significant (P < 0.001). The VAS score and NDI score of patients 3 days after surgery, 3 months after surgery, and 1 year after surgery were significantly lower than those before surgery (P < 0.001). There was 1 case of dysphagia and 1 case of Cage subsidence after operation, and the complication rate was 8.6%. CONCLUSION Anterior cervical surgery using ultrasonic osteotome in the treatment of cervical radiculopathy with bony foraminal stenosis has reliable clinical efficacy and high safety, and is worthy of clinical promotion.
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Affiliation(s)
- Junlin Liu
- Orthopaedic department, Hospital of Chengdu office of People’s Government of Tibetan Autonomous Region, Chengdu, 610041 Sichuan China
| | - Qingquan Kong
- Orthopaedic department, Hospital of Chengdu office of People’s Government of Tibetan Autonomous Region, Chengdu, 610041 Sichuan China ,grid.13291.380000 0001 0807 1581Orthopaedic department, West China Hospital, Sichuan University, Chengdu, 610041 Sichuan China
| | - Pin Feng
- Orthopaedic department, Hospital of Chengdu office of People’s Government of Tibetan Autonomous Region, Chengdu, 610041 Sichuan China ,grid.13291.380000 0001 0807 1581Orthopaedic department, West China Hospital, Sichuan University, Chengdu, 610041 Sichuan China
| | - Bin Zhang
- Orthopaedic department, Hospital of Chengdu office of People’s Government of Tibetan Autonomous Region, Chengdu, 610041 Sichuan China
| | - Junsong Ma
- Orthopaedic department, Hospital of Chengdu office of People’s Government of Tibetan Autonomous Region, Chengdu, 610041 Sichuan China
| | - Yuan Hu
- Orthopaedic department, Hospital of Chengdu office of People’s Government of Tibetan Autonomous Region, Chengdu, 610041 Sichuan China
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Liu J, Kong Q, Feng P, Zhang B, Hu Y, Ma J. Clinical effect of channel assisted cervical key hole technology combined with ultrasonic bone osteotome in the treatment of single segment cervical spondylotic radiculopathy. Front Surg 2022; 9:1029028. [PMID: 36325044 PMCID: PMC9618798 DOI: 10.3389/fsurg.2022.1029028] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 09/26/2022] [Indexed: 01/24/2023] Open
Abstract
OBJECTIVE To explore the clinical effect and operating skills of channel assisted Cervical Key Hole technology combined with Ultrasonic Bone Osteotome (CKH-UBO) in the treatment of single segment cervical spondylotic radiculopathy (CSR). METHODS From June 2018 to June 2020, 14 patients diagnosed with CSR and treated with channel assisted CKH-UBO were collected. The duration of the disease, the length of the incision, the operation time, the amount of bleeding during the operation, the length of hospitalization and the complications were recorded. The Range Of Motion (ROM) and the stability of the surgical segment were recorded before and after the operation. Visual analog scale (VAS), neck disability index (NDI) and modified macnab efficacy evaluation criteria were used to evaluate the surgical efficacy. RESULTS The operative segments of the enrolled patients were all lower cervical vertebrae. The average incision length was 2.0 ± 0.1 cm, the operation time was 42.2 ± 5.7 min, the intraoperative bleeding volume was 32.7 ± 4.1 ml, and the hospital stay was 5.6 ± 1.2 days. There was no difference in ROM between preoperative and 3 months and 1 year after operation (P > 0.05), and all patients did not have segmental instability. The VAS scores of neck pain before surgery, 3 days after surgery, 3 months after surgery, and 1 year after surgery were 5.6 ± 1.2, 1.6 ± 0.6, 1.1 ± 0.7, 0.6 ± 0.5, and the VAS scores of upper limb pain were 6.2 ± 1.2, 1.7 ± 0.7, 1.1 ± 0.6, 0.6 ± 0.5. The NDI scores of upper limb pain before surgery, 3 days after surgery, 3 months after surgery, and 1 year after surgery were 36.7 ± 3.5, 9.8 ± 2.4, and 3.9 ± 1.5, 1.8 ± 1.0, The VAS and NDI scores at all follow-up time points after operation were significantly lower than those before operation (P < 0.001). One year after operation, the curative effect was evaluated according to the modified macnab evaluation standard, and the excellent and good rate was 100%. The complication rate was 6.25%. CONCLUSION Channel assisted CKH-UBO for single segment CSR has the advantages of short operation time, reliable clinical effect, high safety and low complication rate, which is worthy of clinical promotion.
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Affiliation(s)
- Junlin Liu
- Department of Orthopedics Surgery, Hospital of Chengdu Office of People's Government of Tibetan Autonomous Reigion, Chengu Sichuan
| | - Qingquan Kong
- West China Hospital, Sichuan University, Chengdu, China,Correspondence: Qingquan Kong
| | - Pin Feng
- Department of Orthopedics Surgery, Hospital of Chengdu Office of People's Government of Tibetan Autonomous Reigion, Chengu Sichuan
| | - Bin Zhang
- Department of Orthopedics Surgery, Hospital of Chengdu Office of People's Government of Tibetan Autonomous Reigion, Chengu Sichuan
| | - Yuan Hu
- Department of Orthopedics Surgery, Hospital of Chengdu Office of People's Government of Tibetan Autonomous Reigion, Chengu Sichuan
| | - Junsong Ma
- Department of Orthopedics Surgery, Hospital of Chengdu Office of People's Government of Tibetan Autonomous Reigion, Chengu Sichuan
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Lyutenski S, Lieder A, Bloching M. [Piezoelectric ear surgery: a systematic review. German version]. HNO 2022; 70:645-654. [PMID: 35960310 DOI: 10.1007/s00106-022-01210-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND The piezoelectric instrument (PEI) offers a novel technique for bone removal in ear surgery with a combination of micro-oscillation and cavitation. The aim of this review is to explore the advantages, disadvantages, and limitations of this instrument in comparison to the drill. MATERIALS AND METHODS We conducted a search of PubMed/MEDLINE and Google Scholar in accordance with the PRISMA recommendations. The primary selection included all studies reporting on the use of PEI in ear surgery or its effect on the inner ear. Only studies with a control group were included in the secondary selection. RESULTS The first search identified 49 studies between 2003 and 2022. These reported on a total of 1162 ear operations, during which PEI was used for various indications. Most data were based on uncontrolled retrospective studies or case reports (76%). Only one of the five controlled clinical studies was prospective and randomized. The advantages of PEI weighed against its limitations and disadvantages were critically analyzed in comparison to the drill. CONCLUSION Piezoelectric surgery is an innovative and promising surgical technique in the temporal bone. PEI appears to enable safer and more precise bone removal in close proximity to soft tissue when compared to the drill. The slower bone removal and cost factors represent current limitations to its wider use in ear surgery.
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Affiliation(s)
- Stefan Lyutenski
- Klinik für Hals‑, Nasen‑, Ohrenheilkunde, Helios Klinikum Berlin-Buch, Schwanebecker Chaussee 50, 13125, Berlin, Deutschland.
| | - Anja Lieder
- Klinik für Hals‑, Nasen‑, Ohrenheilkunde, Helios Klinikum Berlin-Buch, Schwanebecker Chaussee 50, 13125, Berlin, Deutschland
| | - Marc Bloching
- Klinik für Hals‑, Nasen‑, Ohrenheilkunde, Helios Klinikum Berlin-Buch, Schwanebecker Chaussee 50, 13125, Berlin, Deutschland
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Liu J, Kong Q, Feng P, Chirume W, Zhang B, Ma J, Hu Y. Application of Ultrasonic Bone Osteotome in Anterior Cervical Disc resection and Fusion surgery. World Neurosurg 2022; 162:e484-e491. [DOI: 10.1016/j.wneu.2022.03.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 03/09/2022] [Accepted: 03/10/2022] [Indexed: 11/26/2022]
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Hirose T, Mae T, Ishibashi Y, Suzuki T, Ohori T, Murase T, Nakata K. Comparison of tendon-bone healing between a newly developed ultrasound device and the conventional metallic drill in a rabbit MCL reconstruction model. J Orthop Sci 2021; 26:908-914. [PMID: 32928611 DOI: 10.1016/j.jos.2020.07.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 07/14/2020] [Accepted: 07/31/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Ligament reconstructive surgeries demand tunnel creation using an over-drilling technique, though this technique has some problems such as metallic particle liberation or difficulties in tunnel creation other than circular cross-section. Recently, a new ultrasound (US) device for bone excavation to overcome these problems was developed. This study aimed to compare the tendon-bone healing in tunnels created using the new US device to that created using the conventional drill in a rabbit model. METHODS A total of 72 rabbits underwent a reconstruction for the anterior half of the medial collateral ligament (MCL) using a half of the patellar tendon. For the femoral tunnel creation, a new US device was used in 36 rabbits (US group), while a conventional metallic drill was used for the remaining 36 rabbits (DR group). At 4, 8, and 12 weeks postoperatively, biomechanical (n = 10) and histological (n = 2) evaluations were performed. RESULTS The ultimate failure load was almost equivalent between the US and DR groups at each period (US/DR; 4 weeks, 50.0 ± 12.8 N/43.4 ± 18.9 N, p = 0.62; 8 weeks, 78.6 ± 11.5 N/77.3 ± 29.9 N, p = 0.92; and 12 weeks: 98.9 ± 33.5 N/102.2 ± 38.3 N, p = 0.80). Pull-out failure from the femoral tunnel was only observed in two rabbits in the US group and one rabbit in the DR group at 4 weeks postoperatively. At 8 and 12 weeks, all specimens had a mid-substance tear. The collagen fiber continuity between tendon and bone occurred 8 weeks postoperatively in both groups and no histological difference was recognized throughout the evaluation period. CONCLUSIONS The tunnels created using the new US device and the conventional drill had equivalent biomechanical and histological features in tendon-bone healing. The bone excavation technology by the new US device may be applicable in ligament reconstructive surgeries.
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Affiliation(s)
- Takehito Hirose
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2, Yamada-oka, Suita, Osaka, 565-0871, Japan
| | - Tatsuo Mae
- Department of Sports Medical Biomechanics, Osaka University Graduate School of Medicine, 2-2, Yamada-oka, Suita, Osaka, 565-0871, Japan.
| | - Yasuyuki Ishibashi
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan
| | - Tomoyuki Suzuki
- Department of Orthopaedic Surgery, Sapporo Maruyama Orthopaedic Hospital, N7-W27, 1-3, Chuo-ku, Sapporo, Hokkaido, 060-0007, Japan
| | - Tomoki Ohori
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2, Yamada-oka, Suita, Osaka, 565-0871, Japan
| | - Tsuyoshi Murase
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2, Yamada-oka, Suita, Osaka, 565-0871, Japan
| | - Ken Nakata
- Department of Medicine for Sports and Performing Arts, Osaka University Graduate School of Medicine, 2-2, Yamada-oka, Suita, Osaka, 565-0871, Japan
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Lang Z, Wang Q, Wu X, Liu Y, He D, Fan M, Shi Z, Tian W. Drilling Speed and Bone Temperature of a Robot-assisted Ultrasonic Osteotome Applied to Vertebral Cancellous Bone. Spine (Phila Pa 1976) 2021; 46:E760-E768. [PMID: 33394989 DOI: 10.1097/brs.0000000000003902] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN An experimental investigation of a robot-assisted ultrasonic osteotome applied to vertebral cancellous bone. OBJECTIVE The aim of this study was to investigate the effect of various ultrasonic parameter settings on temperature in the drilling site and penetration time and determine the most suitable parameters for efficient and safe robot-based ultrasonically assisted bone drilling in spinal surgery. SUMMARY OF BACKGROUND DATA A robot-assisted ultrasonic osteotome device may be safe and effective for spinal drilling. METHODS Sixty specimens of bovine vertebral cancellous were randomly assigned to one of six groups, which varied by mode of ultrasonic vibration (L-T and L) and feed rate (one percent [0.8 mm/s], two percent [1.6 mm/s], and three pecent [2.4 mm/s]). Maximum temperature in the drilling site and penetration time was recorded. RESULTS Maximum temperature in the drilling site decreased as output power increased for L-T and L modes, was significantly lower for L-T compared to L mode at each feed rate and power setting, was significantly different at feed rates of 1.6 mm/s versus 0.8 mm/s and 2.4 mm/s versus 0.8 mm/s for L-T mode at an output power of 60 W and 84 W, but was not influenced by feed rate for L mode. Penetration time did not significantly improve as output power increased for both L-T and L modes, was significantly decreased with increased feed rates, but was not significantly different between L-T and L modes. CONCLUSION The optimal parameters for applying a robot-assisted ultrasonic osteotome to vertebral cancellous bone are L-T mode, maximum output power of 120 W, and maximum feed rate of 2.4 mm/s.Level of Evidence: 4.
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Affiliation(s)
- Zhao Lang
- Department of Spine Surgery, Beijing Ji Shui Tan Hospital, Beijing, China
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Niibo T, Takizawa K, Sakurai J, Takebayashi S, Koizumi H, Kobayashi T, Kobayashi R, Kuris K, Gotou S, Tsuchiya R, Kamiyama H. Impact of Anterior Clinoidectomy on Visual Function After Paraclinoid Carotid Artery Aneurysm Surgery: Power-Drill Versus No-Drill Technique. NEUROSURGERY OPEN 2021. [DOI: 10.1093/neuopn/okab016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
ABSTRACT
BACKGROUND
Few studies have attempted to make a direct comparison of the risk of visual impairment following extradural anterior clinoidectomy (EAC) with and without the use of a power drill.
OBJECTIVE
To evaluate postoperative visual outcomes between groups of patients with paraclinoid carotid artery aneurysms (PCAAs) who underwent surgical clipping with and without the use of a power drill during EAC.
METHODS
Between January 2010 and November 2019, 90 patients, 7 with ruptured and 83 with unruptured PCAAs, underwent clipping surgery at our hospital. The authors retrospectively analyzed postoperative visual complications from the medical records of these patients.
RESULTS
Among the 85 patients (excluding 3 patients with disturbance of consciousness caused by subarachnoid hemorrhage and 2 patients with preoperative visual disturbance) evaluated, EAC was conducted using a power drill in 64 patients and using a microrongeur in 21 patients. Permanent postoperative visual impairment developed in 14 (21.9%) patients in the drill group: 9 patients had ipsilateral lower nasal quadrant hemianopsia (ILNQH) and 5 patients had ipsilateral visual acuity reduction. Transient ILNQH developed in only 1 patient in the no-drill group. The incidence of permanent postoperative visual impairments was significantly lower in the no-drill group than in the drill group (P = .020). Seventeen (26.6%) patients developed transient oculomotor nerve palsy in the drill group, while no patients developed oculomotor nerve palsy in the no-drill group.
CONCLUSION
EAC using a microrongeur versus a power drill significantly improved visual outcomes after clipping surgery for PCAAs.
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Affiliation(s)
- Takeya Niibo
- Department of Neurosurgery, Asahikawa Red Cross Hospital, Asahikawa, Japan
| | - Katsumi Takizawa
- Department of Neurosurgery, Asahikawa Red Cross Hospital, Asahikawa, Japan
| | - Jurou Sakurai
- Department of Neurosurgery, Asahikawa Red Cross Hospital, Asahikawa, Japan
| | - Seizi Takebayashi
- Department of Neurosurgery, Asahikawa Red Cross Hospital, Asahikawa, Japan
| | - Hiroyasu Koizumi
- Department of Neurosurgery, Asahikawa Red Cross Hospital, Asahikawa, Japan
| | - Toru Kobayashi
- Department of Neurosurgery, Asahikawa Red Cross Hospital, Asahikawa, Japan
| | - Rina Kobayashi
- Department of Neurosurgery, Asahikawa Red Cross Hospital, Asahikawa, Japan
| | - Kouta Kuris
- Department of Neurosurgery, Asahikawa Red Cross Hospital, Asahikawa, Japan
| | - Syusuke Gotou
- Department of Neurosurgery, Asahikawa Red Cross Hospital, Asahikawa, Japan
| | - Ryousuke Tsuchiya
- Department of Neurosurgery, Asahikawa Red Cross Hospital, Asahikawa, Japan
| | - Hiroyasu Kamiyama
- Department of Neurosurgery, Sapporo Teishinkai Hospital, Sapporo, Japan
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Lu XD, Zhao YB, Zhao XF, Qi DT, Yang X, Wang XN, Zhou RT, Jin YZ, Zhao B. Efficacy and Safety Analysis of Ultrasonic Bone Curette in the Treatment of Thoracic Spinal Stenosis. Orthop Surg 2020; 11:1180-1186. [PMID: 31823498 PMCID: PMC6904590 DOI: 10.1111/os.12581] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 10/13/2019] [Accepted: 10/23/2019] [Indexed: 11/29/2022] Open
Abstract
Objective To investigate the efficacy and safety of ultrasonic bone curette in treating thoracic spinal stenosis. Methods A total of 30 patients of thoracic spinal stenosis who underwent posterior thoracic decompression in the hospital from December 2015 to 2017 were enrolled. Of these, 18 patients (group A) underwent posterior thoracic decompression using ultrasonic bone curette; and 12 patients underwent the treatment using a high‐speed drill (group B). The time of laminectomy, amount of intraoperative blood loss, presence or absence of cerebrospinal fluid leakage, and nerve root injury were recorded. All patients underwent X‐ray, computed tomography with three‐dimensional reconstruction, and magnetic resonance imaging before and after surgery. The Frankel classification and the Japanese Orthopaedic Association (JOA) scores were used to assess the neurological function and neurological recovery in patients. The measured data were statistically processed and analyzed using SPSS21.0 software, and the measurement data were expressed as mean ± SD. Results In groups A and B, the average time for single‐segment laminectomy was 3.3 ± 1.2 min and 6.0 ± 1.8 min and the mean bleeding volume was 105.5 ± 43.3 mL and 177.4 ± 54.7 mL, respectively, with a statistically significant difference between the groups. The difference in JOA scores before and after surgery in groups A and B was statistically significant. No significant difference was found between the groups, in group A, the improvement rate of nerve function at the last follow‐up was 71% and in group B, the improvement rate at the last follow‐up was 70%. In group A, at last follow‐up, two patients had Frankel grade B injury, one had grade C injury, seven had grade D injury, and eight had grade E injury. In group B, at last follow‐up, one patient had Frankel grade B injury, one had grade C injury, five had grade D injury, and five had grade E injury. The Frankel classification of both groups A and B significantly improved. Four patients experienced cerebrospinal fluid leakage in group A and five in group B, with no significant difference between the groups. There was no nerve root injury in both groups, and no complications, such as pulmonary infection and urinary tract infection, occurred after operation. Conclusions With the use of ultrasonic bone curette in posterior thoracic decompression, the decompression surgery could be completed relatively safely and quickly. It effectively reduced the amount of intraoperative blood loss.
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Affiliation(s)
- Xiang-Dong Lu
- Department of Orthopaedics, the Second Hospital, Shanxi Medical University, Taiyuan, China
| | - Yi-Bo Zhao
- Department of Orthopaedics, the Second Hospital, Shanxi Medical University, Taiyuan, China
| | - Xiao-Feng Zhao
- Department of Orthopaedics, the Second Hospital, Shanxi Medical University, Taiyuan, China
| | - De-Tai Qi
- Department of Orthopaedics, the Second Hospital, Shanxi Medical University, Taiyuan, China
| | - Xu Yang
- Department of Orthopaedics, the Second Hospital, Shanxi Medical University, Taiyuan, China
| | - Xiao-Nan Wang
- Department of Orthopaedics, the Second Hospital, Shanxi Medical University, Taiyuan, China
| | - Run-Tian Zhou
- Department of Orthopaedics, the Second Hospital, Shanxi Medical University, Taiyuan, China
| | - Yuan-Zhang Jin
- Department of Orthopaedics, the Second Hospital, Shanxi Medical University, Taiyuan, China
| | - Bin Zhao
- Department of Orthopaedics, the Second Hospital, Shanxi Medical University, Taiyuan, China
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Kutty RK, Kumar A, Yamada Y, Kawase T, Tanaka R, Miyatani K, Higashiguchi S, Ravishankar V, Takizawa K, Kato Y. Visual Outcomes after Surgery for Paraclinoid Aneurysms: A Fujita Experience. Asian J Neurosurg 2020; 15:363-369. [PMID: 32656133 PMCID: PMC7335145 DOI: 10.4103/ajns.ajns_39_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 02/06/2020] [Accepted: 02/25/2020] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION The surgical strategies for clipping of paraclinoid aneurysms are diverse. These aneurysms are unique in their location, as they closely abut the anterior clinoid process (ACP) and the optic nerve. The ultimate goal of clipping encompasses the exposure of neck of the aneurysm which is seldom complete without the manipulation of optic nerve and the ACP. This manipulation may result in disturbances of vision postoperatively. We analyze our results of visual outcomes in the surgery for paraclinoid aneurysms in this retrospective study. MATERIALS AND METHODS All patients with paraclinoid aneurysms who underwent surgery from June 2014 to June 2019 were included in the study. Surgical procedure was uniform in all patients which included anterior clinoidectomy and clipping of aneurysms as per the Bantane protocol. Glasgow Outcome Scale as well as vision was assessed at discharge and at 1 month and 6 months. RESULTS There were 77 cases of paraclinoid aneurysms operated during the abovementioned period. All patients had no symptoms related to vision preoperatively. Visual deterioration was noted in two patients. All patients were discharged with a good outcome on the Glasgow Outcome Scale. CONCLUSION Paraclinoid aneurysm has a good outcome when treated with surgery. The visual deterioration following surgery can be minimized with extradural anterior clinoidectomy and careful handling of the vessels and nerve.
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Affiliation(s)
- Raja K. Kutty
- Department of Neurosurgery, Government Medical College, Trivandrum, Kerala, India
| | - Ambuj Kumar
- Department of Neurosurgery, Netaji Subhash Chandra Bose Medical College, Jabalpur, Madhya Pradesh, India
| | - Yasuhiro Yamada
- Department of Neurosurgery, Banbuntane Hotokukai Hospital, Fujita Health University, Otobashi, Nagoya, Japan
| | - Tsukosa Kawase
- Department of Neurosurgery, Banbuntane Hotokukai Hospital, Fujita Health University, Otobashi, Nagoya, Japan
| | - Riki Tanaka
- Department of Neurosurgery, Banbuntane Hotokukai Hospital, Fujita Health University, Otobashi, Nagoya, Japan
| | - Kyosuke Miyatani
- Department of Neurosurgery, Banbuntane Hotokukai Hospital, Otobashi, Nagoya, Japan
| | - Saeko Higashiguchi
- Department of Neurosurgery, Banbuntane Hotokukai Hospital, Otobashi, Nagoya, Japan
| | - Vigneswar Ravishankar
- Department of Neurosurgery, Institute of Neurosciences and Spinal Disorders, MGM Healthcare, Chennai, Tamil Nadu, India
| | - Katsumi Takizawa
- Department of Neurosurgery, Japanese Red Cross Asahikawa Hospital, Asahikawa, Hokkaido, Japan
| | - Yoko Kato
- Department of Neurosurgery, Banbuntane Hotokukai Hospital, Otobashi, Nagoya, Japan
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Yu L, Wen JK, Wang S, Wang WH, Yu JM, Ye XJ. Removal of calcified lumbar disc herniation with endoscopic-matched ultrasonic osteotome - Our preliminary experience. Br J Neurosurg 2019; 34:80-85. [PMID: 31718310 DOI: 10.1080/02688697.2019.1687850] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objective: To evaluate the clinical efficacy, practicability, and safety of an ultrasonic osteotome for percutaneous transforaminal endoscopic discectomy (PTED) in patients with calcified lumbar disc herniation (CLDH).Methods: A total of 25 CLDH patients who underwent PTED at our department between December 2017 and August 2018 were analyzed retrospectively. Post-operative lumbar spine CT was used to evaluate residual calcification. Efficacy was evaluated by pre- and post-operative with the pain visual analog scale (VAS), Oswestry disability index (ODI), and the Modified MacNab Scale; the incidence of intra- and postoperative complications was also analyzed.Results: All procedures were successfully completed and none of the patients was lost to follow-up. Postoperative CT verified the successful removal of calcified protrusions. VAS and ODI scores improved significantly after surgery. Based on the Modified MacNab scale, >90% patients achieved good or excellent outcomes. There were no complications such as dural tear and infection. Seven patients had varying degrees of postoperative dysesthesia. One patient experienced recurrence of herniation within 1 week after operation; successful recovery was achieved after repeat PTED.Conclusions: Use of this ultrasonic osteotome for PTED facilitated effective removal of calcified disc protrusion, relieved nerve compression, and protected the adjacent neurovascular tissues. The instrument may help expand the indications for endoscopic surgery and avoid open surgery for some CLDH patients.
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Affiliation(s)
- Lei Yu
- Department of Orthopaedics, Changzheng Hospital, Second Military Medical University, Shanghai, PR China
| | - Jian-Kun Wen
- Department of Orthopaedics, Changzheng Hospital, Second Military Medical University, Shanghai, PR China
| | - Shuang Wang
- Department of Orthopaedics, Changzheng Hospital, Second Military Medical University, Shanghai, PR China
| | - Wei-Heng Wang
- Department of Orthopaedics, Changzheng Hospital, Second Military Medical University, Shanghai, PR China
| | - Jiang-Ming Yu
- Department of Orthopaedics, Changzheng Hospital, Second Military Medical University, Shanghai, PR China
| | - Xiao-Jian Ye
- Department of Orthopaedics, Changzheng Hospital, Second Military Medical University, Shanghai, PR China
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Kim CH, Chung CK, Choi Y, Kuo CC, Lee U, Yang SH, Lee CH, Jung JM, Hwang SH, Kim DH, Yoon JH, Paik S, Lee HJ, Jung S, Park SB, Kim KT, Park HP. The Efficacy of Ultrasonic Bone Scalpel for Unilateral Cervical Open-Door Laminoplasty: A Randomized Controlled Trial. Neurosurgery 2019; 86:825-834. [DOI: 10.1093/neuros/nyz301] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 05/18/2019] [Indexed: 11/13/2022] Open
Abstract
Abstract
BACKGROUND
In cervical open-door laminoplasty for cervical myelopathy, a high-speed rotatory drill and rongeurs are used to make unicortical troughs and bicortical openings in the laminae. The lamina is reflected at the trough to enlarge the spinal canal, followed by bone healing on the hinge side to stabilize laminoplasty. The ultrasonic bone scalpel (UBS) has been used due to theoretical advantages including a better hinge union rate, less soft tissue trauma, less neurological injury, and shorter operative time.
OBJECTIVE
To assess the superiority of UBS for hinge union compared to the drill through randomized controlled trial.
METHODS
In 190 randomly allocated cervical myelopathy patients, the trough and opening at the lamina were made using either the drill (n = 95) or UBS (n = 95) during 2015 to 2018. The primary outcome was the hinge union rate on 6-mo postoperative computed tomography. Secondary outcomes included the hinge union rate at 12 mo, the operative time, intraoperative/postoperative bleeding, neurological injury, complications, and clinical outcomes over a 24-mo follow-up.
RESULTS
Hinge union in all laminae was achieved in 60.0% (drill) and 43.9% (UBS) of patients at 6 mo (intention-to-treat analysis; P = .02; odds ratio, 2.1) and in 91.9% (drill) and 86.5% (UBS) at 12 mo. Dural injury only occurred in the drill group (2.1%), and the UBS group showed significantly less intraoperative bleeding (P < .01). The other secondary outcomes did not differ between groups.
CONCLUSION
The hinge union rate was inferior in the UBS group at 6 mo postoperatively, but UBS was efficacious in reducing dural injuries and bleeding.
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Affiliation(s)
- Chi Heon Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul, South Korea
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Chun Kee Chung
- Department of Neurosurgery, Seoul National University Hospital, Seoul, South Korea
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, South Korea
- Department of Brain and Cognitive Sciences, Seoul National University Hospital, Seoul, South Korea
- Human Brain Function Laboratory, Department of Neurosurgery, Seoul National University Hospital, Seoul, South Korea
| | - Yunhee Choi
- Division of Medical Statistics, Medical Research Collaborating Center, Seoul National University Hospital, Seoul, South Korea
| | - Calvin C Kuo
- Regional Spine Surgery Department, Kaiser Permanente, Oakland, California
| | - Urim Lee
- Human Brain Function Laboratory, Department of Neurosurgery, Seoul National University Hospital, Seoul, South Korea
| | - Seung Heon Yang
- Department of Neurosurgery, Seoul National University Hospital, Seoul, South Korea
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Chang-Hyun Lee
- Department of Neurosurgery, Seoul National University Hospital, Seoul, South Korea
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Jong-Myung Jung
- Department of Neurosurgery, Seoul National University Bundang Hospital, Kyung-gi, South Korea
| | - Sung Hwan Hwang
- Department of Neurosurgery, Seoul National University Hospital, Seoul, South Korea
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Dong Hwan Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul, South Korea
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Joon Ho Yoon
- Department of Neurosurgery, Seoul National University Hospital, Seoul, South Korea
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Seoi Paik
- Department of Neurosurgery, Seoul National University Hospital, Seoul, South Korea
- Department of Nursing, Seoul National University Hospital, Seoul, South Korea
| | - Hwa Jin Lee
- Department of Neurosurgery, Seoul National University Hospital, Seoul, South Korea
- Department of Nursing, Seoul National University Hospital, Seoul, South Korea
| | - Sunhyang Jung
- Department of Neurosurgery, Seoul National University Hospital, Seoul, South Korea
- Department of Nursing, Seoul National University Hospital, Seoul, South Korea
| | - Sung Bae Park
- Department of Neurosurgery, Seoul National University Hospital, Seoul, South Korea
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, South Korea
- Department of Neurosurgery, Seoul National University Boramae Hospital, Boramae Medical Center, Seoul, South Korea
| | - Kyoung-Tae Kim
- Department of Neurosurgery, Kyungpook National University Hospital, Daegu, South Korea
- Department of Neurosurgery, School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Hee-Pyoung Park
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, South Korea
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, South Korea
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