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Luzzi S, Crovace A, Carnevale S, Lacitignola L, Staffieri F, Sfondrini D, Ordóñez-Rubiano EG, Crovace AM. Minimizing Invasiveness in Neurosurgical Osteotomies: A Comparative Histomorphometric Study of Piezoelectric Craniotomy versus High-Speed Drill. World Neurosurg 2024:S1878-8750(24)01458-X. [PMID: 39181242 DOI: 10.1016/j.wneu.2024.08.088] [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: 08/15/2024] [Accepted: 08/17/2024] [Indexed: 08/27/2024]
Abstract
BACKGROUND Piezoelectric bone cutting has gained popularity in neurosurgical osteotomies due to perceived lower trauma compared to rotary instruments. However, histological confirmation of its decreased aggressiveness is lacking, hindering conclusive proof. This study compares the bony and neuro-meningeal invasiveness of piezoelectric craniotomy with high-speed drill techniques. METHODS Histological data from 21 sheep undergoing piezoelectric craniotomy and 19 sheep subjected to high-speed electric drill craniotomy were compared. Piezoelectric craniotomy utilized a 0.35 mm micro saw titanium nitride coated. Outcome parameters included the detection of the "smear layer," average osteoblast count per high-power field, and residual bone matrix for bony invasiveness assessment. Parameters for meningeal and brain parenchymal invasiveness included pachymeningeal and leptomeningeal injury, gliosis, and histiocytic infiltration. Statistical significance was determined at P < 0.05. RESULTS Results showed the Piezo group had fewer frequent smear layers (P <0.001), higher residual bone matrix (P < 0.05), and greater osteoblast counts per high-power field (P < 0.05). Additionally, the Piezo group exhibited lower rates of leptomeningeal injury, cerebral gliosis, and histiocytic infiltration (P < 0.05). CONCLUSIONS Piezoelectric craniotomy preserves residual osteoblast viability and leptomeningeal integrity while demonstrating lower rates of thermally induced gliosis and histiocytic infiltration compared to high-speed drills. This suggests the piezoelectric osteotome's minimal invasiveness in bone, meningeal, and brain tissue.
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Affiliation(s)
- Sabino Luzzi
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy; Neurosurgery Unit, Department of Surgical Sciences, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
| | - Antonio Crovace
- Dipartimento di Medicina di Precisione e Rigenerativa Area Jonica (DiMePRe-J), University of Bari, Bari, Italy
| | - Sergio Carnevale
- Section of Anatomical Pathology, Cerba Healthcare Italia, Milan, Italy
| | - Luca Lacitignola
- Dipartimento di Medicina di Precisione e Rigenerativa Area Jonica (DiMePRe-J), University of Bari, Bari, Italy
| | - Francesco Staffieri
- Dipartimento di Medicina di Precisione e Rigenerativa Area Jonica (DiMePRe-J), University of Bari, Bari, Italy
| | - Domenico Sfondrini
- Maxillo-Facial Surgery Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Edgar G Ordóñez-Rubiano
- Department of Neurosurgery, Fundación Santa Fe de Bogotá, Bogotá, Colombia; Department of Neurosurgery, Hospital de San José, Fundación Universitaria de Ciencias de la Salud, Bogotá, Colombia; School of Medicine, Universidad Nacional de Colombia, Bogotá, Colombia
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Yao Z, Zhang S, Liu W, Wei M, Fang W, Li Q, Cai L, Wang Z, Zhou C, Zhou Y. The efficacy and safety of ultrasonic bone scalpel for removing retrovertebral osteophytes in anterior cervical discectomy and fusion: A retrospective study. Sci Rep 2024; 14:80. [PMID: 38168463 PMCID: PMC10761842 DOI: 10.1038/s41598-023-50545-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 12/21/2023] [Indexed: 01/05/2024] Open
Abstract
In this study, we present a novel surgical method that utilizes the ultrasonic bone scalpel (UBS) for the removal of large retrovertebral osteophytes in anterior cervical discectomy and fusion (ACDF) and evaluate its safety and efficacy in comparison to the traditional approach of using high-speed drill (HSD). A total of 56 patients who underwent ACDF for retrovertebral osteophytes were selected. We recorded patients' baseline information, operation time, intraoperative blood loss, complications, JOA and VAS scores, and other relevant data. The mean operation time and the mean intraoperative blood loss in the UBS group were less than those in the HSD group (P < 0.05). Although both groups exhibited considerable improvements in JOA and VAS scores following surgery, there was no statistically significant difference between the two groups (P > 0.05). Additionally, no significant disparities were found in bone graft fusion between the two groups at 6- and 12-months postsurgery. Notably, neither group exhibited complications such as dura tear or spinal cord injury. Our study found that the use of UBS reduced operative time, minimized surgical bleeding, and led to clinical outcomes comparable to HSD in ACDF. This technique offers an effective and safe method of removing large retrovertebral osteophytes.
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Affiliation(s)
- Zhi Yao
- Department of Spine Surgery, Wuhan Fourth Hospital; Puai Hospital, Tongji Medical College Affiliated to Huazhong University of Science and Technology, No. 473 Hanzheng Street, Qiaokou District, Wuhan, 430033, China
| | - Shishuang Zhang
- Department of Spine Surgery, Wuhan Fourth Hospital, School of Medicine, Jianghan University, No. 473 Hanzheng Street, Qiaokou District, Wuhan, 430033, China
| | - Weijun Liu
- Department of Spine Surgery, Wuhan Fourth Hospital, No. 473 Hanzheng Street, Qiaokou District, Wuhan, 430033, China.
| | - Mengcheng Wei
- Department of Spine Surgery, Wuhan Fourth Hospital; Puai Hospital, Tongji Medical College Affiliated to Huazhong University of Science and Technology, No. 473 Hanzheng Street, Qiaokou District, Wuhan, 430033, China
| | - Weizhi Fang
- Department of Spine Surgery, Wuhan Fourth Hospital, No. 473 Hanzheng Street, Qiaokou District, Wuhan, 430033, China
| | - Qingbo Li
- Department of Spine Surgery, Wuhan Fourth Hospital, No. 473 Hanzheng Street, Qiaokou District, Wuhan, 430033, China
| | - Lei Cai
- Department of Spine Surgery, Wuhan Fourth Hospital, No. 473 Hanzheng Street, Qiaokou District, Wuhan, 430033, China
| | - Zhengkun Wang
- Department of Spine Surgery, Wuhan Fourth Hospital, No. 473 Hanzheng Street, Qiaokou District, Wuhan, 430033, China
| | - Chuankun Zhou
- Department of Spine Surgery, Wuhan Fourth Hospital, No. 473 Hanzheng Street, Qiaokou District, Wuhan, 430033, China
| | - Yichi Zhou
- Department of Spine Surgery, Wuhan Fourth Hospital, No. 473 Hanzheng Street, Qiaokou District, Wuhan, 430033, China
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Li YW, Chen HJ, Zhao SX, Li XZ, Wang HJ, Zhou P, Cui W, Xiao W, Li F, Hu B. Using Piezosurgery in Anterior Cervical Discectomy and Fusion to Treat Complex Cervical Spondylotic Myelopathy Is Safe and Effective. Adv Orthop 2023; 2023:5306445. [PMID: 38155878 PMCID: PMC10754634 DOI: 10.1155/2023/5306445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 11/22/2023] [Accepted: 12/11/2023] [Indexed: 12/30/2023] Open
Abstract
Objective To investigate the safety and efficacy of piezosurgery in anterior cervical discectomy and fusion (ACDF) for cervical spondylotic myelopathy (CSM). Methods 47 patients with complex CSM (cCSM) underwent ACDF surgery from 2014 to 2017. Among these patients, 26 underwent ACDF using piezosurgery (group A) and 21 underwent ACDF by using traditional tools such as high-speed air drill, bone curette, and Kerrison bone punch (group B). Average surgical time, intraoperative blood loss, surgical complications, preoperative and postoperative Japanese Orthopaedic Association (JOA) scores, and improvement rate were measured. Results Average surgical time and intraoperative blood loss were significantly lower in group A than those in group B (P < 0.01). The incidences of surgical complications were 3.8% and 23.8% in the A and B groups (P < 0.05), respectively. There were no significant differences in JOA scores and improvement rates between data collection periods at preoperative, 3-day postoperative, and 1-year postoperative follow-ups (P > 0.05). Conclusion For treating cCSM, both the piezosurgery and traditional tools led to significant neurological improvement. However, the piezosurgery was superior to the traditional tools in terms of surgical time, blood loss, and complication rate. Hence, piezosurgery was a safe and effective adjunct for ACDF treating cCSM.
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Affiliation(s)
- Yu-Wei Li
- Department of Orthopedics, Luohe Central Hospital, Luohe, Henan 462000, China
| | - Hao-Jie Chen
- Department of Orthopedics, Luohe Central Hospital, Luohe, Henan 462000, China
| | - Shi-Xin Zhao
- Department of Orthopedics, Luohe Central Hospital, Luohe, Henan 462000, China
| | - Xiu-Zhi Li
- Medical College, Zhengzhou University, Zhengzhou, Henan 450052, China
| | - Hai-Jiao Wang
- Department of Orthopedics, Luohe Central Hospital, Luohe, Henan 462000, China
| | - Peng Zhou
- Department of Orthopedics, Luohe Central Hospital, Luohe, Henan 462000, China
| | - Wei Cui
- Department of Orthopedics, Luohe Central Hospital, Luohe, Henan 462000, China
| | - Wei Xiao
- Department of Orthopedics, Luohe Central Hospital, Luohe, Henan 462000, China
| | - Fan Li
- Department of Orthopedics, Luohe Central Hospital, Luohe, Henan 462000, China
| | - Bingtao Hu
- Department of Orthopedics, Luohe Central Hospital, Luohe, Henan 462000, China
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Lin M, Paul R, Dhar UK, Doulgeris J, O’Connor TE, Tsai CT, Vrionis FD. A Review of Finite Element Modeling for Anterior Cervical Discectomy and Fusion. Asian Spine J 2023; 17:949-963. [PMID: 37408489 PMCID: PMC10622829 DOI: 10.31616/asj.2022.0295] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 11/13/2022] [Accepted: 11/14/2022] [Indexed: 07/07/2023] Open
Abstract
The cervical spine poses many complex challenges that require complex solutions. Anterior cervical discectomy and fusion (ACDF) has been one such technique often employed to address such issues. In order to address the problems with ACDF and assess the modifications that have been made to the technique over time, finite element analyses (FEA) have proven to be an effective tool. The variations of cervical spine FEA models that have been produced over the past couple of decades, particularly more recent representations of more complex geometries, have not yet been identified and characterized in any literature. Our objective was to present material property models and cervical spine models for various simulation purposes. The outlining and refinement of the FEA process will yield more reliable outcomes and provide a stable basis for the modeling protocols of the cervical spine.
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Affiliation(s)
- Maohua Lin
- Department of Ocean and Mechanical Engineering, Florida Atlantic University, Boca Raton, FL,
USA
| | - Rudy Paul
- Department of Ocean and Mechanical Engineering, Florida Atlantic University, Boca Raton, FL,
USA
| | - Utpal Kanti Dhar
- Department of Ocean and Mechanical Engineering, Florida Atlantic University, Boca Raton, FL,
USA
| | - James Doulgeris
- Department of Neurosurgery, Marcus Neuroscience Institute, Baptist Health South Florida, Boca Raton, FL,
USA
| | - Timothy E. O’Connor
- Department of Neurosurgery, Marcus Neuroscience Institute, Baptist Health South Florida, Boca Raton, FL,
USA
| | - Chi-Tay Tsai
- Department of Ocean and Mechanical Engineering, Florida Atlantic University, Boca Raton, FL,
USA
| | - Frank D. Vrionis
- Department of Neurosurgery, Marcus Neuroscience Institute, Baptist Health South Florida, Boca Raton, FL,
USA
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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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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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Bai H, Wang R, Wang Q, Xia GM, Xue Y, Dai Y, Zhang JX. Motor Bur Milling State Identification via Fast Fourier Transform Analyzing Sound Signal in Cervical Spine Posterior Decompression Surgery. Orthop Surg 2021; 13:2382-2395. [PMID: 34792301 PMCID: PMC8654648 DOI: 10.1111/os.13168] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 09/24/2021] [Accepted: 10/19/2021] [Indexed: 01/18/2023] Open
Abstract
Objectives To investigate the real‐time sensitive feedback parameter of the motor bur milling state in cervical spine posterior decompression surgery, to possibly improve the safety of cervical spine posterior decompression and robot‐assisted spinal surgeries. Methods In this study, the cervical spine of three healthy male and three healthy female pigs were randomly selected. Six porcine cervical spine specimens were fixed to the vibration isolation system. The milling state of the motor bur was defined as the lamina cancellous bone (CA), lamina ventral corticalbone (VCO), and penetrating ventral cortical bone (PVCO). A 5‐mm bur milled the CA and VCO, and a 2‐mm bur milled the VCO and PVCO. A miniature microphone was used to collect the sound signal (SS) of milling lamina which was then extracted using Fast Fourier Transform (FFT). When using 5‐mm and 2‐mm bur to mill, the CA, VCO, and PVCO of each specimen were continuously collected at 1, 2, 3, 4, 5, 6, 7, 8, 9, and 10 kHz frequencies for SS magnitudes. The study randomly selected the SS magnitudes of the CA and VCO continuously for 2 s at 1, 2, 3, 4, and 5 kHz frequencies for statistical analyses. When milling the VCO to the PVCO, we randomly collected the SS magnitudes of the VCO for consecutive 2 s and the SS magnitudes of continuous 2 s in the penetrating state at 1, 2, 3, 4, and 5 kHz frequencies for statistical analyses. The independent sample t‐test was used to compare the SS magnitudes of different milling states extracted from the FFT to determine the motor bur milling state. Results The SS magnitudes of the CA and VCO of all specimens extracted from the FFT at 1, 2, and 3 kHz were statistically different (P < 0.01); three specimens were not statistically different at a specific FFT‐extracted frequency (first specimen at 5 kHz, SS magnitudes of the CA were [25.94 ± 8.74] × 10−3, SS magnitudes of the VCO were [28.67 ± 12.94] × 10−3, P = 0.440; second specimen at 4 kHz, SS magnitudes of the CA were [23.79 ± 7.94] × 10−3, SS magnitudes of the VCO were [24.78 ± 4.32] × 10−3, P = 0.629; and third specimen at 5 kHz, SS magnitudes of the CA were [16.76 ± 6.20] × 10−3, SS magnitudes of the VCO were [17.69 ± 6.44] × 10−3, P = 0.643).The SS magnitudes of the VCO and PVCO of all the specimens extracted from the FFT at each frequency were statistically different (P < 0.001). Conclusions Based on the FFT extraction, the SS magnitudes of the motor bur milling state between the CA and VCO, the VCO and PVCO were significantly different, confirming that the SS is a potential sensitive feedback parameter for identifying the motor bur milling state. This study could improve the safety of cervical spine posterior decompression surgery, especially of robot‐assisted surgeries.
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Affiliation(s)
- He Bai
- Department of Orthopaedics Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Rui Wang
- Department of Orthopaedics Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Qiu Wang
- Department of Rehabilitation, Tianjin Medical University General Hospital, Tianjin, China
| | - Guang-Ming Xia
- Tianjin Key Laboratory of Intelligent Robotics, College of Computer and Control Engineering, Institute of Robotics and Automatic Information System, Nankai University, Tianjin, China
| | - Yuan Xue
- Department of Orthopaedics Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Yu Dai
- Tianjin Key Laboratory of Intelligent Robotics, College of Computer and Control Engineering, Institute of Robotics and Automatic Information System, Nankai University, Tianjin, China
| | - Jian-Xun Zhang
- Tianjin Key Laboratory of Intelligent Robotics, College of Computer and Control Engineering, Institute of Robotics and Automatic Information System, Nankai University, Tianjin, China
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Roscamp M, Hataka A, Zambon FC, Ferreira DRC, Minto BW, Dias LGGG. Cervical ventral slot in rabbits (Oryctolagus cuniculus). Piezosurgery versus conventional technique. Acta Cir Bras 2021; 36:e360606. [PMID: 34259789 PMCID: PMC8275061 DOI: 10.1590/acb360606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 05/23/2021] [Indexed: 11/29/2022] Open
Abstract
Purpose To investigate the applicability of piezosurgery for cervical ventral slot (CVS), comparing it with the conventional technique of using high-speed burs for bone wear. Methods Thirty rabbits (Oryctolagus cuniculus) were divided into two treatment groups (T1 and T2) corresponding to CVS between C3-C4. In T1, the surgery was performed with piezoelectric apparatus, and in T2 with high-speed burs. The evaluated parameters were: duration of each stage of surgery, temperature variations during CVS, visibility of the surgical field, intra and postoperative complications, and anesthetic monitoring. At 14, 28, and 56 postoperative days, five animals from each treatment group were submitted for histopathological study of the surgical site. Results Compared with T2, T1 had more precise bone cut, and better visibility of the operative field, although it required longer total surgical time (p = 0.02) and triggered a greater number of intraoperative complications (p < 0.01), microscopic lesions in the spinal cord (p < 0.05), and transient neurological deficits in the postoperatively (p < 0.05). Conclusions It is necessary to perform surgical planning and have several tips of the piezoelectric instrument available for the safe use of the piezoelectric device in neurosurgery.
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Affiliation(s)
- Marcelo Roscamp
- Universidade Estadual Paulista “Julio de Mesquita Filho”, Brazil
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Steiert C, Masalha W, Grauvogel TD, Roelz R, Klingler JH, Heiland DH, Beck J, Scheiwe C, Grauvogel J. Piezosurgery for safe and efficient petrous bone cutting in cerebellopontine angle and petroclival meningioma surgery. J Clin Neurosci 2021; 89:319-328. [PMID: 34119287 DOI: 10.1016/j.jocn.2021.05.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 05/01/2021] [Accepted: 05/04/2021] [Indexed: 11/30/2022]
Abstract
Intradural petrous bone drilling has become a widespread practice, providing extended exposure in the removal of cerebellopontine angle (CPA) or petroclival tumors. Adjacent neurovascular structures are at risk, however, when drilling is performed in this deep and narrow area. Hence, this study evaluates the use of Piezosurgery (PS) as a non-rotating tool for selective bone cutting in CPA surgery. A Piezosurgery® device was used in 36 patients who underwent microsurgery for extra-axial CPA or petroclival tumors in our Neurosurgical Department between 2013 and 2019. The clinical and radiological data were retrospectively analyzed. The use of PS was evaluated with respect to the intraoperative applicability and limitations as well as efficacy and safety of the procedure. Piezosurgical petrous bone cutting was successfully performed in the removal of meningiomas or extra-axial metastases arising from the dura of the petroclival region (21 patients) or petrous bone (15 patients). PS proved to be very helpful in the deep and narrow CPA region, considerably reducing the surgeon's distress toward bone removal in close proximity to cranial nerves and vessels in comparison to common rotating drills. The use of PS was safe without injuries to neurovascular structures. Gross total resection was achieved in 67% of petroclival and 100% of petrous bone tumors. Piezosurgery proved to be an effective and safe method for selective petrous bone cutting in CPA surgery avoiding rotating power and associated risks. This technique can particularly be recommended for bone cutting in close vicinity to critical neurovascular structures.
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Affiliation(s)
- C Steiert
- Department of Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany.
| | - W Masalha
- Department of Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - T D Grauvogel
- Department of Otorhinolaryngology - Head and Neck Surgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - R Roelz
- Department of Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - J H Klingler
- Department of Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - D H Heiland
- Department of Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - J Beck
- Department of Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - C Scheiwe
- Department of Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - J Grauvogel
- Department of Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
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Siu JM, Negandhi J, Harrison RV, Wolter NE, James A. Ultrasonic bone removal from the ossicular chain affects cochlear structure and function. J Otolaryngol Head Neck Surg 2021; 50:23. [PMID: 33810814 PMCID: PMC8017701 DOI: 10.1186/s40463-021-00491-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 01/11/2021] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Ultrasonic bone removal devices (UBD) are capable of cutting through bony tissue without injury to adjacent soft tissue. The feasibility and safety of using this technology for removal of bone from an intact ossicular chain (as might be required for otosclerosis or congenital fixation) was investigated in an animal model. METHODS This was a prospective animal study conducted on seven anesthetised adult chinchillas. An UBD was used to remove bone from the malleus head in situ. Pre and post-operative distortion product otoacoustic emission (DPOAE) levels and auditory brainstem response (ABR) thresholds were recorded. Scanning electron microscopy (SEM) was used to assess cochlear haircell integrity. RESULTS Precise removal of a small quantity of bone from the malleus head was achieved by a 30s application of UBD without disruption of the ossicular chain or tympanic membrane. DPOAEs became undetectable after the intervention with signal-to-noise ratios (SNR) < 5 dB SPL in all ears. Furthermore, ABR thresholds were elevated > 85 dB SPL in 13 ears. SEM showed significant disruption of structural integrity of the organ of Corti, specifically loss and damage of outer haircells. CONCLUSIONS Although UBD can be used to reshape an ossicle without middle ear injury, prolonged contact with the ossicular chain can cause structural and functional injury to the cochlea. Extensive cochlea pathology was found, but we did not investigate for recovery from any temporary threshold shift. In the authors' opinion, further study should be undertaken before consideration is given to use of the device for release of ossicular fixation.
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Affiliation(s)
- Jennifer M Siu
- Department of Otolaryngology - Head & Neck Surgery, University of Toronto, Toronto, Canada
| | - Jaina Negandhi
- Program in Neuroscience and Mental Health, Hospital for Sick Children, Toronto, Canada
| | - Robert V Harrison
- Department of Otolaryngology - Head & Neck Surgery, University of Toronto, Toronto, Canada
- Program in Neuroscience and Mental Health, Hospital for Sick Children, Toronto, Canada
- Department of Otolaryngology, Hospital for Sick Children, University of Toronto, 555 University Avenue, Room 6133, Burton Wing, Toronto, ON, M5G 1X8, Canada
| | - Nikolaus E Wolter
- Department of Otolaryngology - Head & Neck Surgery, University of Toronto, Toronto, Canada
- Department of Otolaryngology, Hospital for Sick Children, University of Toronto, 555 University Avenue, Room 6133, Burton Wing, Toronto, ON, M5G 1X8, Canada
| | - Adrian James
- Department of Otolaryngology - Head & Neck Surgery, University of Toronto, Toronto, Canada.
- Department of Otolaryngology, Hospital for Sick Children, University of Toronto, 555 University Avenue, Room 6133, Burton Wing, Toronto, ON, M5G 1X8, Canada.
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Single level anterior cervical discectomy and fusion in multilevel herniated disc, a case report. Ann Med Surg (Lond) 2020; 60:708-713. [PMID: 33425339 PMCID: PMC7779959 DOI: 10.1016/j.amsu.2020.11.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 11/20/2020] [Accepted: 11/24/2020] [Indexed: 11/30/2022] Open
Abstract
Introduction In managing cervical disc herniation, several treatment options are available. Anterior cervical decompression and fusion (ACDF) remain the gold standard in symptomatic cervical disc herniation. However, multilevel ACDF could diminish the motion of the segment. We planned to salvage the movement by only using single-level ACDF in our patient and osteophyte removal to reduce compression caused by spurs formation related to the herniated nucleus. Methods A male patient, 43 years old, came with a chief complaint of neck pain three months ago. The pain was intermittent, radiated into both hands. There was midline tenderness, and his sensation was decreased from the level of C5 below. We managed to diagnose the patient with Cervical Herniated Disc (CHD) using MRI and performed single-level ACDF. Results After the operation, osteophyte formation was safely removed, the pain and the tingling sensation was no longer felt. The VAS score was reduced from 4 to 1. We observed good spinal fusion in the post x-ray imaging. Conclusion Anterior cervical discectomy and fusion after osteophyte removal proved successful for our patient treatment, with improvement from neck and arms symptoms. However, longer-term evaluation needs to be planned further to assess the result and possible complications of single-level ACDF. Cervical disc herniation can be treated by several options, one of which is anterior cervical decompression and fusion (ACDF). Multilevel ACDF diminish the motion of the segment of the cervical, therefore we planned single level ACDF for our patient. Single level ACDF with osteophyte removal could be one of the option for cervical disc herniation.
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He S, Yang X, Yang J, Ye C, Liu W, Wei H, Xiao J. Customized "Whole-Cervical-Vertebral-Body" Reconstruction After Modified Subtotal Spondylectomy of C2-C7 Spinal Tumor Via Piezoelectric Surgery. Oper Neurosurg (Hagerstown) 2020; 17:580-587. [PMID: 31089696 DOI: 10.1093/ons/opz077] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 12/25/2018] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Radical resection is the first-line option in managing cervical primary chondrosarcoma. Favorable anterior reconstruction is challenging after multilevel total spondylectomy in the cervical spine. OBJECTIVE To illustrate the application of piezoelectric surgery and three-dimensional (3D) printing techniques in spine surgery. METHODS A 27-yr-old patient was referred to our center with complaints of nocturnal neck pain and right upper extremity weakness. A 2-stage radical tumor resection was conducted using piezoelectric surgery with pathologically tumor-free margins. A 3D-printed titanium microporous prosthesis (3D-PTMP) was designed to reconstruct the anterior column of the cervical spine between C1 and T1 for stability. RESULTS The whole intraoperative blood loss was 2300 mL over the 2 procedures. The patient had an uneventful recovery, regaining ambulatory status 3 wk after the 2 operations without ventilator support or other severe complications. By the final 14-mo follow-up, the patient had achieved marked pain relief and favorable neurological improvement; a postoperative computed tomography scan indicated a good position of the 3D-printed construct between the endplates with no sign of tumor recurrence or implant subsidence. CONCLUSION The applications of piezosurgery in total spondylectomy and in 3D-PTMP in reconstruction can be a favorable alternative for managing multilevel cervical spinal tumors. Further studies are warranted to validate this surgical strategy.
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Affiliation(s)
- Shaohui He
- Spinal Tumor Center, Department of Orthopaedic Oncology, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Xinghai Yang
- Spinal Tumor Center, Department of Orthopaedic Oncology, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Jian Yang
- Spinal Tumor Center, Department of Orthopaedic Oncology, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Chen Ye
- Spinal Tumor Center, Department of Orthopaedic Oncology, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Weibo Liu
- Spinal Tumor Center, Department of Orthopaedic Oncology, Changzheng Hospital, Second Military Medical University, Shanghai, China.,Department of Spine Surgery, Central Hospital of Qingdao, Shandong Province, China
| | - Haifeng Wei
- Spinal Tumor Center, Department of Orthopaedic Oncology, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Jianru Xiao
- Spinal Tumor Center, Department of Orthopaedic Oncology, Changzheng Hospital, Second Military Medical University, Shanghai, China
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Liu X, Wen BT, Chen ZQ, Tan L, Zhong J. Ultrasonic osteotome versus high-speed burr in cervical anterior vertebral subtotal resection: A retrospective study of 81 cases. Neurochirurgie 2020; 66:369-372. [PMID: 32861685 DOI: 10.1016/j.neuchi.2020.05.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 04/09/2020] [Accepted: 05/13/2020] [Indexed: 11/18/2022]
Abstract
AIM This study aimed to investigate the safety and effectiveness of ultrasonic osteotome in cervical anterior vertebral subtotal resection. METHODS Retrospective clinical data were collated for 81 patients with cervical spondylotic myelopathy who required cervical anterior vertebral subtotal resection. RESULTS Group A (n=40) was treated with an ultrasonic osteotome and group B (n=41) with a high-speed burr. Vertebrectomy time, intraoperative blood loss, surgical complications, Japanese Orthopedic Association (JOA) scores and JOA score improvement were compared. Group A showed significantly shorter vertebrectomy time and significantly less intraoperative blood loss (P<0.05). In group A, dysphagia occurred in one patient, and superior laryngeal nerve injury in one. Urinary tract infection occurred in one patient in group B. JOA score in both groups significantly increased 3 days after surgery (P<0.05), and at last follow-up compared with 3 days after surgery (P<0.05). CONCLUSION Ultrasonic osteotome was a safe and effective tool for subtotal anterior cervical vertebral resection.
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Affiliation(s)
- X Liu
- Department of orthopedics, Peking University International Hospital, 102206 Beijing, China
| | - B-T Wen
- Department of orthopedics, Peking University International Hospital, 102206 Beijing, China.
| | - Z-Q Chen
- Department of orthopedics, Peking University International Hospital, 102206 Beijing, China
| | - L Tan
- Department of orthopedics, Peking University International Hospital, 102206 Beijing, China
| | - J Zhong
- Department of orthopedics, Peking University International Hospital, 102206 Beijing, China
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Minimal Invasive Piezoelectric Osteotomy in Neurosurgery: Technic, Applications, and Clinical Outcomes of a Retrospective Case Series. Vet Sci 2020; 7:vetsci7020068. [PMID: 32456065 PMCID: PMC7357104 DOI: 10.3390/vetsci7020068] [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: 04/07/2020] [Revised: 05/18/2020] [Accepted: 05/20/2020] [Indexed: 12/16/2022] Open
Abstract
Objective: To report the physical and technical principles, clinical applications, and outcomes of the minimal invasive piezoelectric osteotomy in a consecutive veterinary neurosurgical series. METHODS A series of 292 dogs and 32 cats underwent an osteotomy because a neurosurgical pathology performed with a Mectron Piezosurgery® bone scalpel (Mectron Medical Technology, Genoa, Italy) was retrospectively reviewed. Efficacy, precision, safety, and blood loss were evaluated intraoperatively by two different surgeons, on a case-by-case basis. Postoperative Rx and CT scans were used to assess the selectivity and precision of the osteotomy. A histological study on bony specimens at the osteotomized surface was carried out to evaluate the effects of piezoelectric cutting on the osteocytes and osteoblasts. All the patients underwent a six-months follow-up. A series of illustrative cases was reported. RESULTS All the osteotomies were clear-cut and precise. A complete sparing of soft and nervous tissues and vasculature was observed. The operative field was blood- and heat-free in all cases. A range of inserts, largely different in shape and length, were allowed to treat deep and difficult-to-reach sites. Two mechanical complications occurred. Average blood loss in dogs' group was 52, 47, and 56 mL for traumatic, degenerative, and neoplastic lesions, respectively, whereas it was 25 mL for traumatized cats. A fast recovery of functions was observed in most of the treated cases, early on, at the first sixth-month evaluation. Histology on bone flaps showed the presence of live osteocytes and osteoblasts at the osteotomized surface in 92% of cases. CONCLUSIONS Piezosurgery is based on the physical principle of the indirect piezo effect. Piezoelectric osteotomy is selective, effective, and safe in bone cutting during neurosurgical veterinary procedures. It can be considered a minimal invasive technique, as it is able to spare the neighboring soft tissues and neurovascular structures.
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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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Application of Piezosurgery in En Bloc Laminectomy for the Treatment of Multilevel Thoracic Ossification of Ligamentum Flavum. World Neurosurg 2019; 126:541-546. [DOI: 10.1016/j.wneu.2019.03.200] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 03/18/2019] [Accepted: 03/19/2019] [Indexed: 11/23/2022]
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Wen BT, Chen ZQ, Sun CG, Jin KJ, Zhong J, Liu X, Tan L, Yang P, le G, Luo M. Three-dimensional navigation (O-arm) versus fluoroscopy in the treatment of thoracic spinal stenosis with ultrasonic bone curette: A retrospective comparative study. Medicine (Baltimore) 2019; 98:e15647. [PMID: 31096488 PMCID: PMC6531158 DOI: 10.1097/md.0000000000015647] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 04/15/2019] [Accepted: 04/17/2019] [Indexed: 11/27/2022] Open
Abstract
Three-dimensional intraoperative navigation (O-arm) has been used for many years in spinal surgeries and has significantly improved its precision and safety. This retrospective study compared the efficacy and safety of spinal cord decompression surgeries performed with O-arm navigation and fluoroscopy. The clinical data of 56 patients with thoracic spinal stenosis treated from March 2015 to April 2017 were retrospectively analyzed. Spinal decompression was performed with O-arm navigation and ultrasonic bone curette in 29 patients, and with ultrasonic bone curette and fluoroscopy in 27 patients. Patients were followed-up at postoperative 1 month, 3 months, and the last clinic visit. The neurologic functions were assessed using the Japanese Orthopaedic Association (JOA) Back Pain Evaluation Questionnaire. The accuracy of screw placement was examined using three-dimensional computed tomography (CT) on postoperative day 5. There was no significant difference in the incidences of intraoperative dural tear, nerve root injury, and spinal cord injury between the two groups. The two groups showed no significant difference in postoperative JOA scores (P > .05). The O-arm navigation group had significantly higher screw placement accuracy than the fluoroscopy group (P < .05). O-arm navigation is superior to fluoroscopy in the treatment of thoracic spinal stenosis with ultrasonic bone curette in terms of screw placement accuracy. However, the two surgical modes have similar rates of intraoperative complications and postoperative neurologic functions.
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Affiliation(s)
- Bing-Tao Wen
- Department of Orthopedics, Peking University International Hospital
| | - Zhong-Qiang Chen
- Department of Orthopedics, Peking University International Hospital
| | - Chui-Guo Sun
- Department of Orthopedics, Peking University Third Hospital, Beijing
| | - Kai-Ji Jin
- Department of Orthopedics, Peking University International Hospital
| | - Jun Zhong
- Department of Orthopedics, Peking University International Hospital
| | - Xin Liu
- Department of Orthopedics, Peking University International Hospital
| | - Lei Tan
- Department of Orthopedics, Peking University International Hospital
| | - Peng Yang
- Department of Orthopedics, Peking University International Hospital
| | - Geri le
- Department of Orthopedics, Peking University International Hospital
| | - Man Luo
- Department of Orthopedics, Guangxi International Zhuang Medicine Hospital, Nanning, Guangxi, China
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Zhuo H, Zhou Y, Chai X, Chang Q, Rao G. [The application of ultrasonic bone curette in laminoplasty of spinal canal after resection of intraspinal tumors]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2019; 33:61-65. [PMID: 30644262 DOI: 10.7507/1002-1892.201807086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To explore the practicability and safety of ultrasonic bone curette in the laminoplasty of spinal canal after resection of intraspinal tumors. Methods The clinical data of 17 patients with thoracolumbar intraspinal tumors treated with ultrasonic bone curette after resection of intraspinal tumors between December 2015 and April 2017 were retrospectively analyzed. All patients were male, aged 42-73 years with an average of 57.4 years. The disease duration was 2-47 months with an average of 21.1 months. Among them, there were 4 cases of thoracic intrathoracic tumors (T 10 in 1, T 12 in 3) and 13 cases of lumbar intrathoracic tumors (L 1 in 5, L 2 in 4, L 3 in 2, and L 4 in 2). Postoperative pathological diagnosis showed that 8 cases were schwannoma, 4 cases were meningioma, 2 cases were neurofibroma, 2 cases were dermoid cyst, and 1 case was ependymoma. Spinal nerve function was evaluated preoperatively according to Frankel classification criteria, with 2 cases of grade B, 7 cases of grade C, and 8 cases of grade D. During the operation, the time of single segmental vertebral canal posterior wall incision, the overall operation time, intraoperative blood loss, intraoperative dural injury, and cerebrospinal fluid leakage, spinal cord and nerve root injury were recorded. At 3-6 months after operation, the tumor and bone healing were observed according to MRI and CT three-dimensional reconstruction, and the spinal nerve function was evaluated by Frankel classification. Results The time of ultrasonic osteotomy for the posterior wall of a single segmental vertebral canal was 3.4-5.7 minutes, with an average of 4.1 minutes. The overall operation time was 135-182 minutes, with an average of 157.3 minutes. The intraoperative blood loss was 300-500 mL, with an average of 342.6 mL. There was no accidental dural injury, and cerebrospinal fluid leakage, nerve root injury, or spinal cord injury. The incision healed by first intention after operation. All the 17 patients were followed up 9-18 months, with an average of 12.7 months. MRI examination showed no tumor recurrence, and CT three-dimensional reconstruction showed good bone healing in all patients. During the follow-up, there was no loosening or rupture of the internal fixator and there was no re-compression of the spinal cord. At last follow-up, according to Frankel classification, there were 1 case as grade B, 5 cases as grade C, 7 cases as grade D, and 4 cases as grade E. Conclusion The application of ultrasonic bone curette in laminoplasty of spinal canal after resection of intraspinal tumors can preserve the integrity of the bone ligament structure of posterior column, maintain the volume of vertebral canal, and has high safety, practicability, and good postoperative effectiveness.
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Affiliation(s)
- Hanjie Zhuo
- Department of Spine Surgery, Luoyang Orthopedic Hospital of Henan Province (Henan Orthopedic Hospital), Henan Luoyang, 471002, P.R.China
| | - Yingjie Zhou
- Department of Spine Surgery, Luoyang Orthopedic Hospital of Henan Province (Henan Orthopedic Hospital), Henan Luoyang, 471002,
| | - Xubin Chai
- Department of Spine Surgery, Luoyang Orthopedic Hospital of Henan Province (Henan Orthopedic Hospital), Henan Luoyang, 471002, P.R.China
| | - Qing Chang
- Department of Spine Surgery, Luoyang Orthopedic Hospital of Henan Province (Henan Orthopedic Hospital), Henan Luoyang, 471002, P.R.China
| | - Guangzhong Rao
- Department of Spine Surgery, Luoyang Orthopedic Hospital of Henan Province (Henan Orthopedic Hospital), Henan Luoyang, 471002, P.R.China
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Zhu J, Hao D, Guo Y, Zhang X, Gao W, Wang X. [Safety and effectiveness of ultrasonic osteotome in posterior cervical laminectomy decompression and fusion]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2018; 32:1554-1559. [PMID: 30569683 DOI: 10.7507/1002-1892.201804012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To explore the safety of ultrasonic osteotome used in posterior cervical laminectomy decompression surgery and its effect on surgical outcome. Methods A clinical data of 52 patients with ossification of posterior longitudinal ligament of cervical spine (C-OPLL) undergoing posterior cervical laminectomy decompression and fusion (PCLDF) between April 2013 and April 2017 was retrospectively analysed. The patients were divided into two groups according to whether using the ultrasonic osteotome during operation: group A (20 cases, ultrasonic osteotome group) and group B (32 cases, traditional gun-clamp decompression group). There was no significant difference in gender, age, body weight, height, preoperative hemoglobin, and Japanese Orthopedic Association (JOA) score between the two groups ( P>0.05). The operation time, intraoperative blood loss, postoperative drainage volume, hospitalization time, complications, hemoglobin at 1 day after operation, and JOA score at 6 months after operation were recorded and compared between the two groups, and the improvement rate of JOA was calculated. Results The operation time and intraoperative blood loss in group A were significantly less than those in group B ( P<0.05); there was no significant difference in the drainage volume and hospitalization time between the two groups ( P>0.05). The hemoglobin of group B was slightly higher than that of group A at 1 day after operation, but there was no significant difference between the two groups ( t=-1.260, P=0.214). All the patients were followed up 6-10 months (mean, 7.6 months). No serious complications such as C 5 nerve paralysis, dural tear, infection, epidural hematoma, deep venous thrombosis, pulmonary embolism, transfusion allergy, or shock occurred during and after operation. The JOA scores of the two groups were significant improved at 6 months after operation when compared with preoperative scores ( P<0.05), and there was no significant difference in JOA score and improvement rate between the two groups at 6 months after operation ( P>0.05). Conclusion Compared with the traditional gun-clamp decompression, the effectiveness of PCLDF in treatment of C-OPLL by using ultrasonic osteotome is comparable, but the latter can effectively reduce the operation time and blood loss.
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Affiliation(s)
- Jinwen Zhu
- Department of Spinal Surgery, Xi'an Honghui Hospital Affiliated to Xi'an Jiaotong University Medical College, Xi'an Shaanxi, 710054, P.R.China
| | - Dingjun Hao
- Department of Spinal Surgery, Xi'an Honghui Hospital Affiliated to Xi'an Jiaotong University Medical College, Xi'an Shaanxi, 710054, P.R.China
| | - Yunshan Guo
- Department of Spinal Surgery, Xi'an Honghui Hospital Affiliated to Xi'an Jiaotong University Medical College, Xi'an Shaanxi, 710054, P.R.China
| | - Xinliang Zhang
- Department of Spinal Surgery, Xi'an Honghui Hospital Affiliated to Xi'an Jiaotong University Medical College, Xi'an Shaanxi, 710054, P.R.China
| | - Wenjie Gao
- Department of Spinal Surgery, Xi'an Honghui Hospital Affiliated to Xi'an Jiaotong University Medical College, Xi'an Shaanxi, 710054, P.R.China
| | - Xiaodong Wang
- Department of Spinal Surgery, Xi'an Honghui Hospital Affiliated to Xi'an Jiaotong University Medical College, Xi'an Shaanxi, 710054,
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Franzini A, Legnani F, Beretta E, Prada F, DiMeco F, Visintini S, Franzini A. Piezoelectric Surgery for Dorsal Spine. World Neurosurg 2018. [DOI: 10.1016/j.wneu.2018.03.026] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Grauvogel J, Masalha W, Heiland DH, Jarc N, Grauvogel TD, Scheiwe C. Piezosurgery—A Safe Technique to Perform Lateral Suboccipital Craniotomy? Oper Neurosurg (Hagerstown) 2017; 15:664-671. [DOI: 10.1093/ons/opx272] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 11/24/2017] [Indexed: 11/13/2022] Open
Abstract
Abstract
BACKGROUND
Piezosurgery (PS) is a relatively new technique based on microvibrations generated by the piezoelectric effect. It selectively cuts bone tissue and preserves the surrounding soft tissue.
OBJECTIVE
To evaluate the use of PS for performing lateral suboccipital craniotomy.
METHODS
PS was used to perform a lateral suboccipital craniotomy in 22 patients who underwent surgery for different cerebellopontine angle (CPA) pathologies in the neurosurgical department. The applicability of PS for lateral suboccipital craniotomy was evaluated with respect to safety, preciseness of bone cutting, and in particular the preservation of the adjacent dura and sigmoid and transverse sinuses.
RESULTS
Lateral suboccipital craniotomy in 22 patients who underwent surgery for different CPA pathologies (13 vestibular schwannoma, 5 petrous bone meningioma, 1 petroclival meningioma, 2 epidermoid cysts, and 1 petrous bone cholesterol granuloma) was performed with PS without any complications. A burr hole was set before piezosurgical craniotomy in 6 patients, with no prior burr hole in 16 patients. Incidental durotomy during piezosurgical craniotomy occurred in 6 patients, and small lacerations of the sigmoid sinus caused by the piezosurgical device were observed in 3 patients.
CONCLUSION
Although PS is a safe and selective bone cutting technique that preserves the surrounding soft tissue, it can still lead to unintended dural tears during lateral suboccipital craniotomy. This must be kept in mind when using PS for craniotomies and relying on the selective bone cutting properties of PS.
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Affiliation(s)
- Juergen Grauvogel
- Department of Neurosurgery, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Waseem Masalha
- Department of Neurosurgery, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Dieter Henrik Heiland
- Department of Neurosurgery, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Nadja Jarc
- Department of Neurosurgery, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Tanja Daniela Grauvogel
- Department of Otorhinolaryngology—Head and Neck Surgery, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Christian Scheiwe
- Department of Neurosurgery, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
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Grauvogel J, Scheiwe C, Masalha W, Jarc N, Grauvogel T, Beringer A. Piezosurgery in Modified Pterional Orbital Decompression Surgery in Graves Disease. World Neurosurg 2017; 106:422-429. [DOI: 10.1016/j.wneu.2017.06.180] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 06/28/2017] [Indexed: 12/21/2022]
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Inferior Alveolar Nerve Mobilization Using Ultrasonic Surgery With Crestal Approach Technique, Followed by Immediate Implant Insertion: Evaluation of Neurosensory Disturbance. J Craniofac Surg 2017; 27:1209-11. [PMID: 27380570 DOI: 10.1097/scs.0000000000002755] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Many techniques are described for atrophied mandibles rehabilitation. This article reports on 12 clinical patients of severely atrophied posterior mandibles. In all the patients, a cone beam is performed before the crestal surgical approach to inferior alveolar nerve (IAN) mobilization. For the realization of this technique the piezosurgery device was used to minimize IAN injuries. With the help of this device the selective cutting of the bone has been possible until IAN exposure, in the implant placement site. At the same time, the authors performed the implant osteotomy and implant placement. After 4 months of healing, all implants were osseointegrated and the implant-supported bridges were done.Evaluation by means of neurosurgery function test over a 36-months period found that all patients had a return to normal sensation, after a brief period of neurosensory disturbance.
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Lei T, Wang H, Tong T, Ma Q, Wang L, Shen Y. Enlarged anterior cervical diskectomy and fusion in the treatment of severe localised ossification of the posterior longitudinal ligament. J Orthop Surg Res 2016; 11:129. [PMID: 27809858 PMCID: PMC5096318 DOI: 10.1186/s13018-016-0449-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2016] [Accepted: 09/21/2016] [Indexed: 11/21/2022] Open
Abstract
Background Severe localised ossification of the posterior longitudinal ligament (OPLL) should be directly removed by anterior approach, but the exposure during anterior cervical diskectomy and fusion (ACDF) is restricted and may increase the risk of a cerebrospinal fluid (CSF) leak. Corpectomy is facilitated to extirpate the ossification, but it is relatively more invasive. The purpose of this study was to investigate the feasibility and clinical outcome of enlarged ACDF in treating severe localised OPLL. Methods Twenty-four selective patients with severe localised OPLL who underwent enlarged ACDF from January 2011 to July 2013 were retrospectively investigated. The Japanese Orthopaedic Association (JOA) scales, visual analogue scale (VAS), occupying rate (OR), fused segment height (FSH), sagittal segmental alignment (SSA), range of motion (ROM), and complications were investigated. Results After a mean 34.9-month follow-up, the mean JOA score increased from 9.5 ± 1.4 preoperatively to 14.1 ± 1.5 at the final follow-up (p < 0.05), while OR decreased from 58.9 ± 6.1 % pre- to 10.6 ± 5.5 % postoperatively (p < 0.05). The average VAS was 6.1 ± 1.8 preoperatively and 2.1 ± 1.4 at the final follow-up (p < 0.05). The SSA angles at the final follow-up increased 2.2° compared to the preoperative values (p < 0.05). The mean FSH increased 2.4 mm from pre- to postoperatively, but decreased 2.7 mm from postoperatively to final follow-up. The cervical ROM was not obviously reduced at the final follow-up (p > 0.05) because only one level was fixed. There were three cases of cerebrospinal fluid leakage, one case of haematoma, and one case showed transient neurological deterioration. Conclusions Enlarged ACDF is an effective procedure for treating selective patients with severe localised OPLL. Using this technique, the retrovertebral OPLL can be removed through a one-level diskectomy and a corpectomy can be avoided. Trial registration This study has been registered with the ResearchRegistry and the unique identifying number is researchregistry1365 (K2015-022-04). It was retrospectively registered at 21 June 2016 and the first participant to the trial was at 4 January 2011. Electronic supplementary material The online version of this article (doi:10.1186/s13018-016-0449-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Tao Lei
- Department of Spine Surgery, The Third Hospital of Hebei Medical University, The Key Laboratory of Orthopedic Biomechanics of Hebei Province, 139 Ziqiang Street, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Hui Wang
- Department of Spine Surgery, The Third Hospital of Hebei Medical University, The Key Laboratory of Orthopedic Biomechanics of Hebei Province, 139 Ziqiang Street, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Tong Tong
- Department of Spine Surgery, The Third Hospital of Hebei Medical University, The Key Laboratory of Orthopedic Biomechanics of Hebei Province, 139 Ziqiang Street, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Qinghua Ma
- Department of Spine Surgery, The Third Hospital of Hebei Medical University, The Key Laboratory of Orthopedic Biomechanics of Hebei Province, 139 Ziqiang Street, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Linfeng Wang
- Department of Spine Surgery, The Third Hospital of Hebei Medical University, The Key Laboratory of Orthopedic Biomechanics of Hebei Province, 139 Ziqiang Street, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Yong Shen
- Department of Spine Surgery, The Third Hospital of Hebei Medical University, The Key Laboratory of Orthopedic Biomechanics of Hebei Province, 139 Ziqiang Street, Shijiazhuang, 050051, Hebei, People's Republic of China.
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Li K, Zhang W, Li B, Xu H, Li Z, Luo D, Zhang J, Ma J. Safety and efficacy of cervical laminoplasty using a piezosurgery device compared with a high-speed drill. Medicine (Baltimore) 2016; 95:e4913. [PMID: 27631268 PMCID: PMC5402611 DOI: 10.1097/md.0000000000004913] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Piezosurgery is a relatively new osteotomy technique using microvibrations of scalpels at ultrasonic frequencies to perform safe and effective osteotomies without damage to adjacent soft tissue, which is widely used in spinal, oral, and maxillofacial surgery. We hypothesized that such a device could also be useful in cervical laminoplasty. The purpose of this study was to compare the safety and efficacy of a piezosurgery device with those of a highspeed drill in cervical laminoplasty. METHODS A prospectively randomized clinical study was designed. Forty-two consecutive patients were enrolled in the study. All patients underwent modified expansive open-door laminoplasty and were randomly divided into 2 groups according to the instrument for transection of the lamina, using high-speed drill (drill group) or piezosurgery device (piezosurgery group). The operation time, intraoperative blood loss, and postoperative drainage were recorded. Japanese Orthopedic Association (JOA) score and visual analogue scale (VAS) as clinical assessments were quantified. RESULTS No significant difference was observed in the operation time between the 2 groups. In the piezosurgery group, there were less loss of the intraoperative blood and postoperative drainage compared with the drill group. However, clinical results (VAS and JOA scores) showed no significant difference between both groups during the all follow-up periods. CONCLUSION The piezosurgery is a useful instrument and at least as safe and efficacious as the conventional high-speed drill in cervical laminoplasty.
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Affiliation(s)
| | - Wen Zhang
- Department of Ultrasonography, Liaocheng People's Hospital, Liaocheng
| | - Bin Li
- Department of Orthopedics, Dongping People's Hospital, Tai’an, Shandong, China
| | - Hui Xu
- Department of Orthopedics
| | | | | | | | - Jinzhu Ma
- Department of Orthopedics
- Correspondence: Jinzhu Ma, Department of Orthopedics, Liaocheng People's Hospital, Liaocheng, 252000 Shandong, China (e-mail: )
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Li Z, Yang D, Hao W, Wu T, Wu S, Li X. A novel technique for micro-hole forming on skull with the assistance of ultrasonic vibration. J Mech Behav Biomed Mater 2015; 57:1-13. [PMID: 26698192 DOI: 10.1016/j.jmbbm.2015.11.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Revised: 11/12/2015] [Accepted: 11/21/2015] [Indexed: 11/27/2022]
Abstract
Micro-hole opening on skull is technically challenging and is hard to realize by micro-drilling. Low-stiffness of the drill bit is a serious drawback in micro-drilling. To deal with this problem, a novel ultrasonic vibration assisted micro-hole forming technique has been developed. Tip geometry and vibration amplitude are two key factors affecting the performance of this hole forming technique. To investigate their effects, experiment was carried out with 300μm diameter tools of three different tip geometries at three different vibration amplitudes. Hole forming performance was evaluated by the required thrust force, dimensional accuracy, exit burr and micro-structure of bone tissue around the generated hole. Based on the findings from current study, the 60° conically tipped tool helps generate a micro-hole of better quality at a smaller thrust force, and it is more suitable for hole forming than the 120° conically tipped tool and the blunt tipped tool. As for the vibration amplitude, when a larger amplitude is used, a micro-hole of better quality and higher dimensional accuracy can be formed at a smaller thrust force. Findings from this study would lay a technical foundation for accurately generating a high-quality micro-hole on skull, which enables minimally invasive insertion of a microelectrode into brain for neural activity measuring.
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Affiliation(s)
- Zhe Li
- Department of Mechanical Engineering, National University of Singapore, 117576, Singapore
| | - Daoguo Yang
- School of Mechanical and Electrical Engineering, Guilin University of Electronic Technology, Guilin 541004, China.
| | - Weidong Hao
- School of Mechanical and Electrical Engineering, Guilin University of Electronic Technology, Guilin 541004, China
| | - Tiecheng Wu
- Department of Mechanical Engineering, National University of Singapore, 117576, Singapore
| | - Song Wu
- School of Mechanical and Electrical Engineering, Guilin University of Electronic Technology, Guilin 541004, China
| | - Xiaoping Li
- Department of Mechanical Engineering, National University of Singapore, 117576, Singapore.
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