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Shimizu S, Koizumi H, Shibahara I, Kumabe T. Excessive Heat Generation by Power-Driven Craniotomy Tools: A Possible Cause of Autologous Bone Flap Resorption Observed in an Ex Vivo Simulation. World Neurosurg 2024; 187:e914-e919. [PMID: 38734170 DOI: 10.1016/j.wneu.2024.05.010] [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] [Received: 04/05/2024] [Revised: 05/01/2024] [Accepted: 05/02/2024] [Indexed: 05/13/2024]
Abstract
BACKGROUND Bone flap resorption is an issue after autologous cranioplasty. Critical temperatures above 50°C generated by power-driven craniotomy tools may lead to thermal osteonecrosis, a possible factor in resorption. This ex vivo study examined whether the tools produced excessive heat resulting in bone flap resorption. METHODS Using swine scapulae maintained at body temperature, burr holes, straight and curved cuts, and wire-pass holes were made with power-driven craniotomy tools. Drilling was at the conventional feed rate (FR) plus irrigation (FR-I+), at a high FR plus irrigation (hFR-I+), and at high FR without irrigation (hFR-I-). The temperature in each trial was recorded by an infrared thermographic camera. RESULTS With FR-I+, the maximum temperature at the burr holes, the cuts, and the wire-pass holes was 69.0°C, 56.7°C, and 46.2°C, respectively. With hFR-I+, these temperatures were 53.1°C, 52.1°C, and 46.0°C, with hFR-I- they were 56.0°C, 66.5°C, and 50.0°C; hFR-I- burr hole- and cutting procedures resulted in the highest incidence of bone temperatures above 50°C followed by FR-I+, and hFR-I+. At the site of wire-pass holes, only hFR-I- drilling produced this temperature. CONCLUSIONS Except during prolonged procedures in thick bones, most drilling with irrigation did not reach the critical temperature. Drilling without irrigation risked generating the critical temperature. Knowing those characteristics may be a help to perform craniotomy with less thermal bone damage.
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Affiliation(s)
- Satoru Shimizu
- Department of Neurosurgery, NHO Sagamihara National Hospital, Sagamihara, Kanagawa, Japan.
| | - Hiroyuki Koizumi
- Department of Neurosurgery, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Ichiyo Shibahara
- Department of Neurosurgery, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Toshihiro Kumabe
- Department of Neurosurgery, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
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Rowland AN, Raji OR, Nelles DB, Jang ES, Kondrashov DG. Thermal Damage in Orthopaedics. J Am Acad Orthop Surg 2024; 32:e368-e377. [PMID: 38335498 DOI: 10.5435/jaaos-d-23-00838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 01/11/2024] [Indexed: 02/12/2024] Open
Abstract
There are numerous potential sources of thermal damage encountered in orthopaedic surgery. An understanding of the preclinical mechanisms of thermal damage in tissues is necessary to minimize iatrogenic injuries and use these mechanisms therapeutically. Heat generation is a phenomenon that can be used to a surgeon's benefit, most commonly for hemostasis and local control of tumors. It is simultaneously one of the most dangerous by-products of orthopaedic techniques as a result of burring, drilling, cementation, and electrocautery and can severely damage tissues if used improperly. Similarly, cooling can be used to a surgeon's advantage in some orthopaedic subspecialties, but the potential for harm to tissues is also great. Understanding the potential of a given technique to rapidly alter local temperature-and the range of temperatures tolerated by a given tissue-is imperative to harness the power of heat and cold. In all subspecialties of orthopaedic surgery, thermal damage is a relevant topic that represents a direct connection between preclinical and clinical practice.
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Affiliation(s)
- Andrea N Rowland
- From the Department of Orthopaedic Surgery, San Francisco Orthopaedic Residency Program (Rowland, and Kondrashov), the Biomechanical Lab, The Taylor Collaboration (Raji), the Department of Orthopaedic Surgery, St. Mary's Medical Center, San Francisco, CA (Nelles, and Kondrashov), and the Department of Orthopaedic Surgery, Kaiser Permanente, Oakland, CA (Jang)
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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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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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Dongaonkar KR, Aoki K, Zwueste D, Bates M. Effect of irrigation technique on the vertebral canal temperature during thoracolumbar hemilaminectomy in dogs: An ex vivo study. Vet Surg 2021; 50:1276-1282. [PMID: 33959971 DOI: 10.1111/vsu.13654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 04/15/2021] [Accepted: 04/26/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To determine the influence of continuous and intermittent bolus irrigation on vertebral canal temperature during thoracolumbar hemilaminectomy. STUDY DESIGN Ex vivo study. SAMPLE POPULATION Ten canine cadavers. METHODS Six consecutive thoracolumbar hemilaminectomies starting at T12-13 with alternating left- or right-side selection, and alternating continuous or intermittent bolus irrigation were performed in each dog resulting in 30 hemilaminectomies per irrigation technique. Drilling was performed for 15 s followed by a 10-s pause and resumed until completion of hemilaminectomy. Continuous irrigation consisted of saline delivered at 15 ml/min during drilling. Bolus irrigation consisted of manual delivery of 10 ml saline during the pause. Temperatures were recorded with two sensors placed within the vertebral canal adjacent to target hemilaminectomy site and compared between techniques with a linear mixed model. RESULTS Intermittent bolus irrigation was associated with lower peak vertebral canal temperatures (mean 15.7°C; range 9.4-23.3°C) than continuous irrigation (mean 16.7°C; range 9.6-27.6°C, p = .003) (mean difference of 1.1°C, p = .006). Similarly, mean vertebral canal temperatures remained lower when hemilaminectomies were performed under intermittent rather than continuous irrigation (mean difference of 0.48°C, p = .006, linear mixed model). CONCLUSION Lower vertebral canal temperatures were maintained during hemilaminectomy with intermittent bolus rather than continuous irrigation. CLINICAL SIGNIFICANCE Both intermittent bolus and continuous irrigation are suitable to prevent elevations in canine vertebral canal temperature during hemilaminectomy.
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Affiliation(s)
- Kaustubh R Dongaonkar
- Department of Small Animal Clinical Sciences, Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Koji Aoki
- Department of Small Animal Clinical Sciences, Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Danielle Zwueste
- VCA Vancouver Animal Emergency and Referral Centre, Vancouver, British Columbia, Canada
| | - Miriam Bates
- Department of Small Animal Clinical Sciences, Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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Hu Y, Ding H, Shi Y, Zhang H, Zheng Q. A predictive model for cortical bone temperature distribution during drilling. Phys Eng Sci Med 2021; 44:147-156. [PMID: 33459995 DOI: 10.1007/s13246-020-00962-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 12/15/2020] [Indexed: 02/06/2023]
Abstract
Bone drilling is an important procedure in medical orthopedic surgery and it is inevitable that heat will be generated during the drilling process and higher temperatures can cause thermal damage to the bone tissue near the drilled hole. Therefore, the capability to obtain the cortical bone drilling temperature distribution area can have great significance for medical bone surgery. Based on the theory of heat transfer, a predictive model for cortical bone drilling temperature distribution was established. The energy distribution coefficient in cortical bone drilling was derived, based on conjugate gradient inversion. A cortical bone drilling experiment platform was built to verify the temperature distribution prediction model. The results show that the model of cortical bone drill temperature distribution could predict accurately the drilling temperature distribution, both for different depths and for different radial distances. Additionally, the effects of different drilling conditions (spindle speed, feed rate, drill diameter) on the temperature of drilling cortical bone were considered.
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Affiliation(s)
- Yahui Hu
- Tianjin Key Laboratory for Advanced Mechatronic System Design and Intelligent Control, School of Mechanical Engineering, National Demonstration Center for Experimental Mechanical and Electrical Engineering Education (Tianjin University of Technology), Tianjin, 300384, China
| | - Hao Ding
- Tianjin Key Laboratory for Advanced Mechatronic System Design and Intelligent Control, School of Mechanical Engineering, National Demonstration Center for Experimental Mechanical and Electrical Engineering Education (Tianjin University of Technology), Tianjin, 300384, China
| | - Yutao Shi
- Tianjin Key Laboratory for Advanced Mechatronic System Design and Intelligent Control, School of Mechanical Engineering, National Demonstration Center for Experimental Mechanical and Electrical Engineering Education (Tianjin University of Technology), Tianjin, 300384, China
| | - Huaiyu Zhang
- Tianjin Key Laboratory for Advanced Mechatronic System Design and Intelligent Control, School of Mechanical Engineering, National Demonstration Center for Experimental Mechanical and Electrical Engineering Education (Tianjin University of Technology), Tianjin, 300384, China
| | - Qingchun Zheng
- Tianjin Key Laboratory for Advanced Mechatronic System Design and Intelligent Control, School of Mechanical Engineering, National Demonstration Center for Experimental Mechanical and Electrical Engineering Education (Tianjin University of Technology), Tianjin, 300384, China.
- Tianjin Key Laboratory for Advanced Mechatronic System Design and Intelligent Control, Tianjin University of Technology, Tianjin, 300384, China.
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Nikouei F, Nabizadeh N, Mirzamohammadi E, Ameri M, Sabbaghan S, Givehchian B, Safdari F. Application of Oscillating Saw for Lumbar en Bloc Laminectomy: A Case Series. THE ARCHIVES OF BONE AND JOINT SURGERY 2020; 8:407-412. [PMID: 32766400 DOI: 10.22038/abjs.2019.14126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background An oscillating bone saw is rarely used to perform laminectomy. The purpose of this study was to describe a relatively quick and harmless technique for multilevel laminectomy in patients with lumbar spinal stenosis (LSS) using an oscillating bone saw to find out how this instrument affects the time of surgery and rate of complications. Methods This prospective study was conducted on 45 patients with LSS who required multilevel laminectomy. The bones were cut using an oscillating sagittal saw equipped with a fine 1-cm blade. Posterolateral fusion was performed if any evidence of spinal instability occurred, or the correction of deformity was addressed. The time spent for laminectomy from initial cutting to the whole bone removal (T1) and the duration of laminectomy (i.e., from initiation to the end of decompression; T2) were recorded for the corresponding level. The volume of harvested autograft was also measured, and any dural injuries were reported. Results Posterolateral fusion was performed on 32 (71.1%) patients. The mean T1 and T2 per level were estimated at 70.5±5.4 and 157.5±12.1 sec, respectively. In addition, the mean volume of harvested autograft per level was obtained as 3.5±1.2 cc. No durotomy was observed during laminectomy using an oscillating bone saw. However, a dural tear occurred in one patient when a Kerisson punch was utilized for ligamentum flavum removal and foraminotomy. Conclusion Based on the findings, it can be concluded that laminectomy by means of the oscillating bone saw is a safe procedure that provides a sufficient volume of harvested autograft for fusion. This technique could also induce a remarkable reduction in the time of surgery.
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Affiliation(s)
- Farshad Nikouei
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Naveed Nabizadeh
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
| | | | - Maryam Ameri
- Department of Forensic Medicine and Toxicology, Iran University of Medical Sciences, Tehran, Iran
| | - Saeed Sabbaghan
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Behrooz Givehchian
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Farshad Safdari
- Bone and Joint Related Tissue Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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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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A Surgical Approach to Orbitotomy Using the Bone Scalpel: A Case Report. J Neuroophthalmol 2020; 40:e62-e64. [PMID: 32282509 DOI: 10.1097/wno.0000000000000952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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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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Effects of Combined Use of Ultrasonic Bone Scalpel and Hemostatic Matrix on Perioperative Blood Loss and Surgical Duration in Degenerative Thoracolumbar Spine Surgery. BIOMED RESEARCH INTERNATIONAL 2019; 2019:6286258. [PMID: 31236410 PMCID: PMC6545750 DOI: 10.1155/2019/6286258] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 04/28/2019] [Indexed: 02/07/2023]
Abstract
How to decrease intraoperative bleeding, shorten surgical time, and increase safety in spinal surgery is an important issue. Ultrasonic bone removers and FloSeal have been proven to increase safety, reduce the surgical duration, and decrease intraoperative bleeding in skull base surgery. Therefore, we aimed to compare the surgical duration, blood loss, and complications during spinal surgery with or without the use of FloSeal and an ultrasonic bone scalpel. Therefore, we retrospectively reviewed 293 patients who underwent thoracolumbar spinal surgery with decompression and instrumented fusion performed by a single surgeon. We divided these patients into three groups, including nonuse of FloSeal nor a bone scalpel (group A), use of FloSeal only (group B), and use of FloSeal and a bone scalpel (group C) intraoperatively after pairing in terms of age, sex, and surgical level. The surgical duration, blood loss, and occurrence of complications were all recorded. The mean surgical duration in group A was 160 mins, in group B it was 167 mins, and in group C it was 134 mins. The mean blood loss was 700 ml in group A, 682 ml in group B, and 383 ml in group C. Six patients sustained intraoperative dura injuries in total, 3 in group A, 2 in group B, and 1 in group C. No postoperative neurologic defects or occurrences of hematoma were recorded. According to our results, we concluded that combined use of FloSeal and bone scalpels is recommended during primary thoracolumbar spinal surgery to reduce the intraoperative blood loss and shorten the surgical duration.
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Towner JE, Piper KF, Schoeniger LO, Qureshi SH, Li YM. Use of image-guided bone scalpel for resection of spine tumors: technical note. AME Case Rep 2019; 2:48. [PMID: 30596203 DOI: 10.21037/acr.2018.11.02] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 11/23/2018] [Indexed: 11/06/2022]
Abstract
In the literature, the use of navigation for spine tumor surgery has largely centered on implant placement. We describe the cases of two patients with spinal tumors on whom we utilized our resection technique of registering an ultrasonic bone scalpel (UBS) to a navigation system. In both cases, we achieved a satisfactory tumor resection with negative margins and excellent neurologic outcomes. We feel that using the navigation-registered UBS is a valuable tool to increase the operator's ability to achieve desired resections while minimizing the neurologic deficits and operative morbidity associated with these challenging surgical cases.
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Affiliation(s)
- James E Towner
- Department of Neurosurgery, University of Rochester Medical Center, Rochester, NY, USA
| | - Keaton F Piper
- Department of Neurosurgery, University of Rochester Medical Center, Rochester, NY, USA
| | - Luke O Schoeniger
- Department of Surgical Oncology, University of Rochester Medical Center, Rochester, NY, USA
| | - Shahnawaz H Qureshi
- Department of Neurosurgery, University of Rochester Medical Center, Rochester, NY, USA
| | - Yan Michael Li
- Department of Neurosurgery, University of Rochester Medical Center, Rochester, NY, USA
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Ali Akhbar MF, Yusoff AR. Drilling of bone: Effect of drill bit geometries on thermal osteonecrosis risk regions. Proc Inst Mech Eng H 2018; 233:207-218. [PMID: 30572787 DOI: 10.1177/0954411918819113] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Bone-drilling operation necessitates an accurate and efficient surgical drill bit to minimize thermal damage to the bone. This article provides a methodology for predicting the bone temperature elevation during surgical bone drilling and to gain a better understanding on the influences of the point angle, helix angle and web thickness of the drill bit. The proposed approach utilized the normalized Cockroft-Latham damage criterion to predict material cracking in the drilling process. Drilling simulation software DEFORM-3D is used to approximate the bone temperature elevation corresponding to different drill bit geometries. To validate the simulation results, bone temperature elevations were evaluated by comparison with ex vivo bone-drilling process using bovine femurs. The computational results fit well with the ex vivo experiments with respect to different drill geometries. All the investigated drill bit geometries significantly affect bone temperature rise. It is discovered that the thermal osteonecrosis risk regions could be reduced with a point angle of 110° to 140°, a helix angle of 5° to 30° and a web thickness of 5% to 40%. The drilling simulation could accurately estimate the maximum bone temperature elevation for various surgical drill bit point angles, web thickness and helix angles. Looking into the future, this work will lead to the research and redesign of the optimum surgical drill bit to minimize thermal insult during bone-drilling surgeries.
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Affiliation(s)
| | - Ahmad Razlan Yusoff
- Faculty of Manufacturing Engineering, Universiti Malaysia Pahang, Pekan, Malaysia
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