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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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Rittipoldech CA, Limsomwong P, Thamrongskulsiri N. Ultrasonic Bone Scalpel versus Conventional Technique for Thoracolumbar Spinal Decompression: A Prospective Randomized Controlled Trial. Rev Bras Ortop 2023; 58:e706-e711. [PMID: 37908536 PMCID: PMC10615604 DOI: 10.1055/s-0043-1768627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 09/27/2022] [Indexed: 11/02/2023] Open
Abstract
Objective The purpose of the present study is to compare intraoperative blood loss, operating time, laminectomy time, hospital length of stay, and complications in thoracolumbar spinal decompression using ultrasonic bone scalpels (UBSs) with conventional procedures. Methods Forty-two patients who underwent decompressive laminectomy and pedicular screw fusion with a surgical level of 1-5 levels between February 1, 2020, and June 30, 2022, in a single institution were evaluated for eligibility, and 11 were excluded due to a history of spinal surgery ( n = 3), spinal tumor ( n = 3), and spinal infection ( n = 5). A total of 31 patients were randomly divided into the UBS group ( n =15) and the conventional group ( n =16). Intraoperative blood loss, operating time, laminectomy time, hospital length of stay, and complications were recorded. Results Intraoperative blood loss and laminectomy time were significantly lower in the UBS group (656.0 ± 167.6 ml, 54.5 ± 27.4 minutes, respectively) than in the conventional group (936.9 ± 413.2 ml, 73.4 ± 28.1 minutes, respectively). Overall operation time, hospital length of stay, and complications were all similar between the groups. Conclusion The UBS is a useful instrument for procedures performed near the dura mater or other neural tissue without excessive heat or mechanical injury. This device is recommended for various spinal surgeries in addition to high-speed burrs and Kerrison rongeurs.
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Bansal P, Kumar V, Vatkar AJ, Gaurav A, Dhatt SS. Ultrasonic Bone Scalpel versus Conventional Methods for Osteotomy in Posterior Surgery for Cervical Spondylotic Myelopathy: A Review and Meta-Analysis. Asian Spine J 2023; 17:964-974. [PMID: 37690990 PMCID: PMC10622811 DOI: 10.31616/asj.2022.0400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 12/07/2022] [Accepted: 12/22/2022] [Indexed: 09/12/2023] Open
Abstract
Posterior methods for cervical myelopathy include laminoplasty and laminectomy with/without fusion. A more recent innovation in these treatments is the use of an ultrasonic bone shaver for osteotomy. In this study, we examined the perioperative results after laminectomy/laminoplasty between conventional methods (rongeur/high-speed drill) vs. piezosurgery-based instruments. PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed and the search was performed on four databases (PubMed, Scopus, EMBASE, and Google Scholar). Seven comparative studies were chosen after thorough screening by the authors and a meta-analysis was performed between piezosurgery and conventional technique to ascertain intraoperative and postoperative results after laminectomy/laminoplasty. The analysis includes four retrospective cohort studies and three randomized controlled trials published between 2015 and 2022. The mean age ranged from 55.5 to 64.2 years. Blood loss was significantly reduced in the piezosurgery group, other findings were not significant. On subgroup analysis, laminoplasty dramatically reduced blood loss and the rate of iatrogenic dural rips in the piezosurgery group. The use of ultrasonic bone shaver for osteotomy in cervical spondylotic myelopathy is related to significantly decreased blood loss and no significant increase in postoperative drainage, operative time, complication rate, and functional outcomes as compared to traditional techniques. We noticed significantly reduced blood and rate of dural tears in the laminoplasty subgroup with the use of ultrasonic bone shaver, which was not mirrored in the laminectomy subgroup. Careful intraoperative handling of the instrument can help prevent iatrogenic dural tears and nerve damage.
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Affiliation(s)
- Parth Bansal
- Department of Orthopaedics, Postgraduate Institute of Medical Education and Research, Chandigarh,
India
| | - Vishal Kumar
- Department of Orthopaedics, All India Institute of Medical Sciences, Deoghar,
India
| | | | - Ankit Gaurav
- Department of Orthopaedics, Postgraduate Institute of Medical Education and Research, Chandigarh,
India
| | - Sarvdeep Singh Dhatt
- Department of Orthopaedics, Postgraduate Institute of Medical Education and Research, Chandigarh,
India
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徐 陈, 王 照, 刘 亚, 朱 仲, 段 克, 吴 敏, 官 建. [Study on application of ultrasonic bone curette in anterior cervical spine surgery]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2023; 37:996-1001. [PMID: 37586801 PMCID: PMC10435332 DOI: 10.7507/1002-1892.202302024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 06/25/2023] [Accepted: 06/26/2023] [Indexed: 08/18/2023]
Abstract
Objective To investigate the effect of ultrasonic bone curette in anterior cervical spine surgery. Methods A clinical data of 63 patients with cervical spondylosis who were admitted between September 2019 and June 2021 and met the selection criteria was retrospectively analyzed. Among them, 32 cases were operated with conventional instruments (group A) and 31 cases with ultrasonic bone curette (group B). There was no significant difference between the two groups (P>0.05) in gender, age, surgical procedure, surgical segment and number of occupied cervical space, disease type and duration, comorbidities, and preoperative Japanese Orthopaedic Association (JOA) score, cervical dysfunction index (NDI), and pain visual analogue scale (VAS) score. The operation time, intraoperative bleeding, postoperative drainage, postoperative hospital stay, and the occurrence of postoperative complications were recorded in both groups. Before operation and at 1, 3, and 6 months after operation, the JOA score and NDI were used to evaluate the function and the postoperative JOA improvement rate was calculated, and VAS score was used to evaluate the pain improvement. The anteroposterior and lateral cervical X-ray films were taken at 1, 3, and 6 months after operation to observe whether there was any significant loosening and displacement of internal fixators. Results Compared with group A, group B had shorter operation time and postoperative hospital stay, less intraoperative bleeding and postoperative drainage, and the differences were significant (P<0.05). All incisions healed by first intention in the two groups, and postoperative complications occurred in 5 cases (15.6%) in group A and 2 cases (6.5%) in group B, showing no significant difference (P>0.05). All patients were followed up 6-12 months (mean, 7.9 months). The JOA score and improvement rate gradually increased in groups A and B after operation, while the VAS score and NDI gradually decreased. There was no significant difference in VAS score between 3 months and 1 month in group B (P>0.05), and there were significant differences between the other time points of each indicator in the two groups (P<0.05). At 1, 3, and 6 months after operation, the JOA score and improvement rate in group B were better than those in group A (P<0.05). X-ray films examination showed that there was no screw loosening or titanium plate displacement in the two groups after operation, and the intervertebral cage or titanium mesh significantly sank. Conclusion Compared with traditional instruments, the use of ultrasonic bone curette assisted osteotomy in anterior cervical spine surgery has the advantages of shorter operation time, less intraoperative bleeding, less postoperative drainage, and shorter hospital stay.
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Affiliation(s)
- 陈 徐
- 蚌埠医学院第一附属医院骨科 组织移植安徽省重点实验室(安徽蚌埠 233000)Department of Orthopedics, Anhui Province Key Laboratory of Tissue Transplantation, the First Affiliated Hospital of Bengbu Medical College, Bengbu Anhui, 233000, P. R. China
| | - 照东 王
- 蚌埠医学院第一附属医院骨科 组织移植安徽省重点实验室(安徽蚌埠 233000)Department of Orthopedics, Anhui Province Key Laboratory of Tissue Transplantation, the First Affiliated Hospital of Bengbu Medical College, Bengbu Anhui, 233000, P. R. China
| | - 亚军 刘
- 蚌埠医学院第一附属医院骨科 组织移植安徽省重点实验室(安徽蚌埠 233000)Department of Orthopedics, Anhui Province Key Laboratory of Tissue Transplantation, the First Affiliated Hospital of Bengbu Medical College, Bengbu Anhui, 233000, P. R. China
| | - 仲廉 朱
- 蚌埠医学院第一附属医院骨科 组织移植安徽省重点实验室(安徽蚌埠 233000)Department of Orthopedics, Anhui Province Key Laboratory of Tissue Transplantation, the First Affiliated Hospital of Bengbu Medical College, Bengbu Anhui, 233000, P. R. China
| | - 克友 段
- 蚌埠医学院第一附属医院骨科 组织移植安徽省重点实验室(安徽蚌埠 233000)Department of Orthopedics, Anhui Province Key Laboratory of Tissue Transplantation, the First Affiliated Hospital of Bengbu Medical College, Bengbu Anhui, 233000, P. R. China
| | - 敏 吴
- 蚌埠医学院第一附属医院骨科 组织移植安徽省重点实验室(安徽蚌埠 233000)Department of Orthopedics, Anhui Province Key Laboratory of Tissue Transplantation, the First Affiliated Hospital of Bengbu Medical College, Bengbu Anhui, 233000, P. R. China
| | - 建中 官
- 蚌埠医学院第一附属医院骨科 组织移植安徽省重点实验室(安徽蚌埠 233000)Department of Orthopedics, Anhui Province Key Laboratory of Tissue Transplantation, the First Affiliated Hospital of Bengbu Medical College, Bengbu Anhui, 233000, P. R. China
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Li C, Li Z, Li L, Mei Y, Huang S. Angled Ultrasonic Bone Curette-Assisted Circumferential Decompression for Thoracic Myelopathy Caused by Severely Anterior Ossification. Orthop Surg 2022; 14:2369-2379. [PMID: 35980000 PMCID: PMC9483070 DOI: 10.1111/os.13438] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 07/13/2022] [Accepted: 07/15/2022] [Indexed: 11/26/2022] Open
Abstract
Objective Thoracic myelopathy caused by severe anterior ossification is often progressive and fails to respond to conservative treatment. Removal of the compressing ossification is the most effective method but is hard to operate. In this study, we describe a novel one‐stage posterior circumferential decompressive procedure assisted by an angled ultrasonic bone curette (UBC) for thoracic myelopathy caused by severe anterior ossification and evaluate its safety and efficacy. Methods The current study enrolled 15 consecutive patients (five men and 10 women) with thoracic myelopathy caused by severely anterior ossification between January 2017 and December 2019. All patients underwent posterior circumferential decompression assisted by angled UBC and segmental instrumentation with interbody fusion. At the time of surgery, the average age was 58.6 ± 6.3 years (47–70 years). Before and after surgery, the patient data, clinical manifestation, operative levels, blood loss, operative time, perioperative complications, Japanese Orthopaedic Association (JOA) score were recorded and analyzed retrospectively. Results All patients had successful one‐stage posterior circumferential decompression to remove anterior ossifications directly. There were 12 cases of OPLL, two cases of a calcified giant herniated disc, and one case of osteophyte. The average operation time was 153.4 ± 53.4 min (77–242 min), with a mean blood loss of 463.5 ± 155.8 mL (240–780 mL). The average length of stay in the hospital was 14.3 ± 4.7 days (9–25 days) and the mean follow‐up duration was 20.8 ± 8.8 months (12–39 months). Almost all patients had subjective improvement in motor power and gait. The average preoperative JOA score was 4.5 ± 1.6, which improved to 9.0 ± 1.8 at the final follow‐up. Postoperative differences in the overall JOA scores showed significant improvement (F = 105.446, p < 0.01). The overall recovery rate at the final examination scored 70.9% ± 25.0%. According to Hirabayashi's classification, eight cases were rated as excellent, four as good, two as fair, and one as unchanged. No patient was graded as deteriorated. Two patients (13.3%) experienced intraoperative cerebrospinal fluid leakage, while two cases (13.3%) experienced unilateral intercostal neuralgia, and only one (6.7%) encountered acute neurological deterioration. All these patients were treated conservatively and their neurological function improved significantly. At the follow‐up, there was no evidence of neurological deterioration. Conclusion Circumferential decompression assisted by angled UBC can preserve more posterior elements of the involved levels, maintaining an intact pleura and reducing the operation time and blood loss for thoracic myelopathy caused by severe anterior ossification. It is a safe, effective, and technically feasible method to provide surgeons with a new option for thoracic spinal circumferential decompression.
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Affiliation(s)
- Cheng Li
- Department of Orthopaedic Surgery, Shengjing Hospital of China Medical University, Shenyang, P.R. China
| | - Zeqing Li
- Department of Orthopaedic Surgery, Shengjing Hospital of China Medical University, Shenyang, P.R. China
| | - Lei Li
- Department of Orthopaedic Surgery, Shengjing Hospital of China Medical University, Shenyang, P.R. China
| | - Yunli Mei
- Department of Orthopaedic Surgery, Shengjing Hospital of China Medical University, Shenyang, P.R. China
| | - Shuai Huang
- Department of Orthopaedic Surgery, Shengjing Hospital of China Medical University, Shenyang, P.R. China
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Cleary R, Wallace R, Simpson H, Kontorinis G, Lucas M. A longitudinal-torsional mode ultrasonic needle for deep penetration into bone. ULTRASONICS 2022; 124:106756. [PMID: 35597040 DOI: 10.1016/j.ultras.2022.106756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 04/06/2022] [Accepted: 05/01/2022] [Indexed: 06/15/2023]
Abstract
This work presents a longitudinal-torsional (L-T) composite mode ultrasonic needle device for deep bone penetration. The L-T needle is a geometrically modified version of an L-mode needle whose efficacy as a prototype ultrasonic bone biopsy device has been previously demonstrated by the authors. Finite element analysis (FEA) aided in the design of the L-T needle, with the aim of maximising the achievable torsional displacement while matching the longitudinal displacement achieved by the L-mode needle. Experimental modal analysis (EMA) of the fabricated ultrasonic device was used to identify the modal parameters and validate the FEA model. Harmonic analysis then provided an insight into how the inherent nonlinearities of the high-power transducer are affected by incorporating the geometrical features that degenerate the L mode into an L-T mode. High power characterisation shows that the longitudinal displacement amplitude of the L-T mode needle is larger than that of the L-mode needle. Comparative penetration tests in fresh Wistar rat skull were evaluated by investigating cell death and cell survival. The region of statistically significant cell death was small for both devices, with the combined axial and shear motion of the L-T device causing increased osteocyte necrosis within this region. Nevertheless, the results suggest a promising environment for post-operative healing. It is shown how this technology offers a potential technique for a surgical approach to the petrous apex, an application that requires a deep penetration into bone.
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Affiliation(s)
- Rebecca Cleary
- James Watt School of Engineering, University of Glasgow, Glasgow, UK
| | - Robert Wallace
- Department of Orthopaedics and Trauma, School of Clinical Sciences, University of Edinburgh, Edinburgh, UK
| | - Hamish Simpson
- Department of Orthopaedics and Trauma, School of Clinical Sciences, University of Edinburgh, Edinburgh, UK
| | | | - Margaret Lucas
- James Watt School of Engineering, University of Glasgow, Glasgow, UK.
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Wang H, Wang L, Sun Z, Jiang S, Li W. Unplanned hospital readmission after surgical treatment for thoracic spinal stenosis: incidence and causative factors. BMC Musculoskelet Disord 2021; 22:93. [PMID: 33472615 PMCID: PMC7818723 DOI: 10.1186/s12891-021-03975-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 01/12/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To assess the incidence and causative factors of unplanned hospital readmission within 90 days after surgical treatment of thoracic spinal stenosis (TSS). METHODS Hospital administrative database was queried to identify patients who underwent surgical treatment of TSS from July 2010 through December 2017. All unplanned readmissions within 90 days of discharge were reviewed for causes and the rate of unplanned readmissions was calculated. Patients of unplanned readmission were matched 1:3 to a control cohort without readmission. RESULTS Twenty-one patients (incidence of 1.7 % in 1239 patients) presented unplanned hospital readmission within a 90-day period and enrolled as the study group, 63 non-readmission patients (a proportion of 1: 3) were randomly selected as the control group. Causes of readmission include pseudomeningocele (8 patients; 38 %), CSF leakage combined with poor incision healing (6 patients; 29 %), wound dehiscence (2 patient; 9 %), surgical site infection (2 patients; 9 %), spinal epidural hematoma (1 patient; 5 %), inadequate original surgical decompression (2 patients; 9 %). Mean duration from re-admission to the first surgery was 39.6 ± 28.2 days, most of the patients readmitted at the first 40 days (66.7 %, 14/21 patients). When compared to the non-readmitted patients, diagnosis of OPLL + OFL, circumferential decompression, dural injury, long hospital stay were more to be seen in readmitted patients. CONCLUSIONS The incidence of 90-day unplanned readmission after surgical treatment for TSS is 1.7 %, CSF leakage and pseudomeningocele were the most common causes of readmission, the peak period of readmission occurred from 10 to 40 days after surgery, patients should be closely followed up within this period.
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Affiliation(s)
- Hui Wang
- Orthopaedic Department of Peking, University Third Hospital, 49 Huayuan North Road, Haidian District, 100191, Beijing, China.,Beijing Key Laboratory of Spinal Disease Research , Beijing, China.,Engineering Research Center of Bone and Joint Precision Medicine Ministry of Education , Beijing, China
| | - Longjie Wang
- Orthopaedic Department of Peking, University Third Hospital, 49 Huayuan North Road, Haidian District, 100191, Beijing, China.,Beijing Key Laboratory of Spinal Disease Research , Beijing, China.,Engineering Research Center of Bone and Joint Precision Medicine Ministry of Education , Beijing, China
| | - Zhuoran Sun
- Orthopaedic Department of Peking, University Third Hospital, 49 Huayuan North Road, Haidian District, 100191, Beijing, China.,Beijing Key Laboratory of Spinal Disease Research , Beijing, China.,Engineering Research Center of Bone and Joint Precision Medicine Ministry of Education , Beijing, China
| | - Shuai Jiang
- Orthopaedic Department of Peking, University Third Hospital, 49 Huayuan North Road, Haidian District, 100191, Beijing, China.,Beijing Key Laboratory of Spinal Disease Research , Beijing, China.,Engineering Research Center of Bone and Joint Precision Medicine Ministry of Education , Beijing, China
| | - Weishi Li
- Orthopaedic Department of Peking, University Third Hospital, 49 Huayuan North Road, Haidian District, 100191, Beijing, China. .,Beijing Key Laboratory of Spinal Disease Research , Beijing, China. .,Engineering Research Center of Bone and Joint Precision Medicine Ministry of Education , Beijing, China.
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Sun C, Chen G, Fan T, Li W, Guo Z, Qi Q, Zeng Y, Zhong W, Chen Z. Ultrasonic bone scalpel for thoracic spinal decompression: case series and technical note. J Orthop Surg Res 2020; 15:309. [PMID: 32771031 PMCID: PMC7414581 DOI: 10.1186/s13018-020-01838-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 07/29/2020] [Indexed: 11/25/2022] Open
Abstract
Background Thoracic spinal stenosis (TSS) is a rare but intractable disease that fails to respond to conservative treatment. Thoracic spinal decompression, which is traditionally performed using high-speed drills and Kerrison rongeurs, is a time-consuming and technically challenging task. Unfavorable outcomes and high incidence of complications are the major concerns. The development and adaptation of ultrasonic bone scalpel (UBS) have promoted its application in various spinal operations, but its application and standard operating procedure in thoracic decompression have not been fully clarified. Therefore, the purpose of this study is to describe our experience and technique note of using UBS and come up with a standard surgical procedure for thoracic spinal decompression. Methods A consecutive of 28 patients with TSS who underwent posterior thoracic spinal decompression surgery with UBS between December 2014 and May 2015 was enrolled in this study. The demographic data, perioperative complications, operation time, estimated blood loss, and pre- and postoperative neurological statuses were recorded and analyzed. Neurological status was evaluated with a modified Japanese Orthopaedic Association (JOA) scale, and the neurological recovery rate was calculated using the Hirabayashi’s Method. Results Thoracic spinal decompression surgery was successfully carried out in all cases via a single posterior approach. The average age at surgery was 49.7 ± 8.5 years. The mean operative time of single-segment laminectomy was 3.0 ± 1.4 min, and the blood loss was 108.3 ± 47.3 ml. In circumferential decompression, the average blood loss was 513.8 ± 217.0 ml. Two cases of instrument-related nerve root injury occurred during operation and were cured by conservative treatment. Six patients experienced cerebrospinal fluid (CSF) leakage postoperatively, but no related complications were observed. The mean follow-up period was 39.7 ± 8.9 months, the average JOA score increased from 4.7 before surgery to 10.1 postoperatively, and the average recovery rate was 85.8%. Conclusions The UBS is an optimal instrument for thoracic spinal decompression, and its application enables surgeons to decompress the thoracic spinal cord safely and effectively. This standard operating procedure is expected to help achieve favorable outcomes and can be used to treat various pathologies leading to TSS.
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Affiliation(s)
- Chuiguo Sun
- Department of orthopaedics, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China
| | - Guanghui Chen
- Department of orthopaedics, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China
| | - Tianqi Fan
- Department of orthopaedics, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China
| | - Weishi Li
- Department of orthopaedics, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China
| | - Zhaoqing Guo
- Department of orthopaedics, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China
| | - Qiang Qi
- Department of orthopaedics, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China
| | - Yan Zeng
- Department of orthopaedics, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China
| | - Woquan Zhong
- Department of orthopaedics, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China
| | - Zhongqiang Chen
- Department of orthopaedics, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China.
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