Safety and effectiveness of ultrasonic osteotome in posterior cervical laminectomy decompression and fusion_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHU Jinwen , HAO Dingjun , GUO Yunshan , ZHANG Xinliang , GAO Wenjie ,  WANG Xiaodong

Department of Spinal Surgery, Xi’an Honghui Hospital Affiliated to Xi’an Jiaotong University Medical College, Xi’an Shaanxi, 710054, P.R.China;

Corresponding?author：

WANG Xiaodong, Email: zssl_70@126.com

Keywords：

Ultrasonic osteotome; posterior cervical laminectomy decompression; ossification of posterior longitudinal ligament of cervical spine

DOI：

10.7507/1002-1892.201804012

Video：

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ObjectiveTo 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 C₅ 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.

Citation： ZHU Jinwen, HAO Dingjun, GUO Yunshan, ZHANG Xinliang, GAO Wenjie, WANG Xiaodong. Safety and effectiveness of ultrasonic osteotome in posterior cervical laminectomy decompression and fusion. Chinese Journal of Reparative and Reconstructive Surgery, 2018, 32(12): 1554-1559. doi: 10.7507/1002-1892.201804012 Copy

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5.	Minato T, Miyagi M, Saito W, et al. Spinal epidural hematoma after thoracolumbar posterior fusion surgery without decompression for thoracic vertebral fracture. Case Rep Orthop, 2016, 2016: 6295817.
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9.	Bydon M, Macki M, Xu R, et al. Spinal decompression in achondroplastic patients using high-speed drill versus ultrasonic bone curette: technical note and outcomes in 30 cases. J Pediatr Orthop, 2014, 34(8): 780-786.
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14.	Nakagawa H, Kim SD, Mizuno J, et al. Technical advantages of an ultrasonic bone curette in spinal surgery. J Neurosurg Spine, 2005, 2(4): 431-435.
15.	Kim K, Isu T, Matsumoto R, et al. Surgical pitfalls of an ultrasonic bone curette (SONOPET) in spinal surgery. Neurosurgery, 2006, 59(4 Suppl 2): O390-O393.
16.	Ito K, Ishizaka S, Sasaki T, et al. Safe and minimally invasive laminoplastic laminotomy using an ultrasonic bone curette for spinal surgery: technical note. Surg Neurol, 2009, 72(5): 470-475.
17.	Hazer DB, Ya?ar B, Rosberg HE, et al. Technical aspects on the use of ultrasonic bone shaver in spine surgery: experience in 307 patients. Biomed Res Int, 2016, 2016: 8428530.
18.	Brooks AT, Nelson CL, Stewart CL, et al. Effect of an ultrasonic device on temperatures generated in bone and on bone-cement structure. J Arthroplasty, 1993, 8(4): 413-418.
19.	Onen MR, Yuvruk E, Akay S, et al. The reliability of the ultrasonic bone scalpel in cervical spondylotic myelopathy: a comparative study of 46 patients. World Neurosurg, 2015, 84(6): 1962-1967.
20.	Nakase H, Matsuda R, Shin Y, et al. The use of ultrasonic bone curettes in spinal surgery. Acta Neurochir (Wien), 2006, 148(2): 207-212.
21.	Matsuoka H, Itoh Y, Numazawa S, et al. Recapping hemilaminoplasty for spinal surgical disorders using ultrasonic bone curette. Surg Neurol Int, 2012, 3: 70.
22.	Hosono N, Miwa T, Mukai Y, et al. Potential risk of thermal damage to cervical nerve roots by a high-speed drill. J Bone Joint Surg (Br), 2009, 91(11): 1541-1544.
23.	Schaller BJ, Gruber R, Merten HA, et al. Piezoelectric bone surgery: a revolutionary technique for minimally invasive surgery in cranial base and spinal surgery? Technical note Neurosurgery, 2005, 57(4 Suppl): E410.
24.	薛旭凱, 李高飛, 江建明. 超聲骨刀與高速磨鉆在頸后路單開門椎管擴大成形術中的應用對比. 中國骨科臨床與基礎研究雜志, 2016, 8(2): 75-80.
25.	劉學光, 付強, 孫振中, 等. 超聲骨刀與高速磨鉆在頸椎后路全椎板切除減壓手術應用中的比較研究. 中國脊柱脊髓雜志, 2017, 27(6): 539-544.

1. Li K, Zhang W, Li B, et al. Safety and efficacy of cervical laminoplasty using a piezosurgery device compared with a high-speed drill. Medicine (Baltimore), 2016, 95(37): e4913.
2. 郝定均, 賀寶榮, 吳起寧, 等. 胸椎管狹窄癥術后并發癥的防治. 中華骨科雜志, 2007, 27(1): 30-34.
3. Lemaire R. Strategies for blood management in orthopaedic and trauma surgery. J Bone Joint Surg (Br), 2008, 90(9): 1128-1136.
4. Luo XB, Zhou X, Wang Q, et al. The classification of recurrent spinal epidural hematoma: a review of the literature and a comparison with the cases. Eur Spine J, 2016, 25(Suppl 1): 224-229.
5. Minato T, Miyagi M, Saito W, et al. Spinal epidural hematoma after thoracolumbar posterior fusion surgery without decompression for thoracic vertebral fracture. Case Rep Orthop, 2016, 2016: 6295817.
6. Salami A, Mora R, Dellepiane M, et al. Piezosurgery for removal of symptomatic ear osteoma. Eur Arch Otorhinolaryngol, 2010, 267(10): 1527-1530.
7. Grauvogel J, Scheiwe C, Kaminsky J. Use of Piezosurgery for removal of retrovertebral body osteophytes in anterior cervical discectomy. Spine J, 2014, 14(4): 628-636.
8. Bydon M, Xu R, Papademetriou K, et al. Safety of spinal decompression using an ultrasonic bone curette compared with a high-speed drill: outcomes in 337 patients. J Neurosurg Spine, 2013, 18(6): 627-633.
9. Bydon M, Macki M, Xu R, et al. Spinal decompression in achondroplastic patients using high-speed drill versus ultrasonic bone curette: technical note and outcomes in 30 cases. J Pediatr Orthop, 2014, 34(8): 780-786.
10. Hu X, Ohnmeiss DD, Lieberman IH. Use of an ultrasonic osteotome device in spine surgery: experience from the first 128 patients. Eur Spine J, 2013, 22(12): 2845-2849.
11. Silveri CP, Vaccaro AR. Posterior atlantoaxial fixation: the Magerl screw technique. Orthopedics, 1998, 21(4): 455-459.
12. Horton JE, Tarpley TM Jr, Jacoway JR. Clinical applications of ultrasonic instrumentation in the surgical removal of bone. Oral Surg Oral Med Oral Pathol, 1981, 51(3): 236-242.
13. Sherman JA, Davies HT. Ultracision: the harmonic scalpel and its possible uses in maxillofacial surgery. Br J Oral Maxillofac Surg, 2000, 38(5): 530-532.
14. Nakagawa H, Kim SD, Mizuno J, et al. Technical advantages of an ultrasonic bone curette in spinal surgery. J Neurosurg Spine, 2005, 2(4): 431-435.
15. Kim K, Isu T, Matsumoto R, et al. Surgical pitfalls of an ultrasonic bone curette (SONOPET) in spinal surgery. Neurosurgery, 2006, 59(4 Suppl 2): O390-O393.
16. Ito K, Ishizaka S, Sasaki T, et al. Safe and minimally invasive laminoplastic laminotomy using an ultrasonic bone curette for spinal surgery: technical note. Surg Neurol, 2009, 72(5): 470-475.
17. Hazer DB, Ya?ar B, Rosberg HE, et al. Technical aspects on the use of ultrasonic bone shaver in spine surgery: experience in 307 patients. Biomed Res Int, 2016, 2016: 8428530.
18. Brooks AT, Nelson CL, Stewart CL, et al. Effect of an ultrasonic device on temperatures generated in bone and on bone-cement structure. J Arthroplasty, 1993, 8(4): 413-418.
19. Onen MR, Yuvruk E, Akay S, et al. The reliability of the ultrasonic bone scalpel in cervical spondylotic myelopathy: a comparative study of 46 patients. World Neurosurg, 2015, 84(6): 1962-1967.
20. Nakase H, Matsuda R, Shin Y, et al. The use of ultrasonic bone curettes in spinal surgery. Acta Neurochir (Wien), 2006, 148(2): 207-212.
21. Matsuoka H, Itoh Y, Numazawa S, et al. Recapping hemilaminoplasty for spinal surgical disorders using ultrasonic bone curette. Surg Neurol Int, 2012, 3: 70.
22. Hosono N, Miwa T, Mukai Y, et al. Potential risk of thermal damage to cervical nerve roots by a high-speed drill. J Bone Joint Surg (Br), 2009, 91(11): 1541-1544.
23. Schaller BJ, Gruber R, Merten HA, et al. Piezoelectric bone surgery: a revolutionary technique for minimally invasive surgery in cranial base and spinal surgery? Technical note Neurosurgery, 2005, 57(4 Suppl): E410.
24. 薛旭凱, 李高飛, 江建明. 超聲骨刀與高速磨鉆在頸后路單開門椎管擴大成形術中的應用對比. 中國骨科臨床與基礎研究雜志, 2016, 8(2): 75-80.
25. 劉學光, 付強, 孫振中, 等. 超聲骨刀與高速磨鉆在頸椎后路全椎板切除減壓手術應用中的比較研究. 中國脊柱脊髓雜志, 2017, 27(6): 539-544.

Chinese Journal of Reparative and Reconstructive Surgery

Safety and effectiveness of ultrasonic osteotome in posterior cervical laminectomy decompression and fusion

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