Application of V-shaped stealth decompression technique using ultrasonic bone scalpel in anterior surgery for adjacent two-level cervical spondylosis_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

WANG Zhaodong , DUAN Keyou , LIU Yajun , XU Chen , ZHU Zhonglian , ZHOU Pinghui ,  GUAN Jianzhong

Department of Orthopaedics, the First Affiliated Hospital of Bengbu Medical University, Anhui Provincial Key Laboratory of Tissue Transplantation, Bengbu Anhui, 233004, P. R. China;

Corresponding?author：

GUAN Jianzhong, Email: jzguan2002@163.com

Keywords：

Ultrasonic bone scalpel; two-level cervical spondylosis; stealth decompression; anterior cervical surgery

DOI：

10.7507/1002-1892.202502056

Video：

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Objective To evaluate the effectiveness of V-shaped stealth decompression technique using ultrasonic bone scalpel in anterior surgery for adjacent two-level cervical spondylosis. Methods A clinical data of 41 patients with adjacent two-level cervical spondylosis, who admitted between January 2020 and December 2023 and met the selection criteria, was analyzed retrospectively. Among them, 22 cases were treated with anterior cervical discectomy and fusion (ACDF) assisted by V-shaped stealth decompression technique using ultrasonic bone scalpel (group A) and 19 cases with anterior cervical corpectomy and fusion (ACCF) (group B). There was no significant difference between the two groups in age, gender, disease duration, surgical segment, preoperative Japanese Orthopedic Association (JOA) score, neck dysfunction index (NDI), pain visual analogue scale (VAS) score, and the anteroposterior diameter of the spinal canal in the responsibility space of axial CT (P>0.05). The operation time, intraoperative blood loss, postoperative drainage volume, hospital stay, complications during follow-up, JOA score, NDI, and VAS score at last follow-up, and the incidences of intervertebral fusion at 3 months after operation, and cage subsidence at last follow-up were compared between the two groups. Results The operations in the two groups were successfully completed. The operation time, intraoperative blood loss, postoperative drainage volume, and hospital stay in group A were significantly less than those in group B (P<0.05). Two cases (9.1%) in group A and 4 cases (21.1%) in group B developed complications, with no significant difference in the incidence between the two groups (P>0.05). All patients in the two groups were followed up 6-12 months (mean, 9.3 months). There was no significant difference in follow-up time between the two groups (P>0.05). At last follow-up, the JOA score and VAS score in both groups significantly improved when compared with those before operation (P<0.05). The change values of VAS score and the improvement rate of JOA score in group A were significantly superior to group B (P<0.05). There was no significant difference in the change values of NDI and JOA score between the two group (P>0.05). Imaging reexamination showed that the rate of intervertebral fusion at 3 months after operation was significantly higher in group A (81.8%) than in group B (52.6%) (P<0.05), and all patients obtained bony intervertebral fusion at last follow-up. At last follow-up, 2 cases (9.1%) in group A and 11 cases (57.9%) in group B had cage sinking, and the difference in the incidence was significant (P<0.05). No loosening or fracture of internal fixators occurred in all patients. Conclusion Using ultrasonic bone scalpel can transform single vertebral ACCF into two-segment ACDF in anterior cervical spondylosis surgery. The V-shaped stealth decompression technique is safe and efficient, with the advantages of minimal trauma, fewer postoperative complications, and rapid recovery of patients.

Citation： WANG Zhaodong, DUAN Keyou, LIU Yajun, XU Chen, ZHU Zhonglian, ZHOU Pinghui, GUAN Jianzhong. Application of V-shaped stealth decompression technique using ultrasonic bone scalpel in anterior surgery for adjacent two-level cervical spondylosis. Chinese Journal of Reparative and Reconstructive Surgery, 2025, 39(6): 741-747. doi: 10.7507/1002-1892.202502056 Copy

1.	Le HV, Javidan Y, Khan SN, et al. Dysphagia after anterior cervical spine surgery: pathophysiology, diagnosis, and management. J Am Acad Orthop Surg, 2024, 32(14): 627-636.
2.	Colón LF, Barber L, Soffin E, et al. Management and treatment algorithm of airway complications after anterior cervical spine surgery: systematic review. J Spine Surg, 2024, 10(3): 562-575.
3.	Chen T, Wang Y, Zhou H, et al. Comparison of anterior cervical discectomy and fusion versus anterior cervical corpectomy and fusion in the treatment of localized ossification of the posterior longitudinal ligament. J Orthop Surg (Hong Kong), 2023, 31(1): 10225536231167704. doi: 10.1177/10225536231167704.
4.	Yu H, Li X, Chen S, et al. Comparative effectiveness and safety of anterior cervical corpectomy with fusion, laminoplasty, and laminectomy and instrumented fusion for ossification of the posterior longitudinal ligament: a systematic review and network meta-analysis. J Invest Surg, 2022, 35(3): 667-676.
5.	宋仁謙, 周英杰, 鄭懷亮, 等. 頸椎前路V形截骨Y形減壓融合術治療后縱韌帶骨化癥的臨床療效觀察. 中國脊柱脊髓雜志, 2024, 34(5): 449-457.
6.	田楊, 韓永正, 李嬌, 等. 頸椎前路手術后硬膜外血腫的發生率和危險因素. 北京大學學報(醫學版), 2024, 56(6): 1058-1064.
7.	曹國龍, 陳卓, 施集, 等. 頸椎前路椎體次全切除植骨融合術后鈦網沉降的危險因素. 中國脊柱脊髓雜志, 2023, 33(7): 602-609.
8.	李玉偉, 嚴曉云, 潘傳紅, 等. 超聲骨刀系統行椎板切除、后縱韌帶骨化塊切斷聯合去后凸矯形治療多節段胸椎后縱韌帶骨化癥. 中國修復重建外科雜志, 2024, 38(9): 1086-1091.
9.	Sun K, Zhang S, Yang B, et al. The effect of laminectomy with instrumented fusion carried into the thoracic spine on the sagittal imbalance in patients with multilevel ossification of the posterior longitudinal ligament. Orthop Surg, 2021, 13(8): 2280-2288.
10.	Ando K, Nakashima H, Machino M, et al. Postoperative progression of ligamentum flavum ossification after posterior instrumented surgery for thoracic posterior longitudinal ligament ossification: long-term outcomes during a minimum 10-year follow-up. J Neurosurg Spine, 2021, 36(6): 986-996.
11.	Oshina M, Oshima Y, Tanaka S, et al. Radiological fusion criteria of postoperative anterior cervical discectomy and fusion: a systematic review. Global Spine J, 2018, 8(7): 739-750.
12.	王海波, 李欣, 王子然, 等. 頸椎前路椎體可控前移融合術和頸椎前路椎體次全切除融合術治療多節段脊髓型頸椎病伴椎管狹窄的短期療效. 脊柱外科雜志, 2024, 22(4): 222-227.
13.	Lee CY, Chen PC, Wu MH, et al. Minimally invasive surgical treatment of extensive spinal epidural abscess with unilateral laminotomy for bilateral decompression using an ultrasonic bone curette: a technique note. World Neurosurg, 2022, 168: 111-119.
14.	Renjith KR, Eamani NK, Raja DC, et al. Ultrasonic bone scalpel in spine surgery. J Orthop, 2023, 41: 1-7.
15.	Steinle AM, Chen JW, O’Brien A, et al. Efficacy and safety of the ultrasonic bone scalpel in lumbar laminectomies. Spine Surg Relat Res, 2022, 7(3): 242-248.
16.	Moon RDC, Srikandarajah N, Clark S, et al. Primary lumbar decompression using ultrasonic bone curette compared to conventional technique. Br J Neurosurg, 2021, 35(6): 775-779.
17.	徐陳, 王照東, 劉亞軍, 等. 超聲骨刀在頸椎前路手術中的應用研究. 中國修復重建外科雜志, 2023, 37(8): 996-1001.
18.	Kim CH, Renaldo N, Chung CK, et al. Use of an ultrasonic osteotome for direct removal of beak-type ossification of posterior longitudinal ligament in the thoracic spine. J Korean Neurosurg Soc, 2015, 58(6): 571-577.
19.	鮑小明, 張小平, 郭衛東, 等. 顯微鏡輔助下超聲骨刀在頸椎前路骨化物切除中的應用及臨床療效. 生物骨科材料與臨床研究, 2023, 20(6): 27-31.

1. Le HV, Javidan Y, Khan SN, et al. Dysphagia after anterior cervical spine surgery: pathophysiology, diagnosis, and management. J Am Acad Orthop Surg, 2024, 32(14): 627-636.
2. Colón LF, Barber L, Soffin E, et al. Management and treatment algorithm of airway complications after anterior cervical spine surgery: systematic review. J Spine Surg, 2024, 10(3): 562-575.
3. Chen T, Wang Y, Zhou H, et al. Comparison of anterior cervical discectomy and fusion versus anterior cervical corpectomy and fusion in the treatment of localized ossification of the posterior longitudinal ligament. J Orthop Surg (Hong Kong), 2023, 31(1): 10225536231167704. doi: 10.1177/10225536231167704.
4. Yu H, Li X, Chen S, et al. Comparative effectiveness and safety of anterior cervical corpectomy with fusion, laminoplasty, and laminectomy and instrumented fusion for ossification of the posterior longitudinal ligament: a systematic review and network meta-analysis. J Invest Surg, 2022, 35(3): 667-676.
5. 宋仁謙, 周英杰, 鄭懷亮, 等. 頸椎前路V形截骨Y形減壓融合術治療后縱韌帶骨化癥的臨床療效觀察. 中國脊柱脊髓雜志, 2024, 34(5): 449-457.
6. 田楊, 韓永正, 李嬌, 等. 頸椎前路手術后硬膜外血腫的發生率和危險因素. 北京大學學報(醫學版), 2024, 56(6): 1058-1064.
7. 曹國龍, 陳卓, 施集, 等. 頸椎前路椎體次全切除植骨融合術后鈦網沉降的危險因素. 中國脊柱脊髓雜志, 2023, 33(7): 602-609.
8. 李玉偉, 嚴曉云, 潘傳紅, 等. 超聲骨刀系統行椎板切除、后縱韌帶骨化塊切斷聯合去后凸矯形治療多節段胸椎后縱韌帶骨化癥. 中國修復重建外科雜志, 2024, 38(9): 1086-1091.
9. Sun K, Zhang S, Yang B, et al. The effect of laminectomy with instrumented fusion carried into the thoracic spine on the sagittal imbalance in patients with multilevel ossification of the posterior longitudinal ligament. Orthop Surg, 2021, 13(8): 2280-2288.
10. Ando K, Nakashima H, Machino M, et al. Postoperative progression of ligamentum flavum ossification after posterior instrumented surgery for thoracic posterior longitudinal ligament ossification: long-term outcomes during a minimum 10-year follow-up. J Neurosurg Spine, 2021, 36(6): 986-996.
11. Oshina M, Oshima Y, Tanaka S, et al. Radiological fusion criteria of postoperative anterior cervical discectomy and fusion: a systematic review. Global Spine J, 2018, 8(7): 739-750.
12. 王海波, 李欣, 王子然, 等. 頸椎前路椎體可控前移融合術和頸椎前路椎體次全切除融合術治療多節段脊髓型頸椎病伴椎管狹窄的短期療效. 脊柱外科雜志, 2024, 22(4): 222-227.
13. Lee CY, Chen PC, Wu MH, et al. Minimally invasive surgical treatment of extensive spinal epidural abscess with unilateral laminotomy for bilateral decompression using an ultrasonic bone curette: a technique note. World Neurosurg, 2022, 168: 111-119.
14. Renjith KR, Eamani NK, Raja DC, et al. Ultrasonic bone scalpel in spine surgery. J Orthop, 2023, 41: 1-7.
15. Steinle AM, Chen JW, O’Brien A, et al. Efficacy and safety of the ultrasonic bone scalpel in lumbar laminectomies. Spine Surg Relat Res, 2022, 7(3): 242-248.
16. Moon RDC, Srikandarajah N, Clark S, et al. Primary lumbar decompression using ultrasonic bone curette compared to conventional technique. Br J Neurosurg, 2021, 35(6): 775-779.
17. 徐陳, 王照東, 劉亞軍, 等. 超聲骨刀在頸椎前路手術中的應用研究. 中國修復重建外科雜志, 2023, 37(8): 996-1001.
18. Kim CH, Renaldo N, Chung CK, et al. Use of an ultrasonic osteotome for direct removal of beak-type ossification of posterior longitudinal ligament in the thoracic spine. J Korean Neurosurg Soc, 2015, 58(6): 571-577.
19. 鮑小明, 張小平, 郭衛東, 等. 顯微鏡輔助下超聲骨刀在頸椎前路骨化物切除中的應用及臨床療效. 生物骨科材料與臨床研究, 2023, 20(6): 27-31.

Chinese Journal of Reparative and Reconstructive Surgery

Application of V-shaped stealth decompression technique using ultrasonic bone scalpel in anterior surgery for adjacent two-level cervical spondylosis

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