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      Spinal Decompression using Ultrasonic Bone Scalpel: A Novel Ultrasonic Surgical Device

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          ABSTRACT

          Introduction

          The ultrasonic bone scalpel (UBS) is an ultrasonic device that cuts the bone, but does not harm the surrounding soft tissue and duramater. Such a type of selectivity of bone scalpel, particularly for bone destruction, makes the bone scalpel ideal for spine surgeries where there is the need to remove only bone adjacent to the duramater and neural structures, with the sparing of the duramater. Moreover, dural tear is the most common unintended complication of spinal surgeries nowadays.

          Materials and methods

          This is a retrospective study of 35 patients operated for spinal decompression – cervical, thoracic, or lumbar – between January 2015 and June 2016 at BJ Medical College, Ahmedabad.

          Aim

          To analyze the result of the use of UBS in spinal decompression over the conventional method of decompression, such as using the Kerrison Rongeur, high-speed burr drills, and conventional osteotome.

          Observation and results

          Out of the 35 patients in our study, 21 patients (60%) had cervical, 3 patients (8.6%) had thoracic, and 11 patients (31.4%) had lumbar pathologies. There is significant reduction in duration of surgery and need for blood transfusion. We considered the neck disability index (NDI) and oswestry disability index (ODI) scores to measure the clinical outcomes of using bone scalpel at the end of 1 year. Both the scores were significantly improved. We had one case of dural tear (2.9%) in a patient with lumbar canal stenosis. No neurological worsening in any patients was present.

          Conclusion

          The UBS is a unique surgical device that reduces heat production and decreases the chances of dural tear, which makes it a suitable instrument for different spinal surgeries in recent days.

          How to cite this article

          Modi JV, Patel KR, Patel Z, Soman SV, Tankshali KV. Spinal Decompression using Ultrasonic Bone Scalpel: A Novel Ultrasonic Surgical Device. J Spinal Surg 2016;3(4):140-143.

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          Most cited references10

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          Technical advantages of an ultrasonic bone curette in spinal surgery.

          The authors discuss the safety and efficacy of an ultrasonic bone curette in various spinal surgeries and report its advantages in clinical application. Between April 2002 and September 2003, 76 patients with various spinal diseases (29 cervical, five thoracic, 40 lumbosacral, and two foramen magnum regions) were treated microsurgically by using a Sonopet ultrasonic bone curette with longitudinal and torsional tips and lightweight handpieces. The operations were performed successfully and the device was easy to handle. There were no instrument-related complications or -induced damage to any structure even when removing osseous spurs or ossified lesions near the dura mater, nerves, and vessels. The ultrasonic curette is a useful instrument for procedures performed near the dura mater or other neural tissue without excessive heat production or mechanical injury. This device is recommended for various spinal surgeries in addition to high-speed drills or other tools.
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            • Record: found
            • Abstract: found
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            Use of an ultrasonic osteotome device in spine surgery: experience from the first 128 patients.

            The ultrasonic BoneScalpel is a tissue-specific device that allows the surgeon to make precise osteotomies while protecting collateral or adjacent soft tissue structures. The device is comprised of a blunt ultrasonic blade that oscillates at over 22,500 cycles/s with an imperceptible microscopic amplitude. The recurring impacts pulverize the noncompliant crystalline structure resulting in a precise cut. The more compliant adjacent soft tissue is not affected by the ultrasonic oscillation. The purpose of this study is to report the experience and safety of using this ultrasonic osteotome device in a variety of spine surgeries.
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              • Article: not found

              Potential risk of thermal damage to cervical nerve roots by a high-speed drill.

              Using the transverse processes of fresh porcine lumbar spines as an experimental model we evaluated the heat generated by a rotating burr of a high-speed drill in cutting the bone. The temperature at the drilled site reached 174 degrees C with a diamond burr and 77 degrees C with a steel burr. With water irrigation at a flow rate of 540 ml/hr an effective reduction in the temperature was achieved whereas irrigation with water at 180 ml/hr was much less effective. There was a significant negative correlation between the thickness of the residual bone and the temperature measured at its undersurface adjacent to the drilling site (p < 0.001). Our data suggest that tissues neighbouring the drilled bone, especially nerve roots, can be damaged by the heat generated from the tip of a high-speed drill. Nerve-root palsy, one of the most common complications of cervical spinal surgery, may be caused by thermal damage to nerve roots arising in this manner.
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                Author and article information

                Contributors
                Role: Professor
                Role: Resident Doctor
                Role: Assistant Professor
                Role: Fellow
                Role: Resident Doctor
                Journal
                JOSS
                The Journal of Spinal Surgery
                JOSS
                Jaypee Brothers Medical Publishers
                2349-0462
                2348-6031
                October-December 2016
                : 3
                : 4
                : 140-143
                Affiliations
                [1-5 ] Department of Orthopaedics, BJ Medical College, Ahmedabad Gujarat, India
                Author notes
                Kaushal R Patel, Resident Doctor Department of Orthopaedics, BJ Medical College, Ahmedabad Gujarat, India, Phone: +917922687071, e-mail: kaushal71190@ 123456gmail.com
                Article
                10.5005/jp-journals-10039-1106
                610bf244-054e-4165-ac67-6823dde25478
                Copyright © 2016; Jaypee Brothers Medical Publishers (P) Ltd.

                Creative Commons Attribution 4.0

                History
                Categories
                ORIGINAL ARTICLE
                Custom metadata
                joss-2016-3-140.pdf

                General medicine,Pathology,Surgery,Sports medicine,Anatomy & Physiology,Orthopedics
                Ultrasonic bone scalpel,Spinal decompression,Dural tear,High-speed drill

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