Spinal decompression using ultrasonic bone scalpel: a novel ultrasonic surgical device

Dr. J . V . MODI PROFESSOR, BJMC,

DEPT OF ORTHOPAEDICS Dr. Kaushal Patel Resident, BJMC,

Department of orthopaedics

Introduction Dural tear being the most common unintended complication of spinal surgeries now-a-days.

The Ultrasonic Bone Scalpel (UBS) is a novel ultrasonic surgical device that cuts bone and spares soft tissues.

This relative selectivity for bone destruction makes Bone Scalpel ideal for spine surgeries where bone must be cut adjacent to duramater and neural structures with sparing of duramater.

Aims of the Studies To analyze the result of ultrasonic bone scalpel in spinal decompression over conventional method of decompression like

- Kerrison rongeur

- High speed burr drills - Conventional osteotome.

Materials And Method Study Design: retrospective study of 35 patients operated for spinal decompression either cervical, thoracic or lumbar pathologies.

Region Etiology

Cervical Cervical canal stenosisCorpectomy

Calcified disc, osteophytesCervical myelopathy

thoracic Acquired spinal disorder (fluorosis, tuberculosis)

Lumbar Lumbar canal stenosisMultiple level PID

Recurrent PIDCauda Equina Syndrome

Bone Scalpel The Bone Scalpel assembly consists of an ultrasonic generator/irrigation console that connects to a hand-piece bearing a disposable cutting tip

The cutting tip oscillates back and forth a very small distance at rate of 22,500 times per second (a frequency in the low ultrasonic range).

Cutting tip

Blade

Behaves as ultrasonic

osteotome for removal of bone

Shaver TipBehaves as non

rotating burr Selectivity for bone

PRINCIPLE Principle: large amount of energy is transferred to a small amount of bone at the point of contact, resulting in destruction of that bone. In contrast, soft tissue structures (such as ligamentum flavum, posterior longitudinal ligament, and dura) can bend, deform, move away, and vibrate upon contact with the blade, thus dampening the energy transfer and protecting the tissue from destruction

Observations and Results Age Distribution : Mean age of the patients was 62 years

Sex Distribution: 77% were males while 23% were females

27; 77%

8; 23%

Sex Distribution

Males Females

Levels of spine involved

Cervical Thoracic Lumbar0

5

10

15

20

25

21

3

11

Number of Cases

Number

Out of 35 patients, 21 patients (60%) had cervical pathology, 3 patients (8.6%) had thoracic and 11 patients (31.4%) had lumbar pathology.

Duration of operation

ODI (oswestry disability index) score:

NDI (neck disability index) score:

ODI SCORE PREOPERATIVE POST OPERATIVELUMBAR SPINE 40% 20%

THORACIC SPINE 50% 30%

LEVEL O F SPINE MEAN OPERATION TIMECERVICAL 45-60 MINS

THORACIC 90-120 MINSLUMBAR 60-75 MINS

NDI SCORE PREOPERATIVE POSTOPERATIVE

CERVICAL SPINE 60% 20%

The blood loss

The hospital stay

Complication like neurology worsening, infection , morbidity is not seen in any cases except 1 dural tear in lumbar decompression.

BLOOD LOSS Amount in ml

CERVICAL DECOMPRESSION 250 ml(MINIMUM)

DORSAL SPINE 500 ml(MAXIMUM)

HOSPITAL STAY days

CONVENTIONAL METHOD 4-8 DAYS

USING UBS 2-3 DAYS

BONE SCALPEL

laminectomy using scalpel

Pros and cons of bone scalpel Pros: The Ultrasonic Bone Scalpel (UBS) is a novel ultrasonic surgical device that cuts bone and spares soft tissues. And reduce the chances of dural tear.

Cons: 1)Development of a tactile feel for when the inner cortex of the bone is penetrated

2) requires planning to cut the bone in advance.

3)The limitation is its cost at individual setup.

Conclusion

Bone Scalpel is a safe and effective ultrasonic bone dissector that will soon become an integral part of spine surgery where there is risk of dural injury.It offers distinct advantages in comparison to power drills and hand instruments that make it well-suited to many bone cutting projects in spine surgery.

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