Ultrasonic BoneScalpel for Osteoplastic Laminoplasty in the Resection of Intradural Spinal Pathology

Abstract

Osteoplastic laminoplasty is a well-described technique that may decrease the incidence of progressive kyphosis when used in the setting of intradural spinal cord tumor resection. The BoneScalpel by Aesculap (Central Valley, Pennsylvania) is an ultrasonic osteotome that precisely cuts bone while preserving the underlying soft tissues, potentially reducing the risk of dural laceration during laminoplasty. By producing osteotomies as narrow as 0.5 mm, the device may also facilitate postoperative osteointegration. A retrospective analysis was conducted of 40 patients (mean age, 38.0 years; range, 4.0-79.7 years) who underwent osteoplastic laminoplasty using the BoneScalpel for the treatment of intradural spinal pathology at the Johns Hopkins Hospital between January 2009 and December 2011. After lesion resection, titanium plates were used to reconstruct the lamina in all cases. The technical results and procedure-related complications were subsequently noted. Successful laminoplasty was carried out in all 40 patients. Intraoperatively, 1 case of incidental durotomy was noted after use of the device, which was repaired primarily without neurological or clinical sequelae. During the follow-up period (mean, 195 days; median, 144 days), there were 2 complications (1 cerebrospinal fluid leak, 1 seroma) and no cases of immediate postoperative instability. The BoneScalpel is a safe and technically feasible device for performing osteoplastic laminoplasty.