Abstract
Multilevel severe compressive myelopathy is a challenging disorder for the surgeons, the aim of this study is to assess the efficacy and safety of a newly designed ultrasonic burr as an assistant tool to the ultrasonic scalpel in laminectomy for this disease. This is a retrospective comparative study, the included subjects were patients who received cervical and thoracic laminectomy using ultrasonic device (LUD, n = 9, 10 surgeries) and controls with the high-speed burr (LHB, n = 16). Fifteen patients (60.0%) showed severe cord occupancy and the average number of laminae operated was 3.5. Ultrasonic devices caused less blood loss (P = 0.02) and quicker operative time per level (P < 0.001) than LHB, and was associated with more operated laminae (P = 0.04). Preoperative JOA scores (P = 0.51), improvement rate (P = 0.47), and dural injury (P = 0.51) were not related to LUD. Our experience indicates ultrasonic devices are safe and effective for laminectomy treating multilevel and severe compressive myelopathy, the instrument could be used with ease especially for cases with ossified posterior longitudinal ligament and ossification of the ligamentum flavum, proper utility of the instrument is crucial to prevent complications.
Highlights
Compressive myelopathy is a progressively disabling disorder, the main etiology includes ossification of the posterior longitudinal ligament (OPLL), ossified ligamentum flavum (OLF) and spinal degenerative disorders[1]
The high morbidity correlated with treatment of multilevel and severe compressive myelopathy is due to increased technical difficulty and inherent shortages of traditional surgical instrumentation
High-speed burrs are widely used in spine surgeries for osteotomy, the heat generated by the tip of the device may cause damage to neighboring neural tissue and result in osteonecrosis[12]
Summary
Compressive myelopathy is a progressively disabling disorder, the main etiology includes ossification of the posterior longitudinal ligament (OPLL), ossified ligamentum flavum (OLF) and spinal degenerative disorders[1]. Surgical procedures treating multilevel severe lesions are technically demanding and risky, especially when the patient presents with OPLL (cervical, 3.2%; thoracic, 0.8%) with or without OLF1. Reports in previous literature have employed several surgical approaches for compressive myelopathy including posterior circumferential decompression[2,3], anterior decompression[4], posterior laminectomy or laminoplasty[1,5,6], and anterior combined with posterior decompression[1,7]. Posterior laminectomy and laminoplasty provide indirect decompression by posterior shift of the spinal cord, these procedures are especially applicable for multilevel and severe myelopathy for which direct decompression is risky, these posterior decompressive techniques are associated with inferior neurologic improvement and notable complications[11]. We use a newly designed ultrasonic burr as an assistant tool to the scalpel tip for posterior laminectomy with instrumented fusion, and analyze the technical aspects of this device
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