Role of Ultrasonic Bone Scalpel in Spine Surgery: a Review Article
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SURGERY
Role of Ultrasonic Bone Scalpel in Spine Surgery: a Review Article Vishal Kumar 1 & Deepak Neradi 1 & Amit Kumar Salaria 1 & Ashish Dagar 1 & Sarvdeep Singh Dhatt 1 & Karan Jindal 1 Accepted: 17 August 2020 # Springer Nature Switzerland AG 2020
Abstract During the last 20 years, there have been remarkable advances in the field of spine surgery. Ultrasonic bone scalpel is one of the most impactful advances. It is a unique surgical device which offers a controlled osteotomy which slices the hard bone while the soft tissues remain largely unaffected. The major benefits of using this modern instrument are the soft tissue sparing, controlled cutting, reduced bleeding, and thereby increasing the effectiveness. There are widespread studies in the literature propagating its use in various surgeries like thoracoplasties, osteotomies, vertebral column resections, laminectomies, corpectomies, laminotomy, facetectomy and scoliotic surgeries. It is one of the precise and finest instruments available for bone cutting which can be of great value while working near the vicinity of spinal cord, dura and nerve roots. Although not 100%, it can significantly minimise the risk of ripping the tissues as compared with osteotomes, Kerrison and the high-speed rotating burrs. It also has a distinct advantage of minimizing the thermal damage due to its attached irrigation component. Various studies have proven its efficiency in decreasing the operating time, increased fusion rates and decreasing the blood loss. Although it is a relatively easy technique to master on, a very basic training is required initially. So, we can safely say that ultrasonic bone scalpel is indispensable in the armamentarium of today’s spine surgeon where minimally invasive surgeries are swiping in. Keywords Ultrasonic bone scalpel . Osteotomy . Safety . Blood loss . Spine surgery
Introduction Spinal surgeries involve number of procedures from a simple laminotomy to a deformity correction. This involves removal of bony elements surrounding neural structures. This requires high surgical skills and care, which is achieved by using various instruments such as rongeurs, high speed drills and rotating burrs. Kerrison rongeur is in use for several years. It has benefits like its availability in different sizes, good cutting property and low cost. However, it takes longer duration for decompression. High speed drills improved spinal surgeries to a great extent [1, 2]. If not used properly, high-speed drills can cause direct damage to neural structures. High speed drills also cause indirect injury with heat. There has always been a risk of damage to adjacent soft tissues while using these devices. Incidental durotomies ranging from 0% to as high as This article is part of the Topical Collection on Surgery * Deepak Neradi [email protected] 1
Department of Orthopaedics, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
35% has been reported [3]. Complications resulting from dural tears include CSF leak or fistula, meningitis, ara
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