A prospective study of results of laminectomy using ultrasonic bone scalpel vs. conventional methods

Author(s): Dr. Saral Patel and Dr. Mitul Mistry

Abstract: Dural tear is the most unintended complication during spinal decompressive surgeries. In routine methods of spinal decompression like in congenital stenotic lesion, degenerative/spondylotic changes there is increased incidence of dural injuries due to thin dura and harder bone. High-speed drills and diamond burrs increases heat production and causes dural damage. Ultrasonic bone scalpel (UBS) in spinal laminectomy is gaining popularity due to numerous potential advantages like decreased blood loss, reduced surgical time, less chances of dura tear. It is a prospective study of 100 patients operated for spinal decompression using either through conventional method or UBS. Patients` demographics profile, duration of surgery, blood loss, complications, Oswestry disability index (ODI), Visual Analogue Scale (VAS) pre operatively and 1,6,12 month post operatively were noted. Out of 100 patients, 46 were operated for laminectomy using conventional methods and 54 were operated using UBS. Average blood loss during surgery using conventional methods was 300 ml and with UBS was 90 ml. Average duration of surgery using conventional method was 120 minutes while with UBS was 90 minutes. The difference was statistically significant (p<0.05). Average post-operative VAS score for conventional method was 2.33 and for UBS was 2.12. The difference was not statistically significant (p>0.05). According to ODI score, excellent to good score in conventional method was 64% and excellent to good score in UBS is 78%. But overall there was no statistically significant difference (p > 0.05). Two patients out of 54, operated using conventional methods had dura tear and none of the patient operated with UBS experienced dura tear. The ultrasonic bone scalpel is a unique surgical device that acts by principle of rapid back and forth movement along with continuous saline irrigation system, thereby reducing heat production and having more selectivity to hard tissue thus causing less damage to the soft tissue, lesser blood loss and short surgical time.

DOI: https://doi.org/10.22271/ortho.2019.v5.i1h.76