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Neurosurgery. 2019 Aug 21. pii: nyz301. doi: 10.1093/neuros/nyz301. [Epub ahead of print]

The Efficacy of Ultrasonic Bone Scalpel for Unilateral Cervical Open-Door Laminoplasty: A Randomized Controlled Trial.

Kim CH1,2, Chung CK1,2,3,4, Choi Y5, Kuo CC6, Lee U4, Yang SH1,2, Lee CH1,2, Jung JM7, Hwang SH1,2, Kim DH1,2, Yoon JH1,2, Paik S1,8, Lee HJ1,8, Jung S1,8, Park SB1,2,9, Kim KT10,11, Park HP12,13.

Author information

1
Department of Neurosurgery, Seoul National University Hospital, Seoul, South Korea.
2
Department of Neurosurgery, Seoul National University College of Medicine, Seoul, South Korea.
3
Department of Brain and Cognitive Sciences, Seoul National University Hospital, Seoul, South Korea.
4
Human Brain Function Laboratory, Department of Neurosurgery, Seoul National University Hospital, Seoul, South Korea.
5
Division of Medical Statistics, Medical Research Collaborating Center, Seoul National University Hospital, Seoul, South Korea.
6
Regional Spine Surgery Department, Kaiser Permanente, Oakland, California.
7
Department of Neurosurgery, Seoul National University Bundang Hospital, Kyung-gi, South Korea.
8
Department of Nursing, Seoul National University Hospital, Seoul, South Korea.
9
Department of Neurosurgery, Seoul National University Boramae Hospital, Boramae Medical Center, Seoul, South Korea.
10
Department of Neurosurgery, Kyungpook National University Hospital, Daegu, South Korea.
11
Department of Neurosurgery, School of Medicine, Kyungpook National University, Daegu, South Korea.
12
Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, South Korea.
13
Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, South Korea.

Abstract

BACKGROUND:

In cervical open-door laminoplasty for cervical myelopathy, a high-speed rotatory drill and rongeurs are used to make unicortical troughs and bicortical openings in the laminae. The lamina is reflected at the trough to enlarge the spinal canal, followed by bone healing on the hinge side to stabilize laminoplasty. The ultrasonic bone scalpel (UBS) has been used due to theoretical advantages including a better hinge union rate, less soft tissue trauma, less neurological injury, and shorter operative time.

OBJECTIVE:

To assess the superiority of UBS for hinge union compared to the drill through randomized controlled trial.

METHODS:

In 190 randomly allocated cervical myelopathy patients, the trough and opening at the lamina were made using either the drill (n = 95) or UBS (n = 95) during 2015 to 2018. The primary outcome was the hinge union rate on 6-mo postoperative computed tomography. Secondary outcomes included the hinge union rate at 12 mo, the operative time, intraoperative/postoperative bleeding, neurological injury, complications, and clinical outcomes over a 24-mo follow-up.

RESULTS:

Hinge union in all laminae was achieved in 60.0% (drill) and 43.9% (UBS) of patients at 6 mo (intention-to-treat analysis; P = .02; odds ratio, 2.1) and in 91.9% (drill) and 86.5% (UBS) at 12 mo. Dural injury only occurred in the drill group (2.1%), and the UBS group showed significantly less intraoperative bleeding (P < .01). The other secondary outcomes did not differ between groups.

CONCLUSION:

The hinge union rate was inferior in the UBS group at 6 mo postoperatively, but UBS was efficacious in reducing dural injuries and bleeding.

KEYWORDS:

Cervical vertebra; Laminectomy; Laminoplasty; Spinal cord compression; Spinal fusion; Surgery; Ultrasonic osteotome

PMID:
31435653
DOI:
10.1093/neuros/nyz301

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