Abstract
Introduction
Spinal surgery requires microscopic bone removal, in which high speed drills are used. However, the spinning and increased heat production when drilling with diamond burrs under the microscope may cause damage to the soft tissues such as the dura, nerve roots, the cord and vessels. Ultrasonic bone removers have been introduced to spine surgery recently. We review the clinical application of different types of ultrasonic bone removers in spine surgery and discuss technical points, the safety and efficacy of ultrasonic bone shaver in various spinal surgeries.
Material and Methods
Between June 2010 and January 2014, 307 patients with various spinal diseases were operated with the use of Misonix ultrasonic bone curette with microhook shaver (MUBS). Patients' demographics, disease type, surgery performed and complications and follow up were recorded.
Results
Among the 307 patients, 33 (10,7%) cases had cervical disorder, 17 (%5,5) thoracic disorder, 3(0,9%) foramen magnum disorder and 254 (82,7%) cases had lumbar disorders. Hemilaminectomy, limited-extended foraminotomy, revision lumbar disc surgery, corpectomy, osteophytectomy and laminoplasty were performed either assisted-or alone by MUBS. The duration of the operations was comparable with conventional spine surgeries, and the need for blood replacement was relatively low. The one year follow up with Neck Disability Index (NDI) and Oswestry Disability Index Scores (ODI) were comparable with conventional studies. We had 5 cases of dural tears (1.6%) in patients with lumbar spinal disease.
Conclusion
MUBS does not produce excessive heat and is a useful instrument for procedures performed in narrow epidural spaces near the dura mater. According to our experience; it is also a safe tool with very low complications rates after the learning curve is reached. We recommend this device as an assistant tool in various spine surgeries, and as a primary tool in foraminatomies.