Department of Neurological Surgery, The George Washington University Hospital, Washington, District of Columbia, USA.
Department of Neurological Surgery, The George Washington University Hospital, Washington, District of Columbia, USA.
World Neurosurg. 2024 May;185:e387-e396. doi: 10.1016/j.wneu.2024.02.037. Epub 2024 Feb 11.
Spinal decompression and osteotomies are conventionally performed using high-speed drills (HSDs) and rongeurs. The ultrasonic bone scalpel (UBS) is a tissue-specific osteotome that preferentially cuts bone while sparing the surrounding soft tissues. There is ongoing investigation into its ability to optimize peri- and postoperative outcomes in spine surgery. The purpose of this study was to compare the intraoperative metrics and complications during a transition period from HSD to UBS.
A single-institution, single-surgeon retrospective analysis was conducted of patients undergoing spine surgery from January 2020 to December 2021. Statistical analyses were performed to detect associations between the surgical technique and outcomes of interest. A P value < 0.05 was considered statistically significant.
A total of 193 patients met the inclusion criteria (HSD, n = 100; UBS, n = 93). Multivariate logistic regression revealed similar durotomy (P = 0.10), nerve injury (P = 0.20), and reoperation (P = 0.68) rates. Although the estimated blood loss (EBL) and length of stay were similar, the operative time was significantly longer with the UBS (192.81 vs. 204.72 minutes; P = 0.03). Each subsequent surgery using the UBS revealed a 3.1% decrease in the probability of nerve injury (P = 0.026) but had no significant effects on the operative time, EBL, or probability of durotomy or reoperation.
The UBS achieves outcomes on par with conventional tools, with a trend toward a lower incidence of neurologic injury. The expected reductions in EBL and durotomy were not realized in our cohort, perhaps because of a high proportion of revision surgeries, although these might be dependent on surgeon familiarity, among other operative factors. Future prospective studies are needed to validate our results and further refine the optimal application of this device in spine surgery.
传统上，脊柱减压和截骨术使用高速钻头（HSD）和咬骨钳进行。超声骨刀（UBS）是一种组织特异性截骨刀，它优先切割骨骼，同时保护周围的软组织。目前正在研究它在脊柱手术中优化围手术期结果的能力。本研究的目的是比较从 HSD 过渡到 UBS 期间的术中指标和并发症。
对 2020 年 1 月至 2021 年 12 月期间接受脊柱手术的单机构、单外科医生回顾性分析。进行了统计分析，以检测手术技术与感兴趣结果之间的关联。P 值<0.05 被认为具有统计学意义。
共有 193 名患者符合纳入标准（HSD，n=100；UBS，n=93）。多变量逻辑回归显示，硬膜切开（P=0.10）、神经损伤（P=0.20）和再次手术（P=0.68）的发生率相似。虽然估计失血量（EBL）和住院时间相似，但 UBS 的手术时间明显更长（192.81 与 204.72 分钟；P=0.03）。使用 UBS 进行的每一次后续手术，神经损伤的概率降低 3.1%（P=0.026），但对手术时间、EBL 或硬膜切开或再次手术的概率没有显著影响。
UBS 的结果与传统工具相当，神经损伤的发生率呈下降趋势。在我们的队列中，预计 EBL 和硬膜切开的减少并没有实现，这可能是由于翻修手术的比例较高，但这可能取决于外科医生的熟悉程度，以及其他手术因素。需要进一步开展前瞻性研究来验证我们的结果，并进一步完善该设备在脊柱手术中的最佳应用。
