Segerlind Jenny Petterson, Staartjes Victor E, El-Hajj Victor Gabriel, Edström Erik, Elmi-Terander Adrian
Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
MICN Laboratory, University Hospital of Zurich, Zurich, Switzerland.
Eur Spine J. 2025 Jul 21. doi: 10.1007/s00586-025-09155-7.
Posterior access in the form of (hemi-)laminectomy or laminoplasty is necessary for the treatment of intradural extramedullary tumors. Most frequently, this is carried out using high-speed burrs, rongeurs, and osteotomes. Recently, the principle of piezoelectrically generated high-frequency ultrasonic osteotomy (hfUSO) has become widely available, and promises several advantages including potentially reduced incidental durotomy, compression damage, and heat exchange.
We carry out a single-center cohort study comparing hfUSO-based laminoplasty vs. conventional laminectomy, and including all patients treated for spinal intradural extramedullary tumors using a posterior approach from 2005 to 2020. Patients with missing outcome data were excluded. Exact matching was used for spinal level (cervical, thoracic, and lumbosacral), number of segments operated, and tumor subtype, while age was matched with a ± 10-year tolerance. After matching, two-tailed intergroup comparisons were made. Clinical outcomes analyzed included procedural (operating time, estimated blood loss), perioperative (length of stay, readmission), and complication (reoperation, infection, hematoma, cerebrospinal fluid [CSF] leakage) data.
From 305 eligible patients, 104 had been treated using hfUSO. Accordingly, another 104 patients treated without the use of hfUSO were matched. The two groups (hfUSO vs. conventional) appeared well-matched for baseline data. With hfUSO, operating time was reduced (147 vs. 181 min, p = 0.009) as was length of hospital stay (3 vs. 5 days, p = 0.009). Estimated blood loss was comparable among groups (150 vs. 200 mL, p = 0.137). Overall, there was no change in rate of complications, reoperations, and readmissions (all p > 0.05).
When applied to posterior access, use of hfUSO-based laminoplasty demonstrated its effectiveness and safety, achieving comparable if not slightly superior clinical endpoints when contrasting with conventional laminectomy using high-speed burrs, rongeurs, and osteotomes. Apart from potential ergonomic benefits, the hfUSO technique was associated with relevantly decreased operating time (even with the added laminoplasty step) and length of stay as well as a comparably low blood loss, without increased device-related or overall complications.
（半）椎板切除术或椎板成形术形式的后路入路对于治疗硬膜内髓外肿瘤是必要的。最常见的是使用高速磨钻、咬骨钳和骨凿来进行。最近，压电产生的高频超声截骨术（hfUSO）原理已广泛应用，有望带来多种优势，包括可能减少意外硬脊膜切开、压迫损伤和热交换。
我们开展了一项单中心队列研究，比较基于hfUSO的椎板成形术与传统椎板切除术，并纳入2005年至2020年期间所有采用后路入路治疗脊髓硬膜内髓外肿瘤的患者。排除结局数据缺失的患者。在脊柱节段（颈椎、胸椎和腰骶椎）、手术节段数和肿瘤亚型方面进行精确匹配，年龄匹配的容忍度为±10岁。匹配后，进行两组间的双尾比较。分析的临床结局包括手术相关（手术时间、估计失血量）、围手术期（住院时间、再次入院）和并发症（再次手术、感染、血肿、脑脊液漏）数据。
在305例符合条件的患者中，104例采用hfUSO治疗。相应地，另外104例未使用hfUSO治疗的患者进行了匹配。两组（hfUSO组与传统组）的基线数据匹配良好。采用hfUSO时，手术时间缩短（147分钟对181分钟，p = 0.009），住院时间也缩短（3天对5天，p = 0.009）。两组间估计失血量相当（150毫升对200毫升，p = 0.137）。总体而言，并发症、再次手术和再次入院率没有变化（所有p > 0.05）。
当应用于后路入路时，基于hfUSO的椎板成形术证明了其有效性和安全性，与使用高速磨钻、咬骨钳和骨凿的传统椎板切除术相比，即使没有略微更优，也能达到相当的临床终点。除了潜在的人体工程学益处外，hfUSO技术还与手术时间显著缩短（即使增加了椎板成形术步骤）、住院时间缩短以及失血量相当相关，且与器械相关或总体并发症没有增加。
