Safety and reliability of ultrasonic bone curette on the spinal decompression procedure in patients with thoracic spinal stenosis

English Keywords:Spinal stenosis  Thoracic spine  Operation  Ultrasonic bone curette

English Abstract:

  【Abstract】 Objectives: To evaluate the safety and reliability of ultrasonic bone curette on spinal decompression procedure in patients with thoracic spinal stenosis. Methods: Twenty-eight patients who underwent posterior decompression surgery due to thoracic spinal canal sternosis by using ultrasonic bone curette between December 2014 and May 2015 were collected, posterior decompressive laminectomy was performed in 16 patients with 55 segments, and 12 patients with 44 segments underwent circumferential decompression further. Location of spinal decompression, operation time of decompressive laminectomy, blood loss as well as perioperative complications such as durotomy, cerebrospinal fluid leak, injury of nerve root and spinal cord were recorded. The improvements of clinical symptoms were analyzed on the 5th day after operation. All the indexes above mentioned were used to evaluate the outcome of the application of ultrasonic bone curette. Results: Among these twenty-eight patients, the average time for each segment was 3.0±1.4min (range, 2.0-5.7min). In the 16 patients performed by simple posterior decompressive laminectomy, the average blood loss for each segment was 108.3±47.3ml(range, 50.0-200.0ml). In the 12 patients who underwent circumferential decompression further, the blood loss was 513.8±217.0ml(range, 255.0-800.0ml). No patient suffered from intraoperative dural matter tearing and cerebrospinal fluid leakage due to the application of ultrasonic bone curette. Among the 28 patients(99 segments) treated by ultrasonic bone curette, 2 patients suffered from unilateral T2 and T4 nerve root injury during posterior laminectomy, and one patient experienced new-onset radiation pain in chest wall due to severe ossification of ligmentum flavum, which was cured by conservative treatment. While the other patient presented with no discomfort complaint. The syndromes of these 28 patients relieved in various degrees and no patients had neurological deficits postoperatively. Conclusions: The ultrasonic bone curette is safe and effective for thoracic spinal stenosis. When it is used in extremely stenosis segment, nerve root injury is not uncommon, which can be avoided by cautioning the cutting depth of the ultrasonic bone curette.