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VOL. 4, ISSUE 2 (2022)
Effectiveness of ultrasonic bone scalpel in cervical myelopathy: A case series
Authors
Sagarkumar Babulal Usdadia, Pratik Prajapati, Hardik Hadia, Dhruv Patel
Abstract
Study design: Retrospective case study Aims and Objectives: To know functional outcome and safety of cervical laminectomy done by ultrasonic bone scalpel. Introduction: Cervical spondylotic compressive myelopathy is managed by laminectomy done with either conventional methods by using Kerrison rongeur, high speed drill or ultrasonic bone scalpel in selected patients in whom risk of post-operative cervical kyphosis is minimal. Conventional methods having theoretically more risk of dural injury, neural damage, thermal injuries while ultrasonic bone scalpel provides easy way of doing laminectomy with shorter duration of time. Methodology: This study comprises total 44 patients operated by single surgeon between January 2016 to February 2020. All patient operated by using ultrasonic bone scalpel. Clinical parameter including demographics, affected spinal levels, symptoms, intra and post-operative complications were noted. Patients had pre- and post-operative assessment with modified Japanese Orthopedic Association score (JOA), nurick grading and visual analogue score. Minimal follow up was 10 months with regular interval assessments. Results: This study includes 44 patients with minimum 10 month follow ups. Laminectomy made at total 163 levels. Average time taken for removal of single lamina was 3.7±0.6 min. Expected blood loss occur during surgery was 131.3±23.9 ml and average length of hospital stays was 6.5±0.87 days. Mean canal compression rate was 42.6±8.9%. Mean pre-op mJOA score is 9.2±2.82 and average post-op mJOA score is 14±3.81. Recovery rate in our study is 59.7±29.2%. There is one case of dural tear and deep infection, 2 cases of C5 nerve palsy, 3 cases of delayed wound healing. Conclusion: Cervical laminectomy is frequently used approach for cervical spondylotic myelopathy. Laminectomy done by using ultrasonic bone scalpel which is safe, rapid and having less complications like dural injury, thermal injury, neurological deterioration, blood loss and also decreases hospital admission days. To prevent dural injury, put ultrasonic blade as horizontal to dura, don’t put blade at single point for long time and constant irrigation help to prevent thermal injury. Pre-operative identification of calcified dura and leaving thin inner cortex which is subsequently break by twisting of osteotome may help to reduce dural injury.
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Pages:34-40
How to cite this article:
Sagarkumar Babulal Usdadia, Pratik Prajapati, Hardik Hadia, Dhruv Patel "Effectiveness of ultrasonic bone scalpel in cervical myelopathy: A case series". International Journal of Orthopaedics Research, Vol 4, Issue 2, 2022, Pages 34-40
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