Assistant Professor of Neurosurgery and Orthopaedics Vanderbilt University Medical Center Nashville, Tennessee, United States
Introduction: Despite recent advances in instruments and surgical techniques, the incidence of dural injuries caused by traditional lumbar laminectomy techniques is considerable. The ultrasonic bone scalpel (UBS) uses high-frequency oscillation to create localized tissue disruption and preferentially cut through hard surfaces such as bone. We sought to evaluate whether the use of the UBS in lumbar laminectomies would result in equivalent safety, efficacy, and PROs compared to traditional methods.
Methods: Data from a prospectively collected, single-institution registry was queried between 01/01/2019 - 09/01/2021 for patients with a primary diagnosis of lumbar stenosis who underwent an isolated laminectomy, laminectomy and fusion, or laminectomy and fusion with an interbody. Two patient groups included: laminectomies using traditional methods vs UBS method. Outcomes included 3-month values for all PROMIS subdomains, NRS pain scores, ODI percentage, and PHQ-9 scores, as well as complications, reoperations, and readmissions within 3 months. Laminectomies by traditional methods were propensity matched against laminectomies by the UBS in 2:1 fashion.
Results: 231 traditional method patients were propensity matched against 32 UBS method patients, resulting in 64 “traditional group” patients and 32 “UBS group” patients. Analysis found no differences in demographic or baseline measures except for race and ethnicity. There were no differences between groups at 3 months for all PROMIS subdomain scores, NRS back/leg pain scores, %ODI or PHQ-9. There was a significant difference in rates of durotomies between the traditional and UBS groups (12.5% vs 0.0%, p=0.049). No differences were found in any other complication rate, reoperation rates, or readmission rates.
Conclusion : Our results suggest that using the UBS may help reduce the incidence of durotomies. This data provides valuable information to surgeons about the safety and efficacy of the UBS in lumbar laminectomies. Further studies should investigate if the UBS decreases operative time for lumbar laminectomies compared to traditional methods.
