Ultrasonic bone scalpel for thoracic spinal decompression: case series and technical note

Area of Science:

• Neurosurgery
• Spinal Surgery
• Minimally Invasive Techniques

Background:

• Thoracic spinal stenosis (TSS) is a challenging condition often resistant to conservative treatments.
• Traditional thoracic spinal decompression is technically demanding, time-consuming, and associated with complications.
• The ultrasonic bone scalpel (UBS) shows promise for spinal operations, but its specific application in thoracic decompression requires clarification.

Purpose of the Study:

• To describe the surgical experience and technique using the ultrasonic bone scalpel (UBS) for thoracic spinal decompression.
• To establish a standard operating procedure for UBS-assisted thoracic spinal decompression.

Main Methods:

• A consecutive series of 28 patients with TSS underwent posterior thoracic spinal decompression using UBS.
• Data collected included demographics, complications, operative time, blood loss, and pre/postoperative neurological status.
• Neurological status was assessed using the modified Japanese Orthopaedic Association (JOA) scale and Hirabayashi's Method for recovery rate calculation.

Main Results:

• All 28 patients successfully underwent decompression via a single posterior approach.
• Mean operative time for single-segment laminectomy was 3.0 ± 1.4 min with average blood loss of 108.3 ± 47.3 ml.
• Postoperative JOA scores improved from 4.7 to 10.1, with an average neurological recovery rate of 85.8% over a mean follow-up of 39.7 months.

Conclusions:

• The ultrasonic bone scalpel (UBS) is an optimal instrument for safe and effective thoracic spinal decompression.
• The developed standard operating procedure facilitates favorable outcomes in treating various causes of TSS.
• UBS application in thoracic decompression offers a viable alternative to traditional methods.