Application of Ultrasonic Osteotome in Segmental Resection and Removal of Cage During Revision Surgery for...

Cage removal is essential in revision surgery for intervertebral disc space infection (IVDS). The aim of this study is to investigate the effectiveness and safety of using ultrasonic osteotome in segmental resection and removal of cage during revision surgery for IVDS after lumbar fusion.

We retrospectively reviewed 32 patients who underwent revision surgery for IVDS infection after lumbar fusion in our hospital from June 2018 to November 2024. The operation time, blood loss, nerve damage, success rate of removal, infection control, and fusion rate were compared between the traditional whole removal method (n = 15) and the ultrasonic osteotome-based segmental excision method (n = 17).

The average incision length and hospital stay were not significantly different between the two groups (p > 0.05). Nevertheless, the time taken for removing the cage, the success rate of cage removal, intraoperative blood loss, and postoperative drainage were significantly improved in the ultrasonic osteotome group compared with the traditional surgery group (p < 0.05). The assessment of postoperative recovery at 7 days and 1, 3, 12 months postoperation demonstrated significant improvements in VAS and ODI scores compared with the preoperative values in both groups. However, within-group and between-group analyses did not reveal significant differences at these intervals, even up to the 12-month evaluation (p > 0.05). Contrast-enhanced lumbar MRI scans conducted for the 32 patients at 3 months postoperation confirmed successful infection control among all patients. Both groups demonstrated no incidence of dural tears, cerebrospinal fluid leakages, or wound infection. In contrast, incisional fat liquefaction occurred in one and two patients in the ultrasonic osteotome and traditional surgery group, respectively, with all patients exhibiting satisfactory resolution following appropriate wound care. Moreover, a slight deterioration in the extensor muscle strength of the great toe was observed in two patients and an exacerbation of foot dorsum numbness was detected in one patient in the traditional surgery group, with all symptoms fully resolving within the 3-month follow-up period. In contrast, the ultrasonic osteotome group showed no such significant neurological function impairments. At 1-year postoperation, bone fusion was confirmed in both groups via CT reconstructions of the lumbar spine.

Compared with the traditional whole removal method, the ultrasonic osteotome-based segmental excision method has the advantages of shorter and controllable operation time, lower blood loss, higher success rate of removal, and lower risk of nerve damage, making it uniquely valuable in the revision surgery for IVDS infection after lumbar fusion.