- Department of Neurosurgery, Southern TOHOKU General Hospital, Southern TOHOKU Research Institute for Neuroscience, Japan
- Center for Spine and Spinal Cord Disorders, Southern TOHOKU General Hospital, Japan
- Global Spine, 7-115 Yatsuyamada Koriyama, Fukushima 963-8563, Japan
Global Spine, 7-115 Yatsuyamada Koriyama, Fukushima 963-8563, Japan
DOI:10.4103/2152-7806.97542Copyright: © 2012 Matsuoka H. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
How to cite this article: Matsuoka H, Itoh Y, Numazawa S, Tomii M, Watanabe K, Hirano Y, Nakagawa H. Recapping hemilaminoplasty for spinal surgical disorders using ultrasonic bone curette. Surg Neurol Int 19-Jun-2012;3:70
How to cite this URL: Matsuoka H, Itoh Y, Numazawa S, Tomii M, Watanabe K, Hirano Y, Nakagawa H. Recapping hemilaminoplasty for spinal surgical disorders using ultrasonic bone curette. Surg Neurol Int 19-Jun-2012;3:70. Available from: http://sni.wpengine.com/surgicalint_articles/recapping-hemilaminoplasty-for-spinal-surgical-disorders-using-ultrasonic-bone-curette/
Objective:The authors present a novel method of the recapping hemilaminoplasty in a retrospective study of patients with spinal surgical disorders. This report describes the surgical technique and the results of hemilaminoplasty using an ultrasonic bone curette. The aim of this study was to examine the safety and effectiveness of the hemilaminoplasty technique with ultrasonic bone curette.
Methods:Between April 2003 and July 2011, 33 patients with various spinal diseases (17 spinal tumors, 5 dural arteriovenous fistulas, 3 syringomyelia, 2 sacral perineural cysts, and 2 arachnoid cysts) were treated microsurgically by using an ultrasonic bone curette with scalpel blade and lightweight handpiece. The ultrasonic bone curette was used for division of lamina. After resection of the lesion, the excised lamina was replaced exactly in situ to its original anatomic position with a titanium plate and screw. Additional fusion technique was not required and the device was easy to handle. All patients were observed both neurologically and radiologically by dynamic plain radiographs and computed tomography (CT) scan.
Results:The operation was performed successfully and there were no instrument-related complications such as dural laceration, nerve root injury, and vessels injury. The mean number of resected and restored lamina was 1.7. CT confirmed primary bone fusion in all patients by 12 months after surgery.
Conclusion:The ultrasonic bone curette is a useful instrument for recapping hemilaminoplasty in various spinal surgeries. This method allows anatomical reconstruction of the excised bone to preserve the posterior surrounding tissues.
Keywords: Recapping hemilaminoplasty, spinal surgery, ultrasonic bone curette
The laminoplasty technique is the most widely used procedure in cervical spinal surgery. Hemilaminoplasty with ultrasonic bone curette SONOPET® (Striker Co. Ltd., Tokyo, Japan) was reported as a bone-cutting device.[
Between April 2003 and July 2011, 33 patients with various spinal diseases (17 spinal tumors, 5 dural arteriovenous fistulas, 3 syringomyelia, 2 sacral perineural cysts, and 2 arachnoid cysts) underwent surgeries by the combined use of the ultrasonic bone curette SONOPET® and scalpel blade [
Surgical technique of recapping hemilaminoplasty
Laminotomy is carefully performed using the ultrasonic bone curette with scalpel blade protecting dura mater with a cottonoid in the epidural space [
Schematic drawings of recapping hemilaminoplasty using ultrasonic bone curette with scalpel blade (axial views). (a) After unilateral separation of the paravertebral muscles, cutting of the lamina just medial to the facet joints and pedicle. (b) Cutting of the lamina obliquely at the base of the spinous process; (c) the intradural procedure can be done; (d) the lamina restored to the original site was fixed with titanium miniplates and screws
Recapping hemilaminoplasty was done safely to obtain an enough wider laminotomy space in 33 patients. The average of the operation time and the operation time per lamina were 243 ± 70.1 and 162 ± 72.5 min, respectively. There were no major complications such as cord injury, root injury, and CSF fistula. Dural laceration did not occur during the manipulation with the ultrasonic bone curette.
Bone CT scans and dynamic X-rays confirmed primary bone fusion in all patients within 12 months after surgery. No signs of spinal column deformity such as kyphosis or sinking of the replaced lamina were noted in any patient during the follow-up period.
Laminoplasty has been developed to prevent postoperative spinal instability or kyphotic deformity. Laminoplasty might be a useful procedure to decrease postlaminectomy membrane. Several kinds of laminoplasties have been reported by spinal surgeons. These are divided into expansive and nonexpansive methods, depending on the enlargement of the spinal canal after laminoplasty was performed.
We describe a simple method for nonexpansive laminoplasty performed with a scalpel blade type ultrasonic bone curette with scalpel blade. The first report about recapping hemilaminoplasty using the scalpel blade type ultrasonic bone curette was published in 2009.[
The disadvantages of this method include a somewhat longer operation time during laminotomy as compared with conventional laminectomy, although this did not cause significant complications in the patients we treated. Additionally, we guess it will initially be technically difficult for the beginner to do this procedure. This new method, termed recapping laminoplasty, has several advantages during operation compared with conventional laminoplasty. Therefore, it can be applied widely to various spinal surgeries.
The ultrasonic bone curette is a useful, safe instrument for recapping hemilaminoplasty while avoiding excessive heat production and mechanical injury. This method provides sufficient exposure for intraspinal canal procedures and allows preservation of posterior spinal elements. This procedure with the ultrasonic bone curette is recommended for various spinal surgeries.
The authors express their sincere gratitude to Mr. Shunji Ono (Ammtec Co., Tokyo, Japan) for his technical support in preparing the surgical diagrams.
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