Application of ultrasonic osteotome in the posterior lumbar interbody fusion surgery by unilateral fenestration and bilateral decompression in the treatment of degenerative lumbar spinal stenosis_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LIAO Yehui ¹ , YE Rupei ² , TANG Qiang ¹ , TANG Chao ¹ , MA Fei ¹ , LUO Ning ¹ , WANG Gaoju ¹ , WANG Qing ¹ ,  ZHONG Dejun ¹

1. Department of Spinal Surgery, the Affiliated Hospital of Southwest Medical University, Luzhou Sichuan, 646000, P.R.China;
2. Department of Pathology, the Affiliated Hospital of Southwest Medical University, Luzhou Sichuan, 646000, P.R.China;

Corresponding author：

ZHONG Dejun, Email: zdj_1974@163.com

Keywords：

Ultrasonic osteotome; degenerative lumbar spinal stenosis; unilateral fenestration; bilateral decompression; posterior lumbar interbody fusion

DOI：

10.7507/1002-1892.201808037

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Objective To compare the effectiveness of posterior lumbar interbody fusion (PLIF) by unilateral fenestration and bilateral decompression with ultrasounic osteotome and traditional tool total laminectomy decompression PLIF in the treatment of degenerative lumbar spinal stenosis. Methods The clinical data of 48 patients with single-stage degenerative lumbar spinal stenosis between January 2017 and June 2017 were retrospectively analyzed. Among them, 27 patients were treated with unilateral fenestration and bilateral decompression PLIF with ultrasonic osteotome (group A), and 21 patients were treated with total laminectomy and decompression PLIF with traditional tools (group B). There was no significant difference in gender, age, stenosis segment, degree of spinal canal stenosis, and disease duration between the two groups (P>0.05), which was comparable. The time of laminectomy decompression, intraoperative blood loss, postoperative drainage volume, and the occurrence of operation-related complications were recorded and compared between the two groups. Bridwell bone graft fusion standard was applied to evaluate bone graft fusion at last follow-up. Visual analogue scale (VAS) score was used to evaluate the patients’ lumbar and back pain at 3 days, 3 months, and 6 months after operation. Oswestry disability index (ODI) score was used to evaluate the patients’ lumbar and back function improvement before operation and at 6 months after operation. Results The time of laminectomy decompression in group A was significantly longer than that in group B, and the intraoperative blood loss and postoperative drainage volume were significantly less than those in group B (P<0.05). There was no nerve root injury, dural tear, cerebrospinal fluid leakage, and hematoma formation during and after operation in the two groups. All patients were followed up after operation, the follow-up time in group A was 6-18 months (mean, 10.5 months) and in group B was 6-20 months (mean, 9.3 months). There was no complication such as internal fixation fracture, loosening and nail pulling occurred during the follow-up period of the two groups. There was no significant difference in VAS scores between the two groups at 3 days after operation (t=1.448, P=0.154); the VAS score of group A was significantly lower than that of group B at 3 and 6 months after operation (P<0.05). The ODI scores of the two groups were significantly improved at 6 months after operation (P<0.05), and there was no significant difference in ODI scores between the two groups before operation and at 6 months after operation (P>0.05). At last follow-up, according to Bridwell criteria, there was no significant difference in bone graft fusion between the two groups (Z=–0.065, P=0.949); the fusion rates of groups A and B were 96.3% (26/27) and 95.2% (20/21) respectively, with no significant difference (χ²=0.001, P=0.979 ). Conclusion The treatment of lumbar spinal stenosis with unilateral fenestration and bilateral decompression PLIF with ultrasonic osteotome can achieve similar effectiveness as traditional tool total laminectomy and decompression PLIF, reduce intraoperative blood loss and postoperative drainage, and reduce lumbar back pain during short-term follow-up. It is a safe and effective operation method.

Citation： LIAO Yehui, YE Rupei, TANG Qiang, TANG Chao, MA Fei, LUO Ning, WANG Gaoju, WANG Qing, ZHONG Dejun. Application of ultrasonic osteotome in the posterior lumbar interbody fusion surgery by unilateral fenestration and bilateral decompression in the treatment of degenerative lumbar spinal stenosis. Chinese Journal of Reparative and Reconstructive Surgery, 2019, 33(4): 416-422. doi: 10.7507/1002-1892.201808037 Copy

1.	Azimi P, Mohammadi HR, Benzel EC, et al. Lumbar spinal canal stenosis classification criteria: a new tool. Asian Spine J, 2015, 9(3): 399-406.
2.	Ulutaş M, Yaldız C, Seçer M, et al. Comparison of wiltse and classical methods in surgery of lumbar spinal stenosis and spondylolisthesis. Neurol Neurochir Pol, 2015, 49(4): 251-257.
3.	李玉伟, 王海蛟, 崔巍, 等. 超声骨刀在颈椎后路单开门椎管扩大成形术中的应用. 中国修复重建外科杂志, 2017, 31(6): 683-689.
4.	胡博文, 周春光, 杨曦, 等. 经后路超声骨刀双侧切除齿状突治疗颅底凹陷症合并不可复性寰枢关节脱位一例. 中国修复重建外科杂志, 2017, 31(12): 1523-1525.
5.	陈萧霖, 曾岩, 陈仲强, 等. 超声骨刀与传统工具在退变性腰椎侧凸减压截骨术中的应用比较. 中国脊柱脊髓杂志, 2017, 27(5): 418-422.
6.	Morimoto D, Isu T, Kim K, et al. Microsurgical medial fenestration with an ultrasonic bone curette for lumbar foraminal stenosis. J Nippon Med Sch, 2012, 79(5): 327-334.
7.	Kalichman L, Cole R, Kim DH, et al. Spinal stenosis prevalence and association with symptoms: the Framingham Study. Spine J, 2009, 9(7): 545-550.
8.	Bridwell KH, Lenke LG, McEnery KW, et al. Anterior fresh frozen structural allografts in the thoracic and lumbar spine. Do they work if combined with posterior fusion and instrumentation in adult patients with kyphosis or anterior column defects? Spine (Phila Pa1976), 1995, 20(12): 1410-1418.
9.	陈颖, 罗晓宇, 史文勇, 等. 超声手术刀的研制现状与应用. 生物医学工程学杂志, 2005, 22(2): 377-380.
10.	Ying C, Zhaoying Z, Ganghua Z, et al. Effects of different tissue loads on high power ultrasonic surgery scalpel. Ultrasound Med Biol, 2006, 32(3): 415-420.
11.	Nickele C, Hanna A, Baskaya MK. Osteotomy for laminoplasty without soft tissue penetration, performed using a harmonic bone scalpel: instrumentation and technique. J Neurol Surg A Cent Eur Neurosurg, 2013, 74(3): 183-186.
12.	Hazer DB, Yaşar B, Rosberg HE, et al. Technical aspects on the use of ultrasonic bone Shaver in spine surgery: experience in 307 patients. Biomed Res Int, 2016, 2016: 8428530.
13.	Onen MR, Yuvruk E, Akay S, et al. The reliability of the ultrasonic bone scalpel in cervical spondylotic myelopathy: a comparative study of 46 patients. World Neurosurg, 2015, 84(6): 1962-1967.
14.	徐宝山, 马信龙, 胡永成, 等. 可动式椎间盘镜下单侧开窗双侧减压椎体间融合术治疗复杂的腰椎管狭窄症. 中华骨科杂志, 2016, 36(12): 753-760.
15.	闫立伟, 王文波. 单侧开窗潜行减压治疗双侧腰椎管狭窄的临床研究. 哈尔滨医科大学学报, 2014, 48(6): 509-512.
16.	Sanderson PL, Getty CJ. Long-term results of partial undercutting facetectomy for lumbar lateral recess stenosis. Spine (Phila Pa 1976), 1996, 21(11): 1352-1356.
17.	Sanborn MR, Balzer J, Gerszten PC, et al. Safety and efficacy of a novel ultrasonic osteotome device in an ovine model. J Clin Neurosci, 2011, 18(11): 1528-1533.
18.	田伟, 郎昭. 进一步促进骨磨削技术在脊柱外科的应用. 中华医学杂志, 2015, 95(13): 961-964.
19.	王岩, 陈仲强, 孙垂国. 超声骨刀在胸椎管狭窄症手术中应用的有效性与安全性. 中国脊柱脊髓杂志, 2015, 25(6): 518-523.
20.	张吉涛, 陈佳, 李政, 等. 超声骨刀在脊髓型颈椎病全椎板切除术中的应用. 中国脊柱脊髓杂志, 2018, 28(3): 234-238.
21.	Cho KJ, Suk SI, Park SR, et al. Complications in posterior fusion and instrumentation for degenerative lumbar scoliosis. Spine (Phila Pa 1976), 2007, 32(20): 2232-2237.
22.	赵会, 胡辰甫, 海涌. 脊柱畸形矫形术后严重并发症危险因素分析. 中华医学杂志, 2016, 96(23): 1815-1817.
23.	Hu X, Ohnmeiss DD, Lieberman IH. Use of an ultrasonic osteotome device in spine surgery: experience from the first 128 patients. Eur Spine J, 2013, 22(12): 2845-2849.

1. Azimi P, Mohammadi HR, Benzel EC, et al. Lumbar spinal canal stenosis classification criteria: a new tool. Asian Spine J, 2015, 9(3): 399-406.
2. Ulutaş M, Yaldız C, Seçer M, et al. Comparison of wiltse and classical methods in surgery of lumbar spinal stenosis and spondylolisthesis. Neurol Neurochir Pol, 2015, 49(4): 251-257.
3. 李玉伟, 王海蛟, 崔巍, 等. 超声骨刀在颈椎后路单开门椎管扩大成形术中的应用. 中国修复重建外科杂志, 2017, 31(6): 683-689.
4. 胡博文, 周春光, 杨曦, 等. 经后路超声骨刀双侧切除齿状突治疗颅底凹陷症合并不可复性寰枢关节脱位一例. 中国修复重建外科杂志, 2017, 31(12): 1523-1525.
5. 陈萧霖, 曾岩, 陈仲强, 等. 超声骨刀与传统工具在退变性腰椎侧凸减压截骨术中的应用比较. 中国脊柱脊髓杂志, 2017, 27(5): 418-422.
6. Morimoto D, Isu T, Kim K, et al. Microsurgical medial fenestration with an ultrasonic bone curette for lumbar foraminal stenosis. J Nippon Med Sch, 2012, 79(5): 327-334.
7. Kalichman L, Cole R, Kim DH, et al. Spinal stenosis prevalence and association with symptoms: the Framingham Study. Spine J, 2009, 9(7): 545-550.
8. Bridwell KH, Lenke LG, McEnery KW, et al. Anterior fresh frozen structural allografts in the thoracic and lumbar spine. Do they work if combined with posterior fusion and instrumentation in adult patients with kyphosis or anterior column defects? Spine (Phila Pa1976), 1995, 20(12): 1410-1418.
9. 陈颖, 罗晓宇, 史文勇, 等. 超声手术刀的研制现状与应用. 生物医学工程学杂志, 2005, 22(2): 377-380.
10. Ying C, Zhaoying Z, Ganghua Z, et al. Effects of different tissue loads on high power ultrasonic surgery scalpel. Ultrasound Med Biol, 2006, 32(3): 415-420.
11. Nickele C, Hanna A, Baskaya MK. Osteotomy for laminoplasty without soft tissue penetration, performed using a harmonic bone scalpel: instrumentation and technique. J Neurol Surg A Cent Eur Neurosurg, 2013, 74(3): 183-186.
12. Hazer DB, Yaşar B, Rosberg HE, et al. Technical aspects on the use of ultrasonic bone Shaver in spine surgery: experience in 307 patients. Biomed Res Int, 2016, 2016: 8428530.
13. Onen MR, Yuvruk E, Akay S, et al. The reliability of the ultrasonic bone scalpel in cervical spondylotic myelopathy: a comparative study of 46 patients. World Neurosurg, 2015, 84(6): 1962-1967.
14. 徐宝山, 马信龙, 胡永成, 等. 可动式椎间盘镜下单侧开窗双侧减压椎体间融合术治疗复杂的腰椎管狭窄症. 中华骨科杂志, 2016, 36(12): 753-760.
15. 闫立伟, 王文波. 单侧开窗潜行减压治疗双侧腰椎管狭窄的临床研究. 哈尔滨医科大学学报, 2014, 48(6): 509-512.
16. Sanderson PL, Getty CJ. Long-term results of partial undercutting facetectomy for lumbar lateral recess stenosis. Spine (Phila Pa 1976), 1996, 21(11): 1352-1356.
17. Sanborn MR, Balzer J, Gerszten PC, et al. Safety and efficacy of a novel ultrasonic osteotome device in an ovine model. J Clin Neurosci, 2011, 18(11): 1528-1533.
18. 田伟, 郎昭. 进一步促进骨磨削技术在脊柱外科的应用. 中华医学杂志, 2015, 95(13): 961-964.
19. 王岩, 陈仲强, 孙垂国. 超声骨刀在胸椎管狭窄症手术中应用的有效性与安全性. 中国脊柱脊髓杂志, 2015, 25(6): 518-523.
20. 张吉涛, 陈佳, 李政, 等. 超声骨刀在脊髓型颈椎病全椎板切除术中的应用. 中国脊柱脊髓杂志, 2018, 28(3): 234-238.
21. Cho KJ, Suk SI, Park SR, et al. Complications in posterior fusion and instrumentation for degenerative lumbar scoliosis. Spine (Phila Pa 1976), 2007, 32(20): 2232-2237.
22. 赵会, 胡辰甫, 海涌. 脊柱畸形矫形术后严重并发症危险因素分析. 中华医学杂志, 2016, 96(23): 1815-1817.
23. Hu X, Ohnmeiss DD, Lieberman IH. Use of an ultrasonic osteotome device in spine surgery: experience from the first 128 patients. Eur Spine J, 2013, 22(12): 2845-2849.

Chinese Journal of Reparative and Reconstructive Surgery

Application of ultrasonic osteotome in the posterior lumbar interbody fusion surgery by unilateral fenestration and bilateral decompression in the treatment of degenerative lumbar spinal stenosis

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