Thoracic Spine Stenosis: Does Ultrasonic Osteotome Improve Outcome in Comparison to Conventional Technique?

@#Introduction: To investigate the efficacy of Ultrasonic Bone Scalpel (UBS) in thoracic spinal stenosis (TSS) in comparison to traditional technique. Materials and methods: A total of 55 patients who had undergone conventional surgery (Group A) are compared with 45 patients of UBS (Group B) in TSS. The primary outcome measure of Modified Japanese Orthopaedic Association score (m JOA) with neurological complications and dural injury were assessed. Secondary outcome measures of total blood loss (TBL), time duration of surgery (ORT) and length of hospital stay (LHS) were analysed. Results: The pre-operative mJOA score 5.00(4.00-6.00) in the group A and 5.00(4.00-6.00) in the group B improved to 7.00(7.00-8.00) in the group A and 9.00(9.00-10.00) in the group B, respectively (P<0.001) at final average follow-up of 117.55 months for group A and 75.69 months in group B. More significant grade of myelopathy improvement and mJOA recovery rate (RR) were noted in group B. The TBL, ORT and LHS were more favourable in group B as compared to group A (p<0.0001). The group A had 9 (16.36%) neurological deficits compared to 2 (4.44%) in group B (p<0.001). Dural tears occurred in both groups (A=11, B=9). It was more frequent and not repairable in group A but without significant statistical difference. Conclusions: UBS can reduce neurological deficits and improve outcomes in TSS. Secondarily, reduced blood loss, lesser surgical time and reduced LHS are significant added advantages of this new technology.

Cerebrospinal Fluid Leakage after Surgeries on the Thoracic Spine: A Review of 362 Cases

STUDY DESIGN: A retrospective clinical review. PURPOSE: To describe the incidence of cerebrospinal fluid leakage (CSFL) after thoracic decompression and examine the CSFL predisposing clinical factors. OVERVIEW OF LITERATURE: CSFL is a common complication following thoracic decompression but has not been sufficiently addressed in former studies. METHODS: A cohort of 362 cases of thoracic decompression from February of 2005 to June of 2013 was examined. The case medical records were reviewed and the occurrence of CSFL and the related clinical parameters were noted. The incidence of CSFL for the entire cohort and each surgical approach were described. Besides, the relationship between CSFL and other clinical parameters were assessed, of which odds ratio values of all CSFL-associated parameters were calculated using multivariate logistic regression analysis. RESULTS: The incidence of CSFL for the entire cohort was 32.3%. Different surgical approaches had different incidences of CSFL, and circumferential decompression had the highest incidence. Though many different clinical parameters were related to the occurrences of CSFL, being older than 52 years, having ossification of the posterior longitudinal ligament or having longer operative segments than 3 vertebrae were significant risk factors for CSFL (p <0.05). Besides, surgeries on the mid-thoracic spine had an increased risk of CSFL (p <0.05). CONCLUSIONS: From our analysis, CSFL was a common complication after thoracic decompression with the incidence of up to 32.3%. This study identified the predisposing clinical factors, and spinal surgeons should be aware of these risk factors to reduce its incidence.

Cerebrospinal Fluid Leakage after Surgeries on the Thoracic Spine: A Review of 362 Cases

STUDY DESIGN: A retrospective clinical review. PURPOSE: To describe the incidence of cerebrospinal fluid leakage (CSFL) after thoracic decompression and examine the CSFL predisposing clinical factors. OVERVIEW OF LITERATURE: CSFL is a common complication following thoracic decompression but has not been sufficiently addressed in former studies. METHODS: A cohort of 362 cases of thoracic decompression from February of 2005 to June of 2013 was examined. The case medical records were reviewed and the occurrence of CSFL and the related clinical parameters were noted. The incidence of CSFL for the entire cohort and each surgical approach were described. Besides, the relationship between CSFL and other clinical parameters were assessed, of which odds ratio values of all CSFL-associated parameters were calculated using multivariate logistic regression analysis. RESULTS: The incidence of CSFL for the entire cohort was 32.3%. Different surgical approaches had different incidences of CSFL, and circumferential decompression had the highest incidence. Though many different clinical parameters were related to the occurrences of CSFL, being older than 52 years, having ossification of the posterior longitudinal ligament or having longer operative segments than 3 vertebrae were significant risk factors for CSFL (p <0.05). Besides, surgeries on the mid-thoracic spine had an increased risk of CSFL (p <0.05). CONCLUSIONS: From our analysis, CSFL was a common complication after thoracic decompression with the incidence of up to 32.3%. This study identified the predisposing clinical factors, and spinal surgeons should be aware of these risk factors to reduce its incidence.