Effect of the Ultrasonic Bone Scalpel on Blood Loss During Pediatric Spinal Deformity Correction Surgery.

STUDY DESIGN: Retrospective cohort. OBJECTIVE: Determine the effect of the ultrasonic bone scalpel (UBS) on intraoperative blood loss and surgical time. SUMMARY OF BACKGROUND DATA: The UBS has shown beneficial effects in limiting blood loss in spinal surgery, but no study has examined its effect in patients with neuromuscular scoliosis. METHODS: Clinical records were reviewed for patients aged 9-18 who underwent posterior spinal fusion surgery of five or more levels for scoliosis correction by the senior author from April 2013 until October 2016. Exclusion criteria included: vertebral column resections, previous spinal surgery, cell saver usage, cases complicated by signal loss on monitoring, and incomplete medical records. A total of 84 patients met the criteria and were included in data analysis. The UBS was routinely used for performing osteotomies and facetectomies for all cases operated after March 2015. These cases were compared to a control group who underwent surgery prior to this date in which the UBS was not used. The experimental and control groups were further divided into adolescent idiopathic (AIS) and neuromuscular (NMS) subgroups. RESULTS: EBL in AIS patients decreased from 1,211 mL in the control group to 771 mL in the UBS group for an average total reduction of 440 mL (95% CI 106, 774, p = .01). In NMS patients, EBL fell from 2,171 mL in controls to 1228 mL in the study group for an average total reduction of 943 mL (95% CI 288, 1598, p < .01). On controlling for weight and number of levels fused, blood loss decreased 26.2% in AIS patients and 46.2% in NMS patients. CONCLUSIONS: The ultrasonic bone scalpel is effective in reducing blood loss in AIS and NMS deformity correction surgery. Surgical time is not adversely affected by its use. LEVEL OF EVIDENCE: Level II, cohort study.

The relationship between cervical lordosis and Nurick scores in patients undergoing circumferential vs. posterior alone cervical decompression, instrumentation and fusion for treatment of cervical spondylotic myelopathy.

The loss of regional cervical sagittal alignment and the progressive development of cervical kyphosis is a factor in the advancement of myelopathy. Adequate decompression of the spinal canal along with reestablishment of cervical lordosis are desired objective with regard to the surgical treatment of patients with cervical spondylotic myelopathy. A retrospective chart review was conducted in which patients who underwent either a combined anterior/posterior instrumentation and decompression or a posterior alone instrumentation and decompression for the treatment of CSM at our institution were identified. Any patient undergoing operative intervention for trauma, infection or tumors were excluded. Similarly, patients undergoing posterior instrumentation with constructs extending beyond the level of C2-C7 were similarly excluded from this study. A total of 67 patients met the inclusion criteria for this study. A total of 32 patients underwent posterior alone surgery and the remaining 35 underwent combined anterior/posterior procedure. Radiographic evaluation of patient's preoperative and postoperative cervical lordosis as measured by the C2-C7 Cobb angle was performed. Each patient's preoperative and postoperative functional disability as enumerated by the Nurick score was also recorded. Statistical analysis was conducted to determine if there was a significant relationship between improvement in cervical lordosis and improvement in patient's clinical outcomes as enumerated by the Nurick Score in patients undergoing posterior alone versus combined anterior/posterior decompression, instrumentation and fusion of the cervical spine.