Original ArticleUse of a Pediatric Craniotome Drill for Cervical and Thoracic Spine Decompression: Safety and Efficacy
Introduction
Cervical and thoracic laminectomies are among the most common spine surgeries performed. Posterior decompression of the cervical spine has become a standard approach to treatment of cervical spondylotic myelopathy. In addition, posterior decompressive approaches to the thoracic spine are popular due to the relative ease of access to the thoracic spinal cord, foraminal elements, and lateral discs.1 Frequently described, laminectomies are achieved using a high-speed drill (HSD) with a cutting bit to create bilateral troughs of bone at the laminar-facet groove medial to the lateral mass with or without the use of the kerrison rongeur.2 Common surgical complications associated with laminectomies have been well documented, including but not limited to infection, dural injury, cerebrospinal fluid leaks, epidural hematomas, and/or injury to the spinal cord or nerve root itself.3
Although the HSD with an unprotected cutting bit can be rapid and effective, it has been associated with bone bleeding, thermal injury causing neurological damage, and dural tears.3, 4 Durotomies lead to extended hospital stays, increased risk of wound break down, infection, and additional procedures or surgeries.5, 6, 7 Alternative techniques with equal decompressive results have been explored such as an ultrasonic bone scalpel or the pediatric craniotome drill with the footplate attachment.8, 9 Albeit an older technique, the pediatric craniotome has been demonstrated in pediatric laminectomies, and in cervical laminoplasties and osteoplastic laminotomies in adults with comparable results.10, 11
To our knowledge, there is no literature comparing laminectomies with the pediatric craniotome footplate drill to the HSD. The present study aims to compare technical and clinical outcomes between patients who underwent laminectomies with a HSD to a pediatric craniotome footplate drill.
Section snippets
Methods
A retrospective review was conducted among patients aged ≥18 years who underwent cervical or thoracic laminectomies at our institution between 2010 and 2016. Partial laminectomy, trauma, and extension of fusion to cervical-1, cervical-2, occiput, or lumbar spine were excluded. Operative reports and anesthesia records were reviewed. Type of drilling method, operative time, estimated blood loss, and incidence of cerebrospinal fluid leak secondary to drilling were documented. The Institutional
Results
A total of 91 patients were included in the final analysis. Table 1 represents the demographic summary. The average age was 52.3 ± 11.7 years, 57.1% being male patients. There was no statistical significance on the effects of age, gender, and race distribution between the footplate and the HSD group (P > 0.05 for all 3 variables). There was a statistically significant difference with respect to the number of laminectomy levels, with the footplate group on average undergoing more laminectomy
Discussion
During the past few decades, the standard laminectomy technique uses an unprotected HSD; however, with the increased usage of the HSD, the associated complications are becoming more apparent.4, 12 HSD can lead to traumatized spinal cord injury, dural tears, or indirect neural injury from drill bit vibrations and uncontrolled slippage from the bone. Newer modalities, such as ultrasonic bone scalpel, have also been reported in the literature. However, these methods are costly and have been
Conclusion
Cervical and thoracic laminectomy performed with a pediatric craniotome with a footplate attachment is an older technique. However, our study demonstrates that its safety is comparable to HSD. Although our cohort demonstrated improved operating room efficacy in the footplate group, reproducible results are operator-dependent. We do not advocate surgeons deviating outside of their comfort-level zone. We recommend that surgeons consider refamiliarizing themselves with this technique, as it is
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Cited by (2)
Recent update on basic mechanisms of spinal cord injury
2020, Neurosurgical ReviewHow I do it: en-bloc subaxial cervical laminectomy using a high-speed drill with a footplate attachment
2020, Acta Neurochirurgica
Conflict of interest statement: The authors declare that the article content was composed in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.