Elsevier

World Neurosurgery

Volume 113, May 2018, Pages e486-e489
World Neurosurgery

Original Article
Use of a Pediatric Craniotome Drill for Cervical and Thoracic Spine Decompression: Safety and Efficacy

https://doi.org/10.1016/j.wneu.2018.02.061Get rights and content

Highlights

  • Older techniques for laminectomies using a pediatric craniotome with a footplate attachment have been described.

  • Our cohort demonstrated significantly shorter operating time in the footplate group when compared with the high speed drill group.

  • A craniotome can be a safe and efficient alternative to performing a laminectomy, although reproducible results are surgeon dependent.

Background

Laminectomy, using a high-speed drill with an unprotected cutting drill bit, can be rapid and effective, but it has been associated with known complications. Another technique uses a pediatric craniotome drill with the footplate attachment. At present, there are no studies comparing clinical outcomes between these 2 stated decompressive techniques.

Methods

A retrospective review was conducted at a single institution. Two cohorts of patients were considered based on the technical method of laminectomy for decompression. One group had decompression with utilization of a high-speed drill, whereas the other group had decompression with a pediatric craniotome drill with a footplate attachment. The outcomes from each group were compared based on the length of operation, estimated blood loss, and associated complications.

Results

A total of 91 patients were included in the final analysis. Forty-five of the patients underwent laminectomy using a footplate and 46, using a high-speed drill. The footplate group was associated with significantly shorter operative time (159 vs. 205 minutes; P = 0.008). In addition, the footplate technique demonstrated less estimated blood loss (254 vs. 349 mL), and less incidence of durotomies (2.2% vs. 10.9%); however, neither of these 2 outcomes achieved statistical significance.

Conclusions

Despite being an older technique, there was a shorter operative time in the footplate group without increased blood loss or incidence of durotomy. Although comparable results are operator dependent, this technique is a safe alternative for performing cervical and thoracic laminectomies.

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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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.

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