Heat generation during bony decompression of lumbar spinal stenosis using high-speed diamond drill with or without automated irrigation and ultrasonic bone cutting knife.

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Heat generation during bony decompression of lumbar spinal stenosis using high-speed diamond drill with or without automated irrigation and ultrasonic bone cutting knife.

World Neurosurg. 2017 Dec 08;:

Authors: Matthes M, Pillich DT, El Refaee E, Schroeder HWS, Müller JU

Abstract
OBJECTIVE: The main objective of the present prospective randomized single-blinded controlled study was to measure heat during bony decompression of lumbar spinal stenosis with high-speed drills, and ultrasonic bone cutting knife.
METHODS: 90 patients diagnosed lumbar spinal stenosis were included in this study, and randomized for lumbar spinal canal decompression using either a high-speed drill with automatic irrigation (HSA), high-speed drill with manual irrigation (HSM), or an ultrasonic bone cutting knife with automatic irrigation (USBCD). For evaluation of group homogeneity VAS pain score and neurological findings were measured pre- and postoperatively. Temperatures during bony decompression were measured using a FLIR (Forward Looking InfraRed) camera system.
RESULTS: Clinical results between the three groups did not differ in pain reduction, improvement of neurological findings or the rate of complications. However, significantly lower values were found for absolute and mean maximal temperatures during bony decompression in the USBCD group compared to HSA and HSM groups of patients, indicating this technique to be less aggressive in terms of thermal induction of bone necrosis. USBCD allows more precise bone removal compared to high-speed drills, and despite increased device time, no significant difference in the overall decompression time was observed.
CONCLUSIONS: All examined methods produced short temperature peaks with a possible, at least temporary, damage of bone and neural tissue. Automatic irrigation was associated with lower heat development compared to manual irrigation. Despite evidence of critical temperatures no clinical correlation, e.g. neurological deficits, was encountered in this study. Clinically, all three methods presented equally good results.

PMID: 29229343 [PubMed - as supplied by publisher]

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