Becker's Spine Review

49 Executive Briefing Sponsored by: H istorically, pneumatic drills have been the bone- cutting tool of choice for surgeons performing spine procedures. Ultrasonic bone scalpels, however, have elevated the art of bone removal. Neurosurgeons can now perform complex surgeries with incredible precision and accuracy, reducing blood loss and increasing patient safety. Becker's Spine Review recently spoke with two experts about their experience using ultrasonic tools for spine surgery and their predictions about the future of ultrasonics in their field: • Kai Ming Gregory Fu, MD, PhD, neurosurgeon with Weill Cornell Medicine Brain and Spine Center in New York City • Nicholas Theodore, MD, director of the Neurosurgical Spine Center and a professor of neurosurgery at Johns Hopkins Medicine in Baltimore Ultrasonic bone scalpels are changing the game for surgeons For decades, pneumatic drills have been the standard for high-speed removal of bone during spine surgeries. Although these tools are effective, they also have some drawbacks. "For years, there haven't been significant changes in the pneumatic drill except for new hand pieces and new drill bits," Dr. Theodore said. "It's still a high-velocity instrument that removes bone quickly and it's a little bit messy. There's often bone dust and other material flying around." Another concern is the unintentional removal of too much bone. Regular pneumatic drills can be hard to control because there is a lot of torque involved. It's not uncommon for drills to skip and move around. Lack of control is also a problem physicians encounter with the hand tools used in spinal surgeries. "In the past, I used a couple of drill bits very frequently when performing laminectomies," Dr. Fu said. "With a drill, however, you can very readily damage the dura. I would also sometimes use an osteotome after making the initial cut. The osteotome ideally cracks the bone where you want to crack it, but it's an uncontrolled force." According to Dr. Theodore, ultrasonics have elevated the art of bone removal. Instead of vaporizing bone with a drill, surgeons can now use an ultrasonic tool like a Misonix BoneScalpel. "The term 'scalpel' is key. This ultrasonic device is matched to the correct frequency and cuts through bone in a very precise way," Dr. Theodore said. "I can make bone cuts with incredible precision without worrying about thinning the bone out or destroying bone." When Dr. Theodore performs a laminectomy in the cervical spine, he makes two straight surgical cuts through the bone within a minute and removes the piece of bone. The ultrasonic bone scalpel also supports precise cuts for scoliosis surgery, osteotomies and en bloc tumor resections. "Bone scalpels give us the opportunity to make beautiful cuts and respect the human anatomy," Dr. Theodore said. "The other interesting thing is that there is much less bone bleeding. As we are drilling and get into the cancellous, the heat from the bone scalpel coagulates the surface and reduces blood loss." Dr. Fu has had similar positive experiences with the Misonix BoneScalpel. "I tried it a couple of years ago for my more complex operations, out of a desire for patient safety and efficacy," he said. "The Misonix allows for precision cutting and its strength is that you can use it pretty much as you would an osteotome, but it is much safer. Since the BoneScalpel doesn't cut through dura easily, it's also a lot safer than a drill." After seeing the benefits of the ultrasonic bone scalpel, Dr. Fu began to use it on his simpler, degenerative cases, especially laminectomies and transforaminal lumbar interbody fusion procedures. The tool has dramatically changed his overall practice. Ultrasonic bone scalpels and the art of spine surgery — 2 leading neurosurgeons weigh in "Bone scalpels give us the opportunity to make beautiful cuts and respect the human anatomy." Nicholas Theodore, MD, Director of the Neurosurgical Spine Center; Professor of Neurosurgery at Johns Hopkins Medicine in Baltimore

• Cover