Becker's Spine Review

50 Executive Briefing "With the Misonix BoneScalpel, I have found that laminectomy procedures are a completely different animal," Dr. Fu said. "What used to take an hour to an hour and a half, with a lot of drilling, now takes three cuts with the Misonix, a little bit of work to remove the ligamentous hypertrophy and then the case is done and there is no bleeding. Now I use the ultrasonic bone scalpel almost exclusively for these types of cases." From an anatomic and a teaching perspective, Dr. Theodore feels that the Misonix BoneScalpel has raised the game when it comes to bone removal. "When you have a scalpel and you make an incision, you want to be accurate," he said. "The BoneScalpel enables us to make cuts where we couldn't before and it teaches the residents to make thoughtful cuts as they remove a chunk of bone." Paired ultrasonic and robotic technology could transform the future of spine surgery Looking ahead, both Dr. Theodore and Dr. Fu anticipate ultrasonic tools will be used in novel ways to improve the safety and efficiency of spine surgery. In the field of neurosurgery, tools based on ultrasonic technologies aren't new. For years, neurosurgeons have used ultrasonic aspirators to treat tumors. They insert these devices into brain or spine tumors. The ultrasonic waves emitted from the tip vaporize and morselize the tumor. "Ultrasonic technology for bone cutting uses the same principles," Dr. Theodore said. "It uses sound waves to power the metal blade at a certain harmonic frequency that cuts through bone. What's fascinating is that ultrasound opens up tremendous possibilities in medicine. We can use it now for tumors and for bone. The next question is whether we could use it for soft tissue, like disc removal and things like that. I think the potential is definitely there." Dr. Fu also believes the neurosurgery field is in the early stages of what it can accomplish with ultrasonic tools. "The instruments we have today are a blade, but I think there could be even more unique, individualized tools designed for different processes which could make it much easier to perform surgeries of various types," he said. Pairing ultrasonic tools with robotics appears to represent the next generation of spine surgery technologies on the horizon. "As we get more sophisticated in spine surgery, we are becoming more precise in what we do," Dr. Theodore said. "We are now using image-guided surgery to navigate in the spine, just as we've done with brain surgery for the last 35 years. I can foresee a future where robotics and ultrasonic technologies are coupled together to harness the power and precision of robotic positioning to make very precise cuts in the bone." Dr. Fu also believes that robotics will be the next step in advancing the use of ultrasonics during spine surgery. "I could envision a day where a robot will control where you want to make the cut and the cut can be made very precisely," he said. "I think that would be a really great way to get higher levels of safety and reproducibility that would increase patient safety overall." Coupling high-precision ultrasonic bone cutting with high- precision robotics could lead to standardization of scoliosis procedures and minimally invasive spine procedures. By using ultrasound under the power of image guidance and robotic technology, neurosurgeons could remove bone in a safer and more accurate way. Conclusion Ultrasonic tools like the Misonix BoneScalpel enable neurosurgeons to perform complex surgeries more accurately and more rapidly. They also decrease patient blood loss in cases where surgeons must remove significant amounts of bone to reconstruct the spine. It seems, however, that the full potential of ultrasonic tools has only just started to be recognized in this clinical field. "The adoption of new technology in the area of spine surgery has been exciting," Dr. Theodore said. "What's encouraging now, as I train residents and talk to people across the world, is that these technologies significantly improve the safety and accuracy of procedures. I think the most exciting thing is coupling innovations, whether it's ultrasound and robots or other technologies like robotics and imaging, to see what the next generation will have to offer patients undergoing spine surgery. I think it's a very exciting time." n Misonix is a world leader in ultrasonic surgical devices utilized for hard and soft tissue resection. neXus, Misonix's latest revolution in ultrasonic technology, provides surgeons with an all-in-one ultrasonic system, that can be used in various applications across multiple surgical specialties, bringing unity to the already renowned BoneScalpel, SonicOne and SonaStar platforms. "I could envision a day where a robot will control where you want to make the cut and the cut can be made very precisely. I think that would be a really great way to get higher levels of safety and reproducibility that would increase patient safety overall" Kai Ming Gregory Fu, MD, PhD, neurosurgeon with Weill Cornell Medicine Brain and Spine Center in New York City

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