title: Surgical pitfalls of an ultrasonic bone curette (SONOPET) in spinal surgery.
abstract: OBJECTIVE
  We report our experience with the SONOPET ultrasonic bone curette.
  
  
  METHODS
  Between September 2001 and July 2005, 546 patients underwent microscopic spinal surgeries using a high-speed drill and the SONOPET instrument.
  
  
  RESULTS
  We encountered operative complications thought to be attributable to the use of the SONOPET in six patients (1.1%). There were five instances of dural puncture and one spinal cord injury. All dural tears occurred when the dura mater was aspirated into the tip of the SONOPET. None of the affected patients developed postoperative clinical complications because cerebrospinal fluid leakage was avoided by appropriate closure. We think that the transient spinal cord injury occurred because the vibration emanating from the SONOPET was transmitted directly to the spinal cord. Some patients experienced damage to the epidural venous plexus for reasons similar to those described above.
  
  
  CONCLUSIONS
  SONOPET facilitates the removal of bone in a narrow field, such as that encountered during keyhole surgery. It aids in the removal of the lateral edge of bone and is especially useful for expanding the foramen intervertebrale or opening the lateral recess. However, its use is not without risk. To prevent dural tears and venous plexus injury, we recommend that cotton be placed between the SONOPET and important structures. To avoid spinal cord injury, we suggest that the SONOPET be inserted horizontal with the dura mater to avoid the direct transmission of vibrations emanating from the instrument to the spinal cord. SONOPET is suitable for decompression on the lateral side, but not for decompression above the spinal cord.
authors.affiliation: Department of Neurosurgery, Kushiro Rosai Hospital, Hokkaido, Japan. kyongson@nms.ac.jp
authors.forename: Kyongsong
authors.initials: K
authors.lastname: Kim
authors.forename: Toyohiko
authors.initials: T
authors.lastname: Isu
authors.forename: Ryoji
authors.initials: R
authors.lastname: Matsumoto
authors.forename: Masanori
authors.initials: M
authors.lastname: Isobe
authors.forename: Kazunari
authors.initials: K
authors.lastname: Kogure
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003475:Curettage / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods; D005260:Female; D006801:Humans; D007796:Laminectomy / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods; D008875:Middle Aged; D010027:Osteotomy / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods; D018570:Risk Assessment; D013119:Spinal Cord Injuries / Q000209:etiology* / Q000517:prevention & control; D013131:Spine / Q000601:surgery*; D016896:Treatment Outcome; D014464:Ultrasonic Therapy / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods; D014950:Wounds, Penetrating / Q000209:etiology* / Q000517:prevention & control