Spinal decompression in achondroplastic patients using high-speed drill versus ultrasonic bone curette: technical note and outcomes in 30 cases.
BACKGROUND
This manuscript describes the clinical and operative characteristics of achondroplastic children who undergo multilevel thoracolumbar decompressions using either the high-speed drill or the ultrasonic bone curette (BoneScalpel).


METHODS
We retrospectively reviewed 30 thoracolumbar decompressions in achondroplastic patients at a single institution between 2008 and 2013. Patients were classified into either the high-speed drill cohort or the BoneScalpel cohort, depending on which instrument was utilized to perform the decompression. A technical note on the role of the ultrasonic bone curette in decompressing stenotic achondroplastic spines is also provided.


RESULTS
In comparison with the high-speed drill cohort, the BoneScalpel cohort experienced less overall perioperative complications, including durotomy, cerebrospinal fluid leak, pseudomeningoceles, wound infection, and wound dehiscence. Although 45.0% of patients experienced a durotomy in the high-speed drill cohort, only 30.0% of patients experienced a durotomy in the BoneScalpel cohort (P = 0.694). In the high-speed drill cohort, the number of patients complaining of sensory disturbances, back pain, ataxia, incontinence, neurogenic claudication, radiculopathy, ataxia, and/or weakness decreased postoperatively. Similar results were observed in the BoneScalpel cohort.


CONCLUSIONS
Although spinal decompression provides symptomatic resolution in patients with achondroplasia, intraoperative complications, in general, and durotomies, in particular, are common. Here, we report a decreased incidence in intraoperative durotomy and overall perioperative complication rates in the BoneScalpel cohort, although this did not reach the level of statistical significance. Nonetheless, the data demonstrate that the BoneScalpel is a safe and efficacious alternative to the high-speed drill in these challenging patients.


METHODS
Level II-retrospective study.
*Department of Neurosurgery †Medical Scientist Training Program, Johns Hopkins University School of Medicine, Baltimore, MD.
Mohamad
M
Bydon
Mohamed
M
Macki
Risheng
R
Xu
Michael C
MC
Ain
Edward S
ES
Ahn
George I
GI
Jallo
D000130:Achondroplasia / Q000150:complications*; D000293:Adolescent; D065634:Cerebrospinal Fluid Leak / Q000209:etiology; D002648:Child; D019299:Decompression, Surgical / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D004388:Dura Mater / Q000293:injuries; D005260:Female; D006801:Humans; D007431:Intraoperative Complications; D008159:Lumbar Vertebrae / Q000601:surgery; D008297:Male; D012189:Retrospective Studies; D013130:Spinal Stenosis / Q000209:etiology / Q000601:surgery*; D013529:Surgical Wound Dehiscence / Q000209:etiology; D013530:Surgical Wound Infection / Q000209:etiology; D013904:Thoracic Vertebrae / Q000601:surgery; D014464:Ultrasonic Therapy / Q000009:adverse effects; D055815:Young Adult