Quantitative and qualitative analyses of spinal canal encroachment during cervical laminectomy using the kerrison rongeur versus High-Speed burr.
Br J Neurosurg
; 33(2): 131-134, 2019 Apr.
Article
en En
| MEDLINE
| ID: mdl-30681374
ABSTRACT
BACKGROUND:
Several cervical laminectomy techniques have been described. One commonly used method involves making bilateral trough laminotomies using either a Kerrison rongeur or a high speed burr, and then removing the lamina en-bloc. Alternatively, some surgeons prefer to thin the lamina with the burr, and then remove the lamina in a piecemeal fashion using Kerrison rongeurs. Some surgeons have warned against the potential risk of iatrogenic spinal cord injury from inserting the Kerrison footplate into a stenotic canal. We aim to quantify the amount of canal encroachment for various methods of cervical laminectomies.METHODS:
Three attending spine surgeons and two fellows each performed laminectomies using C5 sawbones models. The canal was completely filled with modeling putty to simulate a stenotic spinal cord. Bilateral trough laminotomies were performed using a 1 mm Kerrison, a 2 mm Kerrison, and a 3 mm matchstick high-speed burr. Piecemeal laminectomies were performed with a 2 mm Kerrison. A blinded spine surgery fellow performed all quantitative measurements. Three blinded researchers qualitatively ranked the amount of "canal encroachment".RESULTS:
The average canal encroachment was 0.50 ± 0.45mm for the burr, 1.37 ± 0.68 mm for the 1 mm Kerrison, and 1.47 ± 0.37 mm for the 2 mm Kerrison (p = .002). There was a statistically significant difference between the burr and 1 mm Kerrison (p = .01) and between the burr and the 2 mm Kerrison (p = .001). There was no statistical difference between the 1 mm and 2 mm Kerrison (p = .78). The mean rank of the burr group, the Kerrison rongeur group, and the piecemeal group were 1.41, 1.94, and 2.65, respectively, on an ordinal scale of 1-3.CONCLUSION:
When performing a trough laminotomy, the high-speed burr results in less canal encroachment compared to 1 mm or 2 mm Kerrison rongeurs. In the setting of a stenotic spinal canal, spine surgeons should consider using the burr to perform laminectomy to minimize the degree of canal encroachment.Palabras clave
Texto completo:
1
Colección:
01-internacional
Banco de datos:
MEDLINE
Asunto principal:
Canal Medular
/
Traumatismos de la Médula Espinal
/
Instrumentos Quirúrgicos
/
Vértebras Cervicales
/
Procedimientos Neuroquirúrgicos
/
Laminectomía
Tipo de estudio:
Etiology_studies
/
Qualitative_research
/
Risk_factors_studies
Límite:
Humans
Idioma:
En
Revista:
Br J Neurosurg
Asunto de la revista:
NEUROCIRURGIA
Año:
2019
Tipo del documento:
Article
País de afiliación:
Estados Unidos