Spinal deformity surgery — On the cutting edge with Drs. Isador Lieberman, Suken Shah

Laura Dyrda -  

The ultrasonic BoneScalpel from Misonix is designed to increase bone cutting effectiveness and safety in spinal procedures, which has a huge impact on patient safety and outcomes for spinal deformity procedures.

The technology cuts bone while leaving elastic soft tissue mostly unaffected during incidental contact.

 

"The BoneScalpel modernizes deformity correction since it provides for a safer and faster procedure than traditional instruments, like osteotomes and kerrisons," says Suken Shah, MD, a spine surgeon with Alfred I. DuPont Hospital for Children in Wilmington, DE. He uses the BoneScalpel for several procedures, including:


• Facectomies
• Ponte osteotomes
• Vertebral column resections
• Thoracoplasties.

 

The technology can also be used in more complex procedures. "Any time you have to remove, cut or reshape bone, the BoneScalpel will help. If you're doing a deformity, it's great," says Isador Lieberman, MD, director of the scoliosis and spine tumor center at the Texas Back Institute in Plano, TX.

 

The instrument amplifies an electrical signal and converts it into a high back-and-forth motion with a blunt blade going at the frequency of 22,500 times per second. The oscillation makes the device unique and ensures surgeons don't damage the surrounding soft tissue.

 

"It's like going from cutting with a chainsaw to having a fine, precise tool so what I plan ahead of time I can implement in the operating room more efficiently," says Dr. Lieberman. "It replaces a lot of the other tools I would use about 80 percent of the time. The other instruments we have are high-speed, rotating burrs and if you get too close to the nerve or dura, you rip the tissue. I don't have that issue with the BoneScalpel."

 

Dr. Lieberman says spinal deformity procedures using the BoneScalpel are quicker and have less blood loss because of the ultrasonic technology.

 

"The blood actually coagulates on the surface of the bone and you end up losing a lot less blood during the operation," he says. "You are losing less blood because your procedure is faster and the bone ends aren't bleeding."

 

A study published in The Spine Journal found the ultrasonic BoneScalpel for adult idiopathic scoliosis patients led to significantly less bleeding when compared with standard instruments.

 

"The BoneScalpel offers controlled cutting and excising of bone without the potential for damage to soft tissue, nerves, dura or pleura," says Dr. Shah. "Essentially any bone can be cut with the BoneScalpel but when there are important soft tissue structures in the vicinity that need to be preserved, it becomes much more valuable. Also, since it does not heat the bone while cutting like a burr or oscillating saw, it may induce less thermal damage to osteocytes."

 

And it's easy to incorporate into an experienced surgeon's armamentarium.

 

"There isn't really a learning curve; it's more like an anxiety curve," says Dr. Lieberman. "Anyone working around the spinal cord on a day-to-day basis knows how to treat tissues carefully. The BoneScalpel has an irrigation component to make sure the blade stays cool and doesn't scorch the bone you're working on."

 

This technology isn't new to healthcare. Low power ultrasonics have been used in dentistry for decades for fine work. The BoneScalpel has been developed with high power ultrasonics for spine surgery procedures. "I don't know why we haven't caught on in orthopedics," says Dr. Lieberman. "We do bigger work with larger bones and bone cavities, but now with minimally invasive procedures we're also doing fine, detailed work. I think this technology will take off in the orthopedics and neurosurgery community."

 

Spine surgery techniques and ultrasonic technology will continue to improve in the future, improving outcomes and reducing complications.

 

"Our hope is that we will have safe, efficient tools to expose the spine of its soft tissue rather than the traditional Cobb elevator and electrocautery," says Dr. Shah. "Ultrasonic technology offers tremendous promise in this area. This would further decrease blood loss during spinal deformity surgeries and offer procedural efficiencies not available up to this point. Devices to control epidural bleeding without injuring the dura or neural structures would also be welcomed, as well as devices to seal the dura in the event of duratomy."

 

This article is sponsored by Misonix.

 

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