Spinal decompression in achondroplastic patients using high-speed drill versus ultrasonic bone curette: technical note and outcomes in 30 cases.

[achondroplasia]

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 ).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 .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 .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 .Level II -retrospective study .

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achondroplasia

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