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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
.
Diseases
Validation
Diseases presenting
"and"
symptom
achondroplasia
adrenomyeloneuropathy
aniridia
carcinoma of the gallbladder
cutaneous mastocytosis
cystinuria
esophageal squamous cell carcinoma
harlequin ichthyosis
hodgkin lymphoma, classical
hydrocephalus with stenosis of the aqueduct of sylvius
kallmann syndrome
liposarcoma
locked-in syndrome
neonatal adrenoleukodystrophy
omenn syndrome
oral submucous fibrosis
pleomorphic liposarcoma
primary hyperoxaluria type 1
proteus syndrome
pyomyositis
pyruvate dehydrogenase deficiency
sneddon syndrome
triple a syndrome
trochlear dysplasia
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