Introduction: The BoneScalpel? is a relatively new instrument that is used to perform laminectomies in lieu of the traditional high-speed drill. The reported advantage of this instrument is its ability to spare soft tissue injury, namely incidental durotomy, during bony decompression. This study aims to compare the incidence of inadvertent dural injury during laminectomy utilizing the traditional high-speed drill versus the BoneScalpel?.
Methods: This study is a retrospective review of 337 consecutive neurosurgical spinal procedures performed at a single institution over a 21-month period. We included posterior cervical and thoracic laminectomies performed for extradural pathologies. We excluded procedures that required intradural exploration. Incidental dural tears attributed to the use of the high-speed drill or the BoneScalpel? were identified using operative reports.
Results: Of the 337 procedures that met the inclusion criteria, the BoneScalpel? was used to perform the laminectomy in 88 cases, while the high-speed drill was utilized in 249 cases. Of the 88 cases during which the BoneScalpel? was used, incidental durotomy was encountered in 5 cases 5.7%. Comparatively, in the 249 cases involving the high-speed drill, incidental durotomy was encountered in 9 cases or 3.6%. Although the incidence of durotomy was lower in the high-speed drill cohort, there was no statistically significant difference between the two cohors (p-value 0.4).
Conclusions: This study compares the incidence of dural tears during laminectomies utilizing the BoneScalpel? versus the high-speed drill. Although more durotomies were encountered using the BoneScalpel?, this difference did not reach statistical significance. This study highlights the fact that incidental durotomy can be encountered with both instruments.
Patient Care: Meticulous laminectomy is of significant to prevent dural tears. Careful utilization of these two surgical instruments can reduce the incidence of dural tears and subsequent adverse outcomes, such as re-operation and CSF fistula.
Learning Objectives: To describe the associated risk of inadvertent dural tears using the Bonescalpel versus the high-speed drill.