The Technique of a Modified Ponte Osteotomy Using Ultrasonic Bone Scalpel in Spinal Deformity Correction: Does It Save Time and Reduce Blood Loss?

TL;DR

This study shows that using an ultrasonic bone scalpel in spinal surgery reduces operation time and blood loss while maintaining safety.

Contribution

The study introduces a refined technique for modified Ponte osteotomy using an ultrasonic bone scalpel, demonstrating reduced operative time and blood loss.

Findings

The average time per modified Ponte osteotomy segment was 3.05 minutes, with total operative time averaging 19.16 minutes per surgery.

Epidural bleeding averaged 1.65 points per surgery, effectively controlled with bipolar ablation and absorbable gelatin sponge.

No intraoperative neuromonitoring signal loss or dural tears occurred, confirming the safety of the UBS technique.

Abstract

Background and objective

Posterior column osteotomies, such as Smith-Petersen and Ponte osteotomies, are widely utilized in the surgical correction of spinal deformities to address sagittal and coronal imbalances by releasing the posterior tension band. While traditional methods using rongeurs and osteotomies are effective, these are often associated with prolonged operative time, significant blood loss, and increased risk to neural structures. These challenges have driven interest in advanced tools like the ultrasonic bone scalpel (UBS), which uses high-frequency vibrations to enable precise bone cutting with minimal damage to surrounding tissues. This innovative tool has demonstrated significant reductions in blood loss and operative time in various spinal procedures. However, its specific application in modified Ponte osteotomies remains underexplored. This study evaluates the UBS's safety, efficiency, and impact on blood loss in complex deformity corrections and presents a refined technique for optimizing outcomes in these challenging surgeries. Additionally, it outlines a refined technique for executing modified Ponte osteotomies with this advanced tool.

Methods

This retrospective study included all patients who underwent spinal deformity surgery involving modified Ponte osteotomy with a UBS between January 2013 and June 2022. Key metrics analyzed included the number of modified Ponte osteotomy segments performed per surgery, the total time taken for osteotomies, and the average time required per segment. Blood loss was evaluated with a focus on epidural and bony sources, and methods for controlling bleeding were documented. Safety parameters included intraoperative neurophysiological signal integrity and the incidence of dural tears.

Results

A total of 695 modified Ponte osteotomy segments were performed in 111 patients undergoing complex spinal deformity correction surgery. The average number of segments created per procedure was 6.26 ± 1.59 (range: three to nine). The mean operative time required for all segments per surgery was 19.16 ± 5.66 minutes, with an average time of 3.05 ± 0.29 minutes per segment (range: 2.13-4.66 minutes). Epidural bleeding was observed at an average of 1.65 ± 1.27 points per surgery (range: 0-6), equating to 0.26 ± 0.20 points per segment. Bleeding was effectively controlled with bipolar ablation and absorbable gelatin sponge packing, and no significant bony bleeding was reported. Of note, there were no instances of intraoperative neuromonitoring signal loss or dural tears, demonstrating the safety of the technique. No splinters occurred while osteotomizing in any case.

Conclusions

The use of UBS significantly enhances the efficiency and safety of modified Ponte osteotomy during spinal deformity correction surgeries. This technique not only reduces operative time but also minimizes blood loss, offering an advanced approach to achieving precise osteotomies without compromising patient safety. These findings underscore the benefits of incorporating UBS into complex spinal surgical procedures.

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