Application of V-shaped stealth decompression technique using ultrasonic bone scalpel in anterior surgery for adjacent two-level cervical spondylosis_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

WANG Zhaodong , DUAN Keyou , LIU Yajun , XU Chen , ZHU Zhonglian , ZHOU Pinghui ,  GUAN Jianzhong

Department of Orthopaedics, the First Affiliated Hospital of Bengbu Medical University, Anhui Provincial Key Laboratory of Tissue Transplantation, Bengbu Anhui, 233004, P. R. China;

Corresponding author：

GUAN Jianzhong, Email: jzguan2002@163.com

Keywords：

Ultrasonic bone scalpel; two-level cervical spondylosis; stealth decompression; anterior cervical surgery

DOI：

10.7507/1002-1892.202502056

Video：

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Objective To evaluate the effectiveness of V-shaped stealth decompression technique using ultrasonic bone scalpel in anterior surgery for adjacent two-level cervical spondylosis. Methods A clinical data of 41 patients with adjacent two-level cervical spondylosis, who admitted between January 2020 and December 2023 and met the selection criteria, was analyzed retrospectively. Among them, 22 cases were treated with anterior cervical discectomy and fusion (ACDF) assisted by V-shaped stealth decompression technique using ultrasonic bone scalpel (group A) and 19 cases with anterior cervical corpectomy and fusion (ACCF) (group B). There was no significant difference between the two groups in age, gender, disease duration, surgical segment, preoperative Japanese Orthopedic Association (JOA) score, neck dysfunction index (NDI), pain visual analogue scale (VAS) score, and the anteroposterior diameter of the spinal canal in the responsibility space of axial CT (P>0.05). The operation time, intraoperative blood loss, postoperative drainage volume, hospital stay, complications during follow-up, JOA score, NDI, and VAS score at last follow-up, and the incidences of intervertebral fusion at 3 months after operation, and cage subsidence at last follow-up were compared between the two groups. Results The operations in the two groups were successfully completed. The operation time, intraoperative blood loss, postoperative drainage volume, and hospital stay in group A were significantly less than those in group B (P<0.05). Two cases (9.1%) in group A and 4 cases (21.1%) in group B developed complications, with no significant difference in the incidence between the two groups (P>0.05). All patients in the two groups were followed up 6-12 months (mean, 9.3 months). There was no significant difference in follow-up time between the two groups (P>0.05). At last follow-up, the JOA score and VAS score in both groups significantly improved when compared with those before operation (P<0.05). The change values of VAS score and the improvement rate of JOA score in group A were significantly superior to group B (P<0.05). There was no significant difference in the change values of NDI and JOA score between the two group (P>0.05). Imaging reexamination showed that the rate of intervertebral fusion at 3 months after operation was significantly higher in group A (81.8%) than in group B (52.6%) (P<0.05), and all patients obtained bony intervertebral fusion at last follow-up. At last follow-up, 2 cases (9.1%) in group A and 11 cases (57.9%) in group B had cage sinking, and the difference in the incidence was significant (P<0.05). No loosening or fracture of internal fixators occurred in all patients. Conclusion Using ultrasonic bone scalpel can transform single vertebral ACCF into two-segment ACDF in anterior cervical spondylosis surgery. The V-shaped stealth decompression technique is safe and efficient, with the advantages of minimal trauma, fewer postoperative complications, and rapid recovery of patients.

Citation： WANG Zhaodong, DUAN Keyou, LIU Yajun, XU Chen, ZHU Zhonglian, ZHOU Pinghui, GUAN Jianzhong. Application of V-shaped stealth decompression technique using ultrasonic bone scalpel in anterior surgery for adjacent two-level cervical spondylosis. Chinese Journal of Reparative and Reconstructive Surgery, 2025, 39(6): 741-747. doi: 10.7507/1002-1892.202502056 Copy

1.	Le HV, Javidan Y, Khan SN, et al. Dysphagia after anterior cervical spine surgery: pathophysiology, diagnosis, and management. J Am Acad Orthop Surg, 2024, 32(14): 627-636.
2.	Colón LF, Barber L, Soffin E, et al. Management and treatment algorithm of airway complications after anterior cervical spine surgery: systematic review. J Spine Surg, 2024, 10(3): 562-575.
3.	Chen T, Wang Y, Zhou H, et al. Comparison of anterior cervical discectomy and fusion versus anterior cervical corpectomy and fusion in the treatment of localized ossification of the posterior longitudinal ligament. J Orthop Surg (Hong Kong), 2023, 31(1): 10225536231167704. doi: 10.1177/10225536231167704.
4.	Yu H, Li X, Chen S, et al. Comparative effectiveness and safety of anterior cervical corpectomy with fusion, laminoplasty, and laminectomy and instrumented fusion for ossification of the posterior longitudinal ligament: a systematic review and network meta-analysis. J Invest Surg, 2022, 35(3): 667-676.
5.	宋仁谦, 周英杰, 郑怀亮, 等. 颈椎前路V形截骨Y形减压融合术治疗后纵韧带骨化症的临床疗效观察. 中国脊柱脊髓杂志, 2024, 34(5): 449-457.
6.	田杨, 韩永正, 李娇, 等. 颈椎前路手术后硬膜外血肿的发生率和危险因素. 北京大学学报(医学版), 2024, 56(6): 1058-1064.
7.	曹国龙, 陈卓, 施集, 等. 颈椎前路椎体次全切除植骨融合术后钛网沉降的危险因素. 中国脊柱脊髓杂志, 2023, 33(7): 602-609.
8.	李玉伟, 严晓云, 潘传红, 等. 超声骨刀系统行椎板切除、后纵韧带骨化块切断联合去后凸矫形治疗多节段胸椎后纵韧带骨化症. 中国修复重建外科杂志, 2024, 38(9): 1086-1091.
9.	Sun K, Zhang S, Yang B, et al. The effect of laminectomy with instrumented fusion carried into the thoracic spine on the sagittal imbalance in patients with multilevel ossification of the posterior longitudinal ligament. Orthop Surg, 2021, 13(8): 2280-2288.
10.	Ando K, Nakashima H, Machino M, et al. Postoperative progression of ligamentum flavum ossification after posterior instrumented surgery for thoracic posterior longitudinal ligament ossification: long-term outcomes during a minimum 10-year follow-up. J Neurosurg Spine, 2021, 36(6): 986-996.
11.	Oshina M, Oshima Y, Tanaka S, et al. Radiological fusion criteria of postoperative anterior cervical discectomy and fusion: a systematic review. Global Spine J, 2018, 8(7): 739-750.
12.	王海波, 李欣, 王子然, 等. 颈椎前路椎体可控前移融合术和颈椎前路椎体次全切除融合术治疗多节段脊髓型颈椎病伴椎管狭窄的短期疗效. 脊柱外科杂志, 2024, 22(4): 222-227.
13.	Lee CY, Chen PC, Wu MH, et al. Minimally invasive surgical treatment of extensive spinal epidural abscess with unilateral laminotomy for bilateral decompression using an ultrasonic bone curette: a technique note. World Neurosurg, 2022, 168: 111-119.
14.	Renjith KR, Eamani NK, Raja DC, et al. Ultrasonic bone scalpel in spine surgery. J Orthop, 2023, 41: 1-7.
15.	Steinle AM, Chen JW, O’Brien A, et al. Efficacy and safety of the ultrasonic bone scalpel in lumbar laminectomies. Spine Surg Relat Res, 2022, 7(3): 242-248.
16.	Moon RDC, Srikandarajah N, Clark S, et al. Primary lumbar decompression using ultrasonic bone curette compared to conventional technique. Br J Neurosurg, 2021, 35(6): 775-779.
17.	徐陈, 王照东, 刘亚军, 等. 超声骨刀在颈椎前路手术中的应用研究. 中国修复重建外科杂志, 2023, 37(8): 996-1001.
18.	Kim CH, Renaldo N, Chung CK, et al. Use of an ultrasonic osteotome for direct removal of beak-type ossification of posterior longitudinal ligament in the thoracic spine. J Korean Neurosurg Soc, 2015, 58(6): 571-577.
19.	鲍小明, 张小平, 郭卫东, 等. 显微镜辅助下超声骨刀在颈椎前路骨化物切除中的应用及临床疗效. 生物骨科材料与临床研究, 2023, 20(6): 27-31.

1. Le HV, Javidan Y, Khan SN, et al. Dysphagia after anterior cervical spine surgery: pathophysiology, diagnosis, and management. J Am Acad Orthop Surg, 2024, 32(14): 627-636.
2. Colón LF, Barber L, Soffin E, et al. Management and treatment algorithm of airway complications after anterior cervical spine surgery: systematic review. J Spine Surg, 2024, 10(3): 562-575.
3. Chen T, Wang Y, Zhou H, et al. Comparison of anterior cervical discectomy and fusion versus anterior cervical corpectomy and fusion in the treatment of localized ossification of the posterior longitudinal ligament. J Orthop Surg (Hong Kong), 2023, 31(1): 10225536231167704. doi: 10.1177/10225536231167704.
4. Yu H, Li X, Chen S, et al. Comparative effectiveness and safety of anterior cervical corpectomy with fusion, laminoplasty, and laminectomy and instrumented fusion for ossification of the posterior longitudinal ligament: a systematic review and network meta-analysis. J Invest Surg, 2022, 35(3): 667-676.
5. 宋仁谦, 周英杰, 郑怀亮, 等. 颈椎前路V形截骨Y形减压融合术治疗后纵韧带骨化症的临床疗效观察. 中国脊柱脊髓杂志, 2024, 34(5): 449-457.
6. 田杨, 韩永正, 李娇, 等. 颈椎前路手术后硬膜外血肿的发生率和危险因素. 北京大学学报(医学版), 2024, 56(6): 1058-1064.
7. 曹国龙, 陈卓, 施集, 等. 颈椎前路椎体次全切除植骨融合术后钛网沉降的危险因素. 中国脊柱脊髓杂志, 2023, 33(7): 602-609.
8. 李玉伟, 严晓云, 潘传红, 等. 超声骨刀系统行椎板切除、后纵韧带骨化块切断联合去后凸矫形治疗多节段胸椎后纵韧带骨化症. 中国修复重建外科杂志, 2024, 38(9): 1086-1091.
9. Sun K, Zhang S, Yang B, et al. The effect of laminectomy with instrumented fusion carried into the thoracic spine on the sagittal imbalance in patients with multilevel ossification of the posterior longitudinal ligament. Orthop Surg, 2021, 13(8): 2280-2288.
10. Ando K, Nakashima H, Machino M, et al. Postoperative progression of ligamentum flavum ossification after posterior instrumented surgery for thoracic posterior longitudinal ligament ossification: long-term outcomes during a minimum 10-year follow-up. J Neurosurg Spine, 2021, 36(6): 986-996.
11. Oshina M, Oshima Y, Tanaka S, et al. Radiological fusion criteria of postoperative anterior cervical discectomy and fusion: a systematic review. Global Spine J, 2018, 8(7): 739-750.
12. 王海波, 李欣, 王子然, 等. 颈椎前路椎体可控前移融合术和颈椎前路椎体次全切除融合术治疗多节段脊髓型颈椎病伴椎管狭窄的短期疗效. 脊柱外科杂志, 2024, 22(4): 222-227.
13. Lee CY, Chen PC, Wu MH, et al. Minimally invasive surgical treatment of extensive spinal epidural abscess with unilateral laminotomy for bilateral decompression using an ultrasonic bone curette: a technique note. World Neurosurg, 2022, 168: 111-119.
14. Renjith KR, Eamani NK, Raja DC, et al. Ultrasonic bone scalpel in spine surgery. J Orthop, 2023, 41: 1-7.
15. Steinle AM, Chen JW, O’Brien A, et al. Efficacy and safety of the ultrasonic bone scalpel in lumbar laminectomies. Spine Surg Relat Res, 2022, 7(3): 242-248.
16. Moon RDC, Srikandarajah N, Clark S, et al. Primary lumbar decompression using ultrasonic bone curette compared to conventional technique. Br J Neurosurg, 2021, 35(6): 775-779.
17. 徐陈, 王照东, 刘亚军, 等. 超声骨刀在颈椎前路手术中的应用研究. 中国修复重建外科杂志, 2023, 37(8): 996-1001.
18. Kim CH, Renaldo N, Chung CK, et al. Use of an ultrasonic osteotome for direct removal of beak-type ossification of posterior longitudinal ligament in the thoracic spine. J Korean Neurosurg Soc, 2015, 58(6): 571-577.
19. 鲍小明, 张小平, 郭卫东, 等. 显微镜辅助下超声骨刀在颈椎前路骨化物切除中的应用及临床疗效. 生物骨科材料与临床研究, 2023, 20(6): 27-31.

Chinese Journal of Reparative and Reconstructive Surgery

Application of V-shaped stealth decompression technique using ultrasonic bone scalpel in anterior surgery for adjacent two-level cervical spondylosis

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