• Chi Heon Kim, Chun Kee Chung, Yunhee Choi, Calvin C Kuo, Urim Lee, Seung Heon Yang, Chang-Hyun Lee, Jong-Myung Jung, Sung Hwan Hwang, Dong Hwan Kim, Joon Ho Yoon, Seoi Paik, Hwa Jin Lee, Sunhyang Jung, Sung Bae Park, Kyoung-Tae Kim, and Hee-Pyoung Park.
• Department of Neurosurgery, Seoul National University Hospital, Seoul, South Korea.
• Neurosurgery. 2020 Jun 1; 86 (6): 825-834.

BackgroundIn cervical open-door laminoplasty for cervical myelopathy, a high-speed rotatory drill and rongeurs are used to make unicortical troughs and bicortical openings in the laminae. The lamina is reflected at the trough to enlarge the spinal canal, followed by bone healing on the hinge side to stabilize laminoplasty. The ultrasonic bone scalpel (UBS) has been used due to theoretical advantages including a better hinge union rate, less soft tissue trauma, less neurological injury, and shorter operative time.ObjectiveTo assess the superiority of UBS for hinge union compared to the drill through randomized controlled trial.MethodsIn 190 randomly allocated cervical myelopathy patients, the trough and opening at the lamina were made using either the drill (n = 95) or UBS (n = 95) during 2015 to 2018. The primary outcome was the hinge union rate on 6-mo postoperative computed tomography. Secondary outcomes included the hinge union rate at 12 mo, the operative time, intraoperative/postoperative bleeding, neurological injury, complications, and clinical outcomes over a 24-mo follow-up.ResultsHinge union in all laminae was achieved in 60.0% (drill) and 43.9% (UBS) of patients at 6 mo (intention-to-treat analysis; P = .02; odds ratio, 2.1) and in 91.9% (drill) and 86.5% (UBS) at 12 mo. Dural injury only occurred in the drill group (2.1%), and the UBS group showed significantly less intraoperative bleeding (P < .01). The other secondary outcomes did not differ between groups.ConclusionThe hinge union rate was inferior in the UBS group at 6 mo postoperatively, but UBS was efficacious in reducing dural injuries and bleeding.Copyright © 2019 by the Congress of Neurological Surgeons.

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