Quantitative and qualitative analyses of spinal canal encroachment during cervical laminectomy using the kerrison rongeur versus High-Speed burr

James D. Lin, Lee A. Tan, Alexander Tuchman, Xudong Joshua Li, Hao Zhang, Kai Ren, K. Daniel Riew

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

Background: Several cervical laminectomy techniques have been described. One commonly used method involves making bilateral trough laminotomies using either a Kerrison rongeur or a high speed burr, and then removing the lamina en-bloc. Alternatively, some surgeons prefer to thin the lamina with the burr, and then remove the lamina in a piecemeal fashion using Kerrison rongeurs. Some surgeons have warned against the potential risk of iatrogenic spinal cord injury from inserting the Kerrison footplate into a stenotic canal. We aim to quantify the amount of canal encroachment for various methods of cervical laminectomies. Methods: Three attending spine surgeons and two fellows each performed laminectomies using C5 sawbones models. The canal was completely filled with modeling putty to simulate a stenotic spinal cord. Bilateral trough laminotomies were performed using a 1 mm Kerrison, a 2 mm Kerrison, and a 3 mm matchstick high-speed burr. Piecemeal laminectomies were performed with a 2 mm Kerrison. A blinded spine surgery fellow performed all quantitative measurements. Three blinded researchers qualitatively ranked the amount of “canal encroachment”. Results: The average canal encroachment was 0.50 ± 0.45mm for the burr, 1.37 ± 0.68 mm for the 1 mm Kerrison, and 1.47 ± 0.37 mm for the 2 mm Kerrison (p =.002). There was a statistically significant difference between the burr and 1 mm Kerrison (p =.01) and between the burr and the 2 mm Kerrison (p =.001). There was no statistical difference between the 1 mm and 2 mm Kerrison (p =.78). The mean rank of the burr group, the Kerrison rongeur group, and the piecemeal group were 1.41, 1.94, and 2.65, respectively, on an ordinal scale of 1–3. Conclusion: When performing a trough laminotomy, the high-speed burr results in less canal encroachment compared to 1 mm or 2 mm Kerrison rongeurs. In the setting of a stenotic spinal canal, spine surgeons should consider using the burr to perform laminectomy to minimize the degree of canal encroachment.

Original languageEnglish
Pages (from-to)131-134
Number of pages4
JournalBritish Journal of Neurosurgery
Volume33
Issue number2
DOIs
StatePublished - 4 Mar 2019
Externally publishedYes

Keywords

  • Cervical spine
  • Kerrison rongeur
  • cervical myelopathy
  • decompression
  • high-speed burr
  • laminectomy

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