Thermal Generation in Spinal Surgery: Does Rate of Irrigation Matter During Anterior Cervical Discectomy?

Autor:	Low LYH; Spine Service, Galway University Hospitals, Galway, Ireland lowl@tcd.ie., Baig MN; Spine Service, Galway University Hospitals, Galway, Ireland., McCabe JP; Spine Service, Galway University Hospitals, Galway, Ireland.; School of Medicine, University of Galway, Galway, Ireland.
Jazyk:	angličtina
Zdroj:	International journal of spine surgery [Int J Spine Surg] 2023 Aug; Vol. 17 (4), pp. 542-546. Date of Electronic Publication: 2023 Apr 20.
DOI:	10.14444/8471
Abstrakt:	Background: High-speed rotational burring is considered the mainstay of modern spinal decompression surgery. However, high-energy burrs generate significant heat due to the friction between the bone and the rotating burr. This study determines the effects of automated irrigation rate on burr tip temperatures either with a serrated steel burr or diamond-coated burr during anterior cervical discectomy and fusion (ACDF). Methods: This is an observational study of the routine practice of a single surgeon for 20 patients aged 18 years or older undergoing elective single- or multilevel ACDF. Various continuous irrigation rates of 0, 0.5, 1.0, or 2.0 cc/min were used. Forward-looking infrared thermography was used to measure the burr tip temperatures. The Midas Rex Legend EHS (Medtronic, PLC, Minneapolis, MN) stylus high-speed surgical drill was used with 3-mm burrs (diamond-coated and carbide-serrated steel) paired to the Medtronic Integrated Power Console set at 60,000 rpm. Results: The 0.5-cc/min irrigation rate kept the maximum burr temperatures below 45°C ( P < .001). With no irrigation (0 cc/min), the steel burrs reached a maximum of 141°C, and the diamond-coated burrs reached 177°C, which was the only significant difference related to the burr materials ( P = 0.0354). With irrigation rates of 0.5 cc/min and above, the maximum recorded temperature for steel burrs was 40.6°C, and the maximum temperature for diamond-coated burrs was 38.9°C. Irrigation rates greater than 0.5 cc/min yielded little additional benefit. Conclusion: This study highlights the importance of adequate irrigation during high-speed burr drilling. Continuous irrigation is recommended even as low as 0.5 cc/min. It is good operative practice to reduce the risk of heat transmission to surrounding tissues, especially considering the proximity of cervical spinal nerve roots during uncoforaminal decompression. Competing Interests: Declaration of Conflicting Interests : The authors report no conflicts of interest in this work. (This manuscript is generously published free of charge by ISASS, the International Society for the Advancement of Spine Surgery. Copyright © 2023 ISASS. To see more or order reprints or permissions, see http://ijssurgery.com.)
Databáze:	MEDLINE
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