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

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.

Keywords:

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

Disclosure statement

Dr. Riew receives royalties from Biomet and Medtronic, receives grants from AOSpine, Cerapedics and Medtronic, and receives honorarium from North American Spine Society (NASS) and AOSpine. The other authors report no conflicts of interest