William Sonstein, MD, FACS, senior partner at Neurological Surgery, chief of neurosurgery at North Shore-LIJ Hospital at Plainview (N.Y.) and co-chief of neurosurgery at St. Joseph's Hospital in Bethpage, N.Y., is among the early adopters of new technologies that may help prevent complications for spine surgery: the Medtronic Aquamantys System, Stryker Sonopet Aspirator and Misonix Sonastar Ultrasonic Aspiration System. The Stryker and Misonix systems include ultrasonic bone emulsification devices, while the Medtronic system includes a device that uses "transcollation" technology. This technology combines radiofrequency energy and saline to deliver heat to the spinal cord to promote hemostatic sealing of soft tissue and bone during surgery. The Medtronic device is designed to reduce the risk of infection and blood transfusion rates. The Stryker and Misonix devices are designed to prevent spinal fluid leakage.Dr. Sonstein discusses the use of these systems in his practice and where he sees this technology going in the future.
Q: What makes these devices unique and imperative for spine surgeons?
Dr. William Sonstein: These systems are revolutionary in the treatment of spine surgery; there has been a lot of innovation in implants and screws and variations on that theme, but the outcomes really come down to how well you can control bleeding and what you can do to decompress the spine and prevent spinal fluid leakage. These technologies allow us to do spine surgery much more safely than before.
The Stryker and Misonix ultrasonic device systems include existing technology, but the tips are shaped differently. These instruments literally melt the bone as you touch it, sparing the soft tissue — particularly the dura — so you can decompress the lateral part of the sac safely. You can also access the foramen, which allows you to get an excellent decompression.
It's a smooth device and you can even use it for retraction. It really increases the safety factor for doing particularly hard stenosis cases, such as elderly patients.
Q: What advantage does the Aquamantys system give surgeons?
WS: The Aquamantys system is amazing because it allows you to do bigger revision surgeries without lots of bleeding. You can go in with much more confidence because you can easily coagulate blood vessels in a wider field. Coagulation is faster because it doesn't require pinpoint accuracy. When there is bleeding you can stop it more quickly.
You also perform surgery faster because you aren't spending time trying to stop bleeding, and it saves money on the transfusion. There aren't any delayed surgeries because of blood loss.
Q: How widespread is use of this system? Do you think more surgeons will be using it in the future?
WS: This is a relatively new system that is used in some institutions, but not every hospital. Every time I discuss it with other surgeons, we talk about possible improvements to care. You can use the system as part of your armamentarium but in the end, surgeons really need to get into parts of the spine where it's very dangerous in order to decompress the nerves. You can remove the bone safely and start the opening and then complete the decompression.
Q: Is there a learning curve to implementing this technology?
WS: No — you can start using it immediately. There isn't a training period involved. I think every hospital should have it. As time goes on, these things are becoming more important to allow for safer surgery and ultimately save money in terms of time and complications.
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