Dural Changes Induced by an Ultrasonic Bone Curette in an Excised Porcine Spinal Cord

SIMPLE SUMMARY: An ultrasonic bone curette is a surgical device used for bone removal during spinal surgery. This curette is considered unlikely to cause mechanical injury to the dura, a thick membrane surrounding the spinal cord, when it accidentally makes contact with the dura. We investigated the effect of direct contact with an ultrasonic bone curette on the dura and the protective effect of covering the dura with a piece of cotton using an excised porcine spinal cord. The ultrasonic bone curette was pressed against the porcine spinal cord and activated for 1 s, with or without covering the dura with a piece of cotton. None of the specimens showed dural perforation, although non-perforating injuries to the dura were observed in many specimens. Histological changes were also observed in some of the specimens. The use of cotton reduced the occurrence of these changes, but it did not prevent them when ultrasonic vibration was applied with a large force. We considered ultrasonic bone curettes to have a low risk of dural perforation and, thus, to be a safe surgical device as long as they did not accidentally make strong contact with the dura. ABSTRACT: In spinal surgery, ultrasonic bone curettes are considered unlikely to cause mechanical injury to the dura; however, there is little evidence to support this claim. We investigated the effect of direct contact with an ultrasonic bone curette on the dura and the protective effect of covering the dura with a cotton pattie using an excised porcine spinal cord. The ultrasonic bone curette was pressed against the porcine spinal cord with constant force and activated for 1 s, with or without covering the dura with a cotton pattie. The dural surface and cross-section were observed using electron and light microscopy. When the ultrasonic bone curette was applied directly against the dura, most specimens showed non-perforating dural injuries. However, none of the specimens showed dural perforation. Histological changes were also observed. The use of a cotton pattie reduced the occurrence of these changes, although it did not prevent them when ultrasonic vibration was applied with a large force. We considered ultrasonic bone curettes to have a low risk of dural perforation and, thus, to be a safe surgical device as long as they did not accidentally make strong contact with the dura.