Preclinical Comparison of Thermal Tissue Effects from Traditional Electrosurgery and a Low-Temperature Electrosurgical Device during Anterior Cervical Discectomy and Fusion

Abstract

Background: Exposure of the anterior cervical spine requires dissection in proximity to critical neurovascular structures. Monopolar electrosurgical (ES) devices generate heat in contacted tissues, resulting in thermal damage and temperature change. This study examined depth of thermal injury and temperature change associated with use of a lowtemperature electrosurgical device (LTD) compared to traditional electrosurgery during a cadaveric anterior cervical discectomy and fusion (ACDF) dissection.Methods: ACDF was performed, using ES or LTD, on cervical spines (C3-4 and C4-5) from 2 fresh human cadavers with intact neck soft tissues and no history of surgery. Cadavers were maintained at 22-238C, and fiber-optic temperature sensors (Neoptix, Qu´ebec City, Qu´ebec, Canada) were placed near relevant structures to measure changes during dissection. Depth of thermal injury was assessed by hematoxylin and eosin and Masson's trichrome histology of fixed tissue specimens.Results: Use of the LTD resulted in a statistically significant reduction in temperature change at platysma (3.0 6 1.04 vs. 11.41 6 3.108C, P ¼ .003), carotid sheath (7.32 6 1.13 vs. 15.57 6 2.568C, P ¼ .007), and longus colli (6.11 6 1.32 vs. 12.9 6 3.628C, P ¼ .016) compared to ES. Temperature change at the trachea was similar between groups (6.06 6 1.99 vs. 4.96 6 1.898C, P ¼ .528). Histology showed that LTD produced less mean and maximal depth of thermal injury compared to ES (mean: 0.5 vs. 1.2 mm; max: 0.9 vs. 1.8 mm; P , .05).Conclusions: The results of this pilot study demonstrate that anterior cervical spine exposure using an LTD reduces tissue temperature change and depth of thermal injury compared to ES.Clinical Relevance: Although exploratory, these results suggest that use of an LTD during ACDF may reduce the extent of thermal tissue injury during dissection. Future studies in live animal models are warranted to determine if thermal injury is a potential cause of common exposure-related complications, such as dysphagia and dysphonia.

Predictive nomogram of cage nonunion after anterior cervical discectomy and fusion: A retrospective study in a spine surgery center

“…Vijay et al determined that lower vitamin D level played an important role in a lower rate of and a longer time to fusion. [ 29 , 30 ] In our study, we also found that serum vitamin D (OR = 0.79, P < .001) was significant predictor of nonunion. These findings indicate it is necessary to proceed a prospective study to analyze the role of vitamin D supplementation on spinal fusion.…”