Elsevier

Surgical Neurology

Volume 71, Issue 4, April 2009, Pages 466-468
Surgical Neurology

Technology
Pneumatic Kerrison rongeur: technical note,☆☆

https://doi.org/10.1016/j.surneu.2008.10.008Get rights and content

Abstract

Background

We report our experience with the Aesculap Pneumatic Powered Kerrison Rongeur (Aesculap AG Company) Tuttlingen, Germany.

Methods

Between February 2007 and January 2008, 125 patients underwent spinal surgery for the treatment of spinal stenosis, spinal tumors, degenerative disk disease, and herniated disks in the cervical, thoracic, and lumbar areas using the pneumatic-powered Kerrison rongeur for bone and tissue removal.

Results

All bone removal for procedures ranging from cervical and lumbar microdiscectomies to extensive multilevel laminectomies was carried out with no complications from instrument design or malfunction. Most importantly, the manual labor required to forcefully squeeze and bite bone was virtually eliminated. The learning curve for instrument application was negligible. Operating room personnel similarly had no difficulty with the simplified tubing connections to an air supply and the Kerrison handle with interchangeable, multisized shafts.

Conclusion

The new pneumatically powered Kerrison rongeur not only is safe and easy to use but also virtually eliminates the manual fatigue and, at times, pain associated with prolonged bone removal from the use of standard Kerrison rongeurs.

Introduction

An estimated 80% of the surgical practice of most neurosurgeons and virtually 100% of orthopedic spinal surgeons involves operations to remove bone in and around the spinal canal. Manual fatigue, soreness, and aching of the hands, as well as at times the tendonous attachments to the elbow, are a common concomitant of manual bone removal particularly when done over the course of several years. To address this problem, engineers at the Aesculap AG Company Tuttlingen, Germany designed a pneumatic powered Kerrison rongeur with a pneumatic module providing 2 pressure levels that we evaluated for safety, ease of use, and the reduction in the surgeon's manual fatigue. We report our experience with the pneumatic Kerrison rongeur and discuss our results.

Section snippets

Instrumentation and methods

The pneumatic Kerrison rongeur used in this study is shown in Fig. 1, Fig. 2, Fig. 3. It consists of 4 parts: the instrument itself which integrates a handle and shafts in different lengths (235 and 285 mm) and widths (2-6 mm) (Table 1); a slim and flexible disposal twin tubing which provides for compressed air; a pneumatic interface; and reusable air hose for connection to the central pressure source.

When squeezing the trigger, 2 pressure levels are sequentially activated: first, a low-power

Patients

Between February 2007 and January 2008, we used the pneumatic Kerrison rongeur in 125 operations. These included anterior cervical discectomies, cervical laminectomies, thoracic laminectomies, lumbar laminectomies, microdiscectomies, medial facetectomies, and foraminotomies (Table 2). These operations were carried out in the standard open fashion as well as through microsurgical incisions using the metrix port and other minimally invasive techniques.

Utility of the pneumatic Kerrison rongeur in different types of spinal surgery

Irrespective of whether the surgery involved the cervical, thoracic, or lumbar spine in an open or minimally invasive approach, bone and ligamentum flavum were removed with no complications and no additional risk of a dural tear or venous plexus damage [2]. No complications occurred as a result of instrument design or malfunction. The pistol grip handle was ergonomically comfortable and used exactly as one would a standard Kerrison rongeur—but with much greater ease. It could be easily held in

Discussion

This pneumatically powered Kerrison rongeur has evolved from previous attempts to design instrumentation to reduce manual fatigue. Approximately 20 years ago, the Ronjair system (3M, Inc, Minn St. Paul) was developed for this purpose. It was also pneumatically driven but had several drawbacks, which led to its obsolescence. The handle grip itself was large and cumbersome. Most importantly, it provided for only one high-force pressure level and could only be opened after applying a maximal

Conclusion

We found the pneumatic Kerrison rongeur highly useful in all of the spinal procedures in which it was evaluated. We had no complications related to instrument design or use. The setup time for operating room personnel took no more than a minute or 2. It offers several advantages over previously introduced pneumatic systems and has a high level of safety. Most significantly, it provides a marked reduction in manual fatigue and discomfort associated with spinal operations and bone removal.

References (4)

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There are more references available in the full text version of this article.

Cited by (5)

The authors have not received any financial support in conjunction with the generation of this paper nor its submission.

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This work was supported in part by a grant from the Dennis and Rose Heindl Foundation.

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