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Results of a prospective randomized study comparing a novel retractor with a Caspar retractor in anterior cervical surgery.
MedLine Citation:
PMID:  21471843     Owner:  NLM     Status:  Publisher    
BACKGROUND:: Retraction injury might explain the soft tissue complications seen after anterior cervical surgery. A novel retractor system (SRS), using a principle of bone fixation with rotation, has been shown to reduce retraction pressure in a cadaveric model of anterior cervical decompression and fusion (ACDF). OBJECTIVE:: To compare conventional Cloward style of retractor (CRS) with the SRS in a prospective randomised clinical trial. METHODS:: After ethics and study registration (ACTRN 12608000430336), eligible patients were randomised to either CRS or SRS retraction system, prior to 1 or 2 level ACDF. The pressure beneath the medial retractor blade was recorded using a thin pressure transducer strip. Postoperative sore throat, dysphagia and dysphonia were assessed after 1, 7 and 28 days. RESULTS:: 26 patients were randomised. There were no serious complications. Complication rates were low with a trend favouring SRS that was not statistically different. Average retraction pressure with SRS was 1.9 mmHg, with CRS 5.6 mmHg. (p = <0.0001 on F-test / p (two tailed) = 0.0015 on t-test). Mean average peak retraction pressure with SRS was 3.4 mmHg, with CRS 20 mmHg (p = <0.0001 on F-test / and p (two tailed) = 0.0054 on t-test). CONCLUSION:: The new retractor is safe, and statistically similar complication rates were observed. SRS generated significantly less retraction pressure compared to the CRS. This can be explained by the different principles governing function of these retractors. Bone fixation gives stability and rotation reduces tissue pressure, both desirable in a retractor.
Ananthababu Pattavilakom; Kevin A Seex
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-4-05
Journal Detail:
Title:  Neurosurgery     Volume:  -     ISSN:  1524-4040     ISO Abbreviation:  -     Publication Date:  2011 Apr 
Date Detail:
Created Date:  2011-4-7     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7802914     Medline TA:  Neurosurgery     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Department of Neurosurgery, Nepean Hospital, Penrith, NSW 2750, Australia.
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