Modified disc rongeur Technical Note
PETEn A. LAKE, M.D.
Eisenhower Medical Center, Palm Desert, California ~" The author presents a modification of a standard pituitary rongeur, designed to avoid instrument penetration into the abdominal cavity during lumbar disc surgery. KEy WoRDs
9 disc surgery
URGEONS who perform lumbar disc surgery are aware of the possible hazards involved in the operation. Among them is the possibility of a rongeur passing beyond the disc space and damaging adjacent vascular and intraabdominal structures. The offending instrument is universally considered to be the pituitary rongeur. 1 Safety measures include inserting the rongeur with the jaws closed, observing the disc space for a falling saline level or the appearance of blood, and a gentle, experienced touch. Despite our familiarity with these measures, the threat of vascular damage remains a very real risk. In an attempt to minimize the hazard of this partially "blind" procedure, we have modified a standard pituitary rongeur by scoring centimeter markings on the shaft. The finish on the distal 4 cm at the jaws has been dulled (Fig. 1).* The surgeon can measure the actual depth of the disc space on preoperative lateral x-ray films, and with the help of the markings on the rongeur shaft have a more accurate guide to his working limits.
*Modified disc rongeur prepared by the Ruggles Corporation, Boston, Massachusetts. 504
FIG. 1. Left: Modified disc rongeur, showing centimeter markings. Right: Modified disc rongeur overlying spine. Note depth to anterior extent of disc from level of lateral facet.
1. Horowitz NH,
Rizzoli HV: Postoperative Complications in Neurosnrgicai Practice. Recognition, Prevention, and Management. Baltimore, Williams & Wilkins, 237-240
Address reprint requests to: Peter A. Lake, M.D., Box 1765, Palm Springs, California 92262. J. Neurosurg. / Volume 43 / October, 1975