Dreal High-Speed Shielded Curved Device May Speed Spinal Decompression and Preserve Vital Spinal Structures

The Dreal high-speed drill, designed with a curved and shielded tip, allowed for safe and efficient bone resection in a case series involving 10 patients undergoing cervical foraminal decompression as part of treatment for cervical stenosis, according to a white paper by Bernard et al.

“With the Dreal device, you can accomplish cervical decompression safely in areas that often times are a more difficult to access using traditional drills, burrs, and manual instruments,” said Richard D. Guyer, MD, spine surgeon, co-founder of the Texas Back Institute in Plano, TX and past president of the North American Spine Society. “Because the Dreal device is curved, it allows more flexibility in terms of its ability to remove bone. It is shielded so it protects adjacent vital structures, such as the spinal cord and nerve root, from harm.”

Case Series Demonstrates Efficacy of Dreal Device
The case series by Bernard et al involved 10 patients with cervical stenosis who underwent anterior cervical discectomy and fusion (ACDF) or cervical disc arthroplasty. The Dreal device (Carevature Medical Ltd.) was used to thin the uncus, allowing the remaining uncus to be removed with a Kerrison Rongeur. This in turn allowed for unobstructed access to the foramen for decompression, according to Bernard et al.

In addition, the Dreal device was used to remove the cartilage endplate in preparation for interbody or arthroplasty implant. The study investigators also noted that the Dreal device was useful in removing posterior osteophytes.

Significant Improvements in Pain and Disability Reported
All patients showed significant improvement in Visual Analog Scale and Neck Disability Index from baseline to one day postsurgery (Table). Complete bony resection was confirmed in all patients using magnetic resonance imaging (MRI). No adverse events related to use of the Dreal device were reported.
Clinical outcome measures before and after ACDF or C-TDR.Figures 1 and 2 below shows an example of before and after results from a patient in the study who underwent uncus resection and foramen decompression.
Figure 1. Preoperative axial MRI of a patient with right-sided nerve root compression. Reprinted with permission from Carevature Medical Ltd.
Figure 2. Postoperative CT scan demonstrates resected uncus and decompressed foramen using the Dreal device. Reprinted with permission from Carevature Medical Ltd.

Clinical Experience With the Dreal Device

“The first time I used the Dreal device was for a patient who had a severe neuroforaminal stenosis of the lumbar spine,” Dr. Guyer told SpineUniverse. “I was trying my traditional instruments, and I just couldn’t adequately decompress the foramen. Then I used the Dreal device, and it accessed the area more easily accomplishing the decompression.”

Dr. Guyer selects the Dreal device, particularly in cases involving severe bony stenosis with or without deformity, “in which you would have to remove too much of the facet joint to do the decompression. Rather than sacrifice the natural anatomy, you can do the decompression in a safer and faster method than our usual techniques.”

In these severe cases, “while you may not have direct visualization, use of fluoroscopy, though optional, allows me to know that I am decompressing in the proper place, so I don’t have to keep removing bone to allow for direct visualization,” Dr. Guyer said. 

“In my limited experience, the Dreal device allows for faster decompression and sacrifices less normal tissue,” Dr. Guyer concluded.

In the future, he hopes that minimally invasive tools such as the Dreal device will advance to the point of allowing for decompression from the inside out. Thus, rather than having to remove bone to perform a decompression, he believes that instruments will be developed that allow for decompression from the inside of the spine out without removing the lamina.

Disclosure: Richard D. Guyer, MD is Head, Scientific Advisory Board and a Consultant for Carevature Medical Ltd.