Development of a New Coupled Cobb-Suction Instrument for Posterior Spinal Approaches: Technical Note

Abstract During dissection of paraspinal muscles in posterior surgical approaches, the spine surgeon usually holds a subperiosteal (Cobb) elevator in one hand and a monopolar cautery in the other hand. In such a scenario, both the surgical smoke generated by the monopolar as well as eventual bleedings constitute a significant hindrance to simultaneous bilateral dissection of the paraspinal muscles by two surgeons. In order to address the identified shortcomings in the currently available instrumentation the authors initially analyzed the most common surgical techniques employed by residents and fellows at our institution for paraspinal muscle dissection during posterior spinal approaches. Additionally, we collected trainees’ feedback regarding the efficacy of available strategies for dealing with surgical smoke. Finally a new coupled Cobb elevator-suction instrument was designed, manufactured and tested by residents, fellows and experienced spine surgeons, and small additional design modifications were performed. In this technical note we present the first description of a new coupled Cobb-suction instrument which has been developed in order to enable simultaneous retraction and suction with one hand while allowing the spine surgeon to use the monopolar cautery with the other hand. In our preliminary institutional experience, this new tool has been proven to be especially useful in long posterior spinal approaches in the thoracolumbar region.