The Ultrasonic Bone Scalpel does not Outperform the High-Speed Drill: A Single Academic Experience

Authors

Bradley Anderson, Department of Neurological Surgery, The George Washington University Hospital, Washington, District of Columbia, USA. Electronic address: Bradanderson@gwu.edu.
Khashayar Mozaffari, Department of Neurological Surgery, The George Washington University Hospital, Washington, District of Columbia, USA.
Chase H. Foster, Department of Neurological Surgery, The George Washington University Hospital, Washington, District of Columbia, USA.
Alejandro A. Jaco, Department of Neurological Surgery, The George Washington University Hospital, Washington, District of Columbia, USA.
Michael K. Rosner, Department of Neurological Surgery, The George Washington University Hospital, Washington, District of Columbia, USA.

Document Type

Journal Article

Publication Date

2-11-2024

Journal

World neurosurgery

DOI

10.1016/j.wneu.2024.02.037

Keywords

High-speed drill; Perioperative outcomes; Spine surgery; Ultrasonic bone scalpel

Abstract

BACKGROUND: Spinal decompression and osteotomies are conventionally performed using high-speed drills (HSDs) and rongeurs. The ultrasonic bone scalpel (UBS) is a tissue-specific osteotome that preferentially cuts bone while sparing the surrounding soft tissues. There is ongoing investigation into its ability to optimize peri- and postoperative outcomes in spine surgery. The purpose of this study was to compare the intraoperative metrics and complications during a transition period from HSD to UBS. METHODS: A single-institution, single-surgeon retrospective analysis was conducted of patients undergoing spine surgery from January 2020 to December 2021. Statistical analyses were performed to detect associations between the surgical technique and outcomes of interest. A P value < 0.05 was considered statistically significant. RESULTS: A total of 193 patients met the inclusion criteria (HSD, n = 100; UBS, n = 93). Multivariate logistic regression revealed similar durotomy (P = 0.10), nerve injury (P = 0.20), and reoperation (P = 0.68) rates. Although the estimated blood loss (EBL) and length of stay were similar, the operative time was significantly longer with the UBS (192.81 vs. 204.72 minutes; P = 0.03). Each subsequent surgery using the UBS revealed a 3.1% decrease in the probability of nerve injury (P = 0.026) but had no significant effects on the operative time, EBL, or probability of durotomy or reoperation. CONCLUSIONS: The UBS achieves outcomes on par with conventional tools, with a trend toward a lower incidence of neurologic injury. The expected reductions in EBL and durotomy were not realized in our cohort, perhaps because of a high proportion of revision surgeries, although these might be dependent on surgeon familiarity, among other operative factors. Future prospective studies are needed to validate our results and further refine the optimal application of this device in spine surgery.

APA Citation

Anderson, Bradley; Mozaffari, Khashayar; Foster, Chase H.; Jaco, Alejandro A.; and Rosner, Michael K., "The Ultrasonic Bone Scalpel does not Outperform the High-Speed Drill: A Single Academic Experience" (2024). GW Authored Works. Paper 4356.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/4356

Department

Neurological Surgery