1071 Ultrasonic Bone Curette Associated With Fewer Durotomies, Decreased Blood Loss Compared to Conventional Technique for Pedicle Subtraction Osteotomies (PSO)

INTRODUCTION: Ultrasonic bone curettes are a promising safety innovation in spine surgery. METHODS: All patients undergoing PSO with a single surgeon across two academic health institutions in the past eight years were obtained by CPT and reviewed. Preoperative variables obtained were demographics, prior spine surgeries, and etiology, while intraoperative predictor variables were ultrasonic bone curettage use and number of fused levels. The principal outcomes were surgical: duration of surgery, estimated blood loss (EBL), incidence of durotomies, and neurovascular injury. Secondary outcomes were postoperative: length of stay, need for revision surgery, minor complications, and major complications. Multiple logistic regression was used to evaluate associations with binary outcomes, while multiple linear regression evaluated continuous outcomes. RESULTS: Overall, 175 patients who underwent PSO with a single surgeon at two institutions were reviewed. In this sample, 89 (51%) had prior surgeries, and 45 (26%) were treated with the ultrasonic bone curettage. Intraoperatively, the mean EBL was 1105 mL (350-3000 mL), 29 (17%) of participants sustained durotomies, 14 (8%) experienced neurovascular injury, and the mean duration of surgery was 401 mins (135-695 mins). Postoperatively, 35 (20%) experienced minor complications, 25 (14%) experienced major complications, and mean length of stay was 11 days (range 2-80 days). Ultrasonic bone curettage use correlated with decreased blood loss (β= -270 mL, p=0.004) and was associated with decreased incidence of durotomy (OR=0.29, p=0.042). CONCLUSIONS: Use of ultrasonic bone curettage in PSO was associated with fewer durotomies and correlated with decreased blood loss in this single surgeon’s multi-institutional experience. Further study should explore the effect of ultrasonic bone curettage on surgical outcomes prospectively across multiple surgeons to support these results.