Ultrasonic Aspirator versus high speed burr in cervical laminectomy: A retrospective comparative study

Cervical laminectomy for cervical myelopathy has been performed traditionally with osteotomes and rongeurs and more recently with High-speed burr (HSB). However, these methods can cause devastating soft tissue injury by direct contact and are difficult to use in areas with an already compressed cord. We evaluated the use of an ultrasonic bone scalpel, for the patients operated for cervical myelopathy and compared the outcomes to those operated with HSB. A retrospective analysis was done and patients operated for cervical laminectomy between January 2017 and October 2020 were included. They were divided into two groups based on the device used for laminectomy i.e, HSB and ultrasonic bone scalpel. We compared the demographic, clinical and functional outcomes for patients for one year post operatively. We used the modified Japanese Orthopaedic Association (mJOA) and Visual Analogue score (VAS) for both arm and neck pain and Nurick Grading. 177 patients were included of which 101 were operated with an HSB and 76 by ultrasonic bone aspirator. Demographic and baseline parameters were comparable. However, the duration of surgery (p < 0.001) and the rates of total complications (p = 0.041) were significantly higher in the HSB group. Of note, accidental durotomies were significantly lower in the ultrasonic bone scalpel group (p = 0.024). Other variables like blood loss, hospital stay and incision length were similar. Functional outcomes were comparable among the two groups. Ultrasonic bone scalpel has a higher safety margin and helps in achieving a shorter duration of surgery. Specially, the rates of accidental durotomies are significantly less with the use of ultrasonic bone scalpel.