Ultrasonic bone scalpel: utility in cervical corpectomy. A technical note

  • Bharat R. Dave
  • Devanand Degulmadi
  • Shreekant Dahibhate
  • Ajay Krishnan
  • Denish Patel
Ideas and Technical Innovations



Anterior cervical corpectomy and fusion (ACCF) is a technically challenging surgery. Use of conventional instruments like high-speed burr and kerrison rongeurs is associated with high complication rates such as increased blood loss and incidental durotomy. Use of ultrasonic bone scalpel (UBS) in cervical corpectomy helps to minimize such adverse events.


We performed a retrospective study based on the data of 101 consecutive patients who underwent cervical corpectomies with UBS for different cervical spine pathologies from December 2014 to December 2016. Total duration of surgery, time taken for corpectomy, estimated blood loss, and incidental durotomies were noted.


Total surgical time was 30–80 min (59.36 ± 13.21 min) for single-level ACCF and 60–120 min (92.74 ± 21.04 min) for double-level ACCF. Time taken for single-level corpectomy was 2 min 11  ± 10 s and 3 min 41  ± 20 s for double-level corpectomy. Estimated blood loss ranged from 20–150 ml (52.07 ± 29.86 ml) in single level and 40–200 ml (73.22 ± 41.64 ml) in double level. Four (3.96%) inadvertent dural tears were noted, two during single-level corpectomy and other two during double-level corpectomy.


Use of UBS is likely to provide a safe, rapid, and effective surgery when compared to conventional rongeurs and high-speed burr. The advantages such as lower blood loss and lower intra-operative incidental dural tears were noted with the use of UBS.

Graphical abstract


Cervical corpectomy Ultrasonic bone scalpel Complications 


Compliance with ethical standards

Conflict of interest

All the authors declare that they have no conflicts of interest.

Supplementary material

586_2018_5536_MOESM1_ESM.pptx (202 kb)
Supplementary material 1 (PPTX 202 kb)


  1. 1.
    Chibbaro S, Benvenuti L, Carnesecchi S, Marsella M, Pulerà F, Serino D et al (2006) Anterior cervical corpectomy for cervical spondylotic myelopathy: experience and surgical results in a series of 70 consecutive patients. J Clin Neurosci 13:233–238CrossRefPubMedGoogle Scholar
  2. 2.
    Eleraky MA, Llanos C, Sonntag VK (1999) Cervical corpectomy: report of 185 cases and review of the literature. J Neurosurg 90(1 suppl):35–41PubMedGoogle Scholar
  3. 3.
    Fessler RG, Steck JC, Giovanini MA (1998) Anterior cervical corpectomy for cervical spondylotic myelopathy. Neurosurgery 43:257–267CrossRefPubMedGoogle Scholar
  4. 4.
    Mayr MT, Subach BR, Comey CH, Rodts GE, Haid RW Jr (2002) Cervical spinal stenosis: outcome after anterior corpectomy, allograft reconstruction, and instrumentation. J Neurosurg 96(1 suppl):10–16PubMedGoogle Scholar
  5. 5.
    Epstein N (1993) The surgical management of ossification of the posterior longitudinal ligament in 51 patients. J Spinal Disord 6:432–454CrossRefPubMedGoogle Scholar
  6. 6.
    Chen Y, Chen D, Wang X et al (2009) Anterior corpectomy and fusion for severe ossification of posterior longitudinal ligament in the cervical spine. Int Orthop 33:477–482CrossRefPubMedGoogle Scholar
  7. 7.
    Emery SE, Bohlman HH, Bolesta MJ, Jones PK (1998) Anterior cervical decompression and arthrodesis for the treatment of cervical spondylotic myelopathy. Two to seventeen year follow-up. J Bone Jt Surg Am 80:941–951CrossRefGoogle Scholar
  8. 8.
    Hosono N, Miwa T, Mukai Y, Takenaka S, Makino T, Fuji T (2009) Thermal damage to cervical nerve roots by a high-speed drill. J Bone Jt Surg Br 91:1541–1544CrossRefGoogle Scholar
  9. 9.
    Sanborn MR, Balzer J, Gerszten PC, Karausky P, Cheng BC, Welch WC (2011) Safety and efficacy of a novel ultrasonic osteotome device in an ovine model. J Clin Neurosci 18:1528–1533CrossRefPubMedGoogle Scholar
  10. 10.
    Xiaobang Hu, Ohnmeiss Donna D, Lieberman Isador H (2013) use of an ultrasonic osteotome device in spine surgery: experience from the first 128 patients. Eur Spine J 22:2845–2849CrossRefGoogle Scholar
  11. 11.
    Li K, Zhang W, Li B, Xu H, Li Z, Luo D, Zhang J, Ma J (2016) Safety and efficacy of cervical laminoplasty using a piezosurgery device compared with a high-speed drill. Medicine (Baltimore) 95(37):e4913CrossRefGoogle Scholar
  12. 12.
    Vercellotti T (2004) Technological characteristics and clinical indications of piezoelectric bone surgery. Minerva Stomatol 53:207–214PubMedGoogle Scholar
  13. 13.
    Bartley CE, Bastrom TP, Newton PO (2014) Blood loss reduction during surgical correction of adolescent idiopathic scoliosis utilizing an ultrasonic bone scalpel. Spine Deformity 2:285–290CrossRefPubMedGoogle Scholar
  14. 14.
    Onen MR, Yuvruk E, Akay S, Saderi S (2015) the reliability of the ultrasonic bone scalpel in cervical spondylotic myelopathy: a comparative study of 46 patients. World Neurosurg 84(6):1962–1967CrossRefPubMedGoogle Scholar
  15. 15.
    Sarkar S, Nair BR, Rajshekhar V (2016) Complications following central corpectomy in 468 consecutive patients with degenerative cervical spine disease. Neurosurg Focus 40(6):e10CrossRefPubMedGoogle Scholar
  16. 16.
    Hazer DB, Yaşar B, Rosberg HE, Akbaş A (2016) Technical aspects on the use of ultrasonic bone shaver in spine surgery: experience in 307 patients. Biomed Res Int 2016:8428530CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Bydon M, Xu R, Papademetriou K, Sciubba DM, Wolinsky JP, Witham TF, Gokaslan ZL, Jallo G, Bydon A (2013) Safety of spinal decompression using an ultrasonic bone curette compared with a high-speed drill: outcomes in 337 patients. J Neurosurg Spine 18(6):627–633CrossRefPubMedGoogle Scholar
  18. 18.
    Bydon M, Macki M, Xu R, Ain MC, Ahn ES, Jallo GI (2014) Spinal decompression in achondroplastic patients using high speed drill versus ultrasonic bone curette: technical note and outcomes in 30 cases. J Pediatr Orthopaed 34(8):780–786CrossRefGoogle Scholar
  19. 19.
    Al-Mahfoudh R, Qattan E, Ellenbogen JR, Wilby M, Barrett C, Pigott T (2014) Applications of the ultrasonic bone cutter in spinal surgery-our preliminary experience. Br J Neurosurg 28(1):56–60CrossRefPubMedGoogle Scholar
  20. 20.
    Nakagawa H, Kim SD, Mizuno J, Ohara Y, Ito K (2005) Technical advantages of an ultrasonic bone curette in spinal surgery. J Neurosurg Spine 2(4):431–435CrossRefPubMedGoogle Scholar
  21. 21.
    Stubinger S, Kuttenberger J, Filippi A, Sader R, Zeilhofer HF (2005) Intraoral piezosurgery: preliminary results of a new technique. J Oral Maxillofac Surg 63:1283–1287CrossRefPubMedGoogle Scholar
  22. 22.
    Vercellotti T, Pollack AS (2006) A new bone surgery device: sinus grafting and periodontal surgery. Compend Contin Educ Dent 27:319–325PubMedGoogle Scholar
  23. 23.
    Horton JE, Tarpley TM Jr, Jr Jacoway (1981) Clinical applications of ultrasonic instrumentation in the surgical removal of bone. Oral Surg Oral Med Oral Pathol 51:236–242CrossRefPubMedGoogle Scholar
  24. 24.
    Sherman JA, Davies HT (2000) Ultracision: the harmonic scalpel and its possible uses in maxillofacial surgery. Br J Oral Maxillofac Surg 38:530–532CrossRefPubMedGoogle Scholar
  25. 25.
    Lei T, Shen Y, Wang LF, Ding WY, Zhang D, Zhang P, Du W, Li J (2014) Anterior longitudinal decompression in the management of severe ossification of the posterior longitudinal ligament in the cervical spine. Orthopedics 37(5):e465–e472CrossRefPubMedGoogle Scholar
  26. 26.
    Iwasaki M, Okuda S, Miyauchi A, Sakaura H, Mukai Y, Yonenobu K et al (2007) Surgical strategy for cervical myelopathy due to ossification of the posterior longitudinal ligament: part 2: advantages of anterior decompression and fusion over laminoplasty. Spine (Phila Pa 1976) 32:654–660CrossRefGoogle Scholar
  27. 27.
    Chen Y, Yang L, Liu Y, Yang H, Wang X, Chen D (2014) Surgical results and prognostic factors of anterior cervical corpectomy and fusion for ossification of the posterior longitudinal ligament. PLoS ONE 9:e102008CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Boakye M, Patil CG, Ho C, Lad SP (2008) Cervical corpectomy: complications and outcomes. Neurosurgery 63(4 suppl 2):295–302PubMedGoogle Scholar
  29. 29.
    Sagi HC, Beutler W, Carroll E, Connolly PJ (2002) Airway complications associated with surgery on the anterior cervical spine. Spine (Phila Pa 1976) 27:949–953CrossRefGoogle Scholar
  30. 30.
    Sherief T, White J, Bommireddy R (2012) Cervical spondylotic myelopathy: the outcome and potential complications of surgical treatment. Acta Chir Orthop Ttraumatol Cechoslov 80(5):328–334Google Scholar
  31. 31.
    Brooks AT, Nelson CL, Stewart CL, Skinner RA, Siems ML (1993) Effect of an ultrasonic device on temperatures generated in bone and on bone-cement structure. J Arthroplasty 8(4):413–418CrossRefPubMedGoogle Scholar
  32. 32.
    Sawamura Y, Fukushima T, Terasaka S, Sugai T (1999) Development of a hand piece and probes for a microsurgical ultrasonic aspirator: instrumentation and application. Neurosurgery 45(5):1192–1197CrossRefPubMedGoogle Scholar
  33. 33.
    Kim K, Isu T, Matsumoto R, Isobe M, Kogure K (2006) Surgical pitfalls of an ultrasonic bone curette (sonopet) in spinal surgery. Neurosurgery 59(4):S-390–S-393Google Scholar
  34. 34.
    Chen Z, Liu B, Dong J, Feng F, Chen R, Xie P, Zhang L, Rong L (2016) Comparison of anterior corpectomy and fusion versus laminoplasty for the treatment of cervical ossification of posterior longitudinal ligament: a meta-analysis. Neurosurg Focus 40(6):E8CrossRefPubMedGoogle Scholar
  35. 35.
    Mc Callum J, Maroon JC, Jannetta PJ (1975) Treatment of postoperative cerebrospinal fluid fistulas by subarachnoid drainage. J Neurosurg 42:434–437CrossRefGoogle Scholar
  36. 36.
    Kitchel SH, Eismont FJ, Green BA (1989) Closed subarachnoid drainage for management of cerebrospinal fluid leakage after an operation on the spine. J Bone Jt Surg Am 71:984–987CrossRefGoogle Scholar
  37. 37.
    Eismont FJ, Wiesel SW, Rothman RH (1981) Treatment of dural tears associated with spinal surgery. J Bone Jt Surg Am 63:1132–1136CrossRefGoogle Scholar
  38. 38.
    Tetreault L, Ibrahim A, Côté P, Singh A, Fehlings MG (2015) a systematic review of clinical and surgical predictors of complications following surgery for degenerative cervical myelopathy. J Neurosurg Spine 24:77–99CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Stavya Spine Hospital and Research Institute Pvt. LtdAhmedabadIndia

Personalised recommendations