Safety of spinal decompression using an ultrasonic bone curette compared with a high-speed drill: outcomes in 337 patients

Clinical article

Restricted access


Unintended durotomies are a common complication of spine surgery and are often correlated with increased postoperative morbidity. Recently, ultrasonic bone curettes have been introduced in spine surgery as a possible alternative to the conventional high-speed drill, offering the potential for greater bone-cutting precision and less damage to surrounding soft tissues. To date, however, few studies have investigated the safety and efficacy of the ultrasonic bone curette in reducing the rates of incidental durotomy compared with the high-speed drill.


The authors retrospectively reviewed the records of 337 consecutive patients who underwent posterior cervical or thoracic decompression at a single institution between January 2009 and September 2011. Preoperative pathologies, the location and extent of spinal decompression, and the use of an ultrasonic bone curette versus the high-speed drill were noted. The rates of incidental durotomy, as well as hospital length of stay (LOS) and perioperative outcomes, were compared between patients who were treated using the ultrasonic bone curette and those treated using a high-speed drill.


Among 88 patients who were treated using an ultrasonic bone curette and 249 who were treated using a high-speed drill, 5 (5.7%) and 9 (3.6%) patients had an unintentional durotomy, respectively. This finding was not statistically significant (p = 0.40). No patients in either cohort experienced statistically higher rates of perioperative complications, although patients treated using an ultrasonic bone curette tended to have a longer hospital LOS. This difference may be attributed to the fact that this series contained a statistically higher number of metastatic tumor cases (p < 0.0001) in the ultrasonic bone curette cohort, likely increasing the LOS for that patient population. In 13 patients, the dural defect was repaired intraoperatively. No patients who experienced an incidental durotomy had new-onset or permanent neurological deficits postoperatively.


The safety and efficacy of ultrasonic bone curettes in spine surgery has not been well established. This study shows that the ultrasonic bone curette has a similar safety profile compared with the high-speed drill, although both are capable of causing iatrogenic dural tears during spine surgery.

Abbreviations used in this paper:IQR = interquartile range; LOS = length of stay.

Article Information

Dr. M. Bydon and Mr. Xu contributed equally to this work.

Address correspondence to: Ali Bydon, M.D., 600 North Wolfe Street, Meyer 5-109, Baltimore, Maryland 21205. email:

Please include this information when citing this paper: published online April 5, 2013; DOI: 10.3171/2013.2.SPINE12879.

© AANS, except where prohibited by US copyright law.




Baker GACizik AMBransford RJBellabarba CKonodi MAChapman JR: Risk factors for unintended durotomy during spine surgery: a multivariate analysis. Spine J 12:1211262012


Black P: Cerebrospinal fluid leaks following spinal surgery: use of fat grafts for prevention and repair. Technical note. J Neurosurg 96:2 Suppl2502522002


Bosacco SJGardner MJGuille JT: Evaluation and treatment of dural tears in lumbar spine surgery: a review. Clin Orthop Relat Res 3892382472001


Brookfield KRandolph JEismont FBrown M: Delayed symptoms of cerebrospinal fluid leak following lumbar decompression. Orthopedics 31:8162008


Cammisa FP JrGirardi FPSangani PKParvataneni HKCadag SSandhu HS: Incidental durotomy in spine surgery. Spine (Phila Pa 1976) 25:266326672000


Cappabianca PCavallo LMEsposito IBarakat MEsposito F: Bone removal with a new ultrasonic bone curette during endoscopic endonasal approach to the sellar-suprasellar area: technical note. Neurosurgery 66:3 Suppl OperativeE1182010


Chang DJ: The “no-drill” technique of anterior clinoidectomy: a cranial base approach to the paraclinoid and parasellar region. Neurosurgery 64:3 Supplons96ons1062009


Chang HSJoko MSong JSIto KInoue TNakagawa H: Ultrasonic bone curettage for optic canal unroofing and anterior clinoidectomy. Technical note. J Neurosurg 104:6216242006


Chen XQYang HLWang GLGu YPan WMDong RB: Surgery for thoracic myelopathy caused by ossification of the ligamentum flavum. J Clin Neurosci 16:131613202009


Davne SHMyers DL: Complications of lumbar spinal fusion with transpedicular instrumentation. Spine (Phila Pa 1976) 17:6 SupplS184S1891992


Eggers GKlein JBlank JHassfeld S: Piezosurgery: an ultrasound device for cutting bone and its use and limitations in maxillofacial surgery. Br J Oral Maxillofac Surg 42:4514532004


Eismont FJWiesel SWRothman RH: Treatment of dural tears associated with spinal surgery. J Bone Joint Surg Am 63:113211361981


Farhat HIElhammady MSLevi ADAziz-Sultan MA: Cervical subarachnoid catheter placement for continuous cerebrospinal fluid drainage: a safe and efficacious alternative to the classic lumbar cistern drain. Neurosurgery 68:1 Suppl Operative52562011


Fountas KNKapsalaki EZJohnston KW: Cerebrospinal fluid fistula secondary to dural tear in anterior cervical discectomy and fusion: case report. Spine (Phila Pa 1976) 30:E277E2802005


Fountas KNKapsalaki EZNikolakakos LGSmisson HFJohnston KWGrigorian AA: Anterior cervical discectomy and fusion associated complications. Spine (Phila Pa 1976) 32:231023172007


Guerin PEl Fegoun ABObeid IGille OLelong LLuc S: Incidental durotomy during spine surgery: Incidence, management and complications. A retrospective review. Injury 43:3974012012


Hadani MFindler GKnoler NTadmor RSahar AShacked I: Entrapped lumbar nerve root in pseudomeningocele after laminectomy: report of three cases. Neurosurgery 19:4054071986


Hannallah DLee JKhan MDonaldson WFKang JD: Cerebrospinal fluid leaks following cervical spine surgery. J Bone Joint Surg Am 90:110111052008


Hodges SDHumphreys SCEck JCCovington LA: Management of incidental durotomy without mandatory bed rest. A retrospective review of 20 cases. Spine (Phila Pa 1976) 24:206220641999


Ito KIshizaka SSasaki TMiyahara THoriuchi TSakai K: Safe and minimally invasive laminoplastic laminotomy using an ultrasonic bone curette for spinal surgery: technical note. Surg Neurol 72:4704752009


Jankowitz BTAtteberry DSGerszten PCKarausky PCheng BCFaught R: Effect of fibrin glue on the prevention of persistent cerebral spinal fluid leakage after incidental durotomy during lumbar spinal surgery. Eur Spine J 18:116911742009


Khan MHRihn JSteele GDavis RDonaldson WF IIIKang JD: Postoperative management protocol for incidental dural tears during degenerative lumbar spine surgery: a review of 3,183 consecutive degenerative lumbar cases. Spine (Phila Pa 1976) 31:260926132006


Kim KIsu TMatsumoto RIsobe MKogure K: Surgical pitfalls of an ultrasonic bone curette (SONOPET) in spinal surgery. Neurosurgery 59:4 Suppl 2ONS390ONS3932006


Kim KIsu TMorimoto DKominami SKobayashi STeramoto A: Anterior vertebral artery decompression with an ultrasonic bone curette to treat bow hunter's syndrome. Acta Neurochir (Wien) 150:3013032008


Lee ISKim HJLee JSKim SJJeong YJKim DK: Dural tears in spinal burst fractures: predictable MR imaging findings. AJNR Am J Neuroradiol 30:1421462009


Lien JRPatel RDGraziano GP: Sternocleidomastoid muscular flap: treatment of persistent cerebrospinal fluid leak after anterior cervical spine surgery. J Spinal Disord Tech [epub ahead of print]2012


Lu CHHo STKong SSCherng CHWong CS: Intracranial subdural hematoma after unintended durotomy during spine surgery. Can J Anaesth 49:1001022002


Matsuoka HItoh YNumazawa STomii MWatanabe KHirano Y: Recapping hemilaminoplasty for spinal surgical disorders using ultrasonic bone curette. Surg Neurol Int 3:702012


McMahon PDididze MLevi AD: Incidental durotomy after spinal surgery: a prospective study in an academic institution. Clinical article. J Neurosurg Spine 17:30362012


Mirza SKDeyo RAHeagerty PJKonodi MALee LATurner JA: Development of an index to characterize the “invasiveness” of spine surgery: validation by comparison to blood loss and operative time. Spine (Phila Pa 1976) 33:265126622008


Mirza SKDeyo RAHeagerty PJTurner JALee LAGoodkin R: Towards standardized measurement of adverse events in spine surgery: conceptual model and pilot evaluation. BMC Musculoskelet Disord 7:532006


Nakagawa HKim SDMizuno JOhara YIto K: Technical advantages of an ultrasonic bone curette in spinal surgery. J Neurosurg Spine 2:4314352005


Nakase HMatsuda RShin YPark YSSakaki T: The use of ultrasonic bone curettes in spinal surgery. Acta Neurochir (Wien) 148:2072132006


Narotam PKJosé SNathoo NTaylon CVora Y: Collagen matrix (DuraGen) in dural repair: analysis of a new modified technique. Spine (Phila Pa 1976) 29:286128692004


O'Connor DMaskery NGriffiths WE: Pseudomeningocele nerve root entrapment after lumbar discectomy. Spine (Phila Pa 1976) 23:150115021998


Ruban DO'Toole JE: Management of incidental durotomy in minimally invasive spine surgery. Neurosurg Focus 31:4E152011


Salami AMora RMora FGuastini LSalzano FADellepiane M: Learning curve for Piezosurgery in well-trained otological surgeons. Otolaryngol Head Neck Surg 142:1201252010


Sanborn MRBalzer JGerszten PCKarausky PCheng BCWelch WC: Safety and efficacy of a novel ultrasonic osteotome device in an ovine model. J Clin Neurosci 18:152815332011


Saxler GKrämer JBarden BKurt APförtner JBernsmann K: The long-term clinical sequelae of incidental durotomy in lumbar disc surgery. Spine (Phila Pa 1976) 30:229823022005


Schaberg MRAltman JIShapshay SMWoo P: Cerebrospinal fluid leak after anterior cervical disc fusion: an unusual cause of dysphagia and neck mass. Laryngoscope 117:189919012007


Schaller BJGruber RMerten HAKruschat TSchliephake HBuchfelder M: Piezoelectric bone surgery: a revolutionary technique for minimally invasive surgery in cranial base and spinal surgery? Technical note. Neurosurgery 57:4 SupplE4102005


Shaffrey CISpotnitz WDShaffrey MEJane JA: Neurosurgical applications of fibrin glue: augmentation of dural closure in 134 patients. Neurosurgery 26:2072101990


Song DPark P: Primary closure of inadvertent durotomies utilizing the U-Clip in minimally invasive spinal surgery. Spine (Phila Pa 1976) 36:E1753E17572011


Stolke DSollmann WPSeifert V: Intra- and postoperative complications in lumbar disc surgery. Spine (Phila Pa 1976) 14:56591989


Street JTLenehan BJDipaola CPBoyd MDKwon BKPaquette SJ: Morbidity and mortality of major adult spinal surgery. A prospective cohort analysis of 942 consecutive patients. Spine J 12:22342012


Sugawara AIsu TIsobe MMatsumoto RMotegi HKim K: [Foraminal stenosis of the lumbar spine treated by decompression with an ultrasonic bone curette: a case report.]. No Shinkei Geka 35:116311672007. (Jpn)


Sun XSun CLiu XLiu ZQi QGuo Z: The frequency and treatment of dural tears and cerebrospinal fluid leakage in 266 patients with thoracic myelopathy caused by ossification of the ligamentum flavum. Spine (Phila Pa 1976) 37:E702E7072012


Wang JCBohlman HHRiew KD: Dural tears secondary to operations on the lumbar spine. Management and results after a two-year-minimum follow-up of eighty-eight patients. J Bone Joint Surg Am 80:172817321998


Weinstein MAMcCabe JPCammisa FP Jr: Postoperative spinal wound infection: a review of 2,391 consecutive index procedures. J Spinal Disord 13:4224262000


Williams BJSansur CASmith JSBerven SHBroadstone PAChoma TJ: Incidence of unintended durotomy in spine surgery based on 108,478 cases. Neurosurgery 68:1171242011


Wu ASGriebel RWMeguro KFourney DR: Spinal subdural empyema after a dural tear. Case report. Neurosurg Focus 17:6E102004




All Time Past Year Past 30 Days
Abstract Views 171 171 42
Full Text Views 148 148 19
PDF Downloads 132 132 14
EPUB Downloads 0 0 0


Google Scholar