Ultrasonic Osteotome in Posterior Endoscopic Cervical Discectomy for Cervical Radiculopathy

Summary

Here, we present a protocol to describe the technical key points of applying the ultrasonic osteotome in posterior endoscopic cervical discectomy.

Abstract

The ultrasonic osteotome, as a novel osteotomy system, demonstrates unique advantages in posterior endoscopic cervical discectomy (PECD), though its technical implementation remains challenging. Accumulated evidence has validated the safety profile of this device in spinal surgery. Meta-analysis has revealed its superior efficacy in enhancing decompression efficiency, reducing intraoperative blood loss, and shortening operative duration compared to conventional high-speed burrs. Notably, no significant differences were observed in symptom improvement rates, hospital stay duration, or postoperative complication incidence between the two techniques. This study provides a video-documented technical protocol for ultrasonic osteotome utilization in PECD, demonstrating successful clinical implementation in a patient with cervical radiculopathy. We enrolled a 62-year-old female patient who presented with a 10-year history of left-sided cervical and upper back pain. She was admitted for surgery following a recent exacerbation that was accompanied by numbness and pain in her left upper limb. The duration of the surgical procedure was 109 minutes. The patient was mobilized with the help of a standard cervical brace on postoperative day 1. The patient demonstrated significant resolution of left-sided neck pain (preoperative visual analog scale [VAS] score 6, decreasing to 1) and left upper limb radiculopathy. Postoperative magnetic resonance imaging (MRI) confirmed adequate nerve root decompression, with significant symptom resolution and absence of device-related complications such as dural tears or neurological deficits. These findings substantiate the technical feasibility and procedural reliability of the ultrasonic osteotome in endoscopic cervical spine surgery.

Introduction

Cervical radiculopathy, a prevalent spinal disorder, affects approximately 3.3 cases per 1,000 individuals in the general population¹. Anterior cervical discectomy and fusion (ACDF) has long been recognized as one of the standard surgical treatments for cervical radiculopathy². However, hardware-related complications following ACDF, including hardware failure, pseudarthrosis, adjacent segment degeneration, and graft subsidence, present significant management challenges^3,4,5,6,

Protocol

The protocol follows the guidelines of the ethics committee of the local hospital. The ethics committee approved the protocol. The patient provided written informed consent.

NOTE: A 62-year-old female patient was included in the study, admitted for treatment due to a 10-year history of left-sided cervical and back pain, which had worsened over the past 10 days and was accompanied by numbness and pain in the left upper limb. Physical examination findings were as follows: (1) restricted left lateral flexion and extension of the cervical spine; (2) positive left brachial plexus stretch test and Spurling's test; (3) muscle strength of the l....

Results

The left C7 nerve root of the patient was successfully and adequately decompressed. Under endoscopic visualization, the ventral herniation compressing the nerve root was effectively removed, and partial laminectomy, facetectomy, and spur removal were achieved on the dorsal aspect of the nerve root. Ultimately, it was confirmed that the compressed nerve root had achieved sufficient space for movement. Postoperative MRI imaging demonstrated sufficient foraminal decompression at the left C7 level, in contrast to the preoper.......

Discussion

Compared with ACDF, PECD achieves more effective decompression in stenotic nerve root canals, making it a viable minimally invasive alternative^17,20,32,33. The ultrasonic osteotome, as a novel osteotomy power system, serves as a reliable tool for bone removal during PECD^17,23,24. Numerous studies have .......

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
0.5% lidocaine	Beijing Tide Pharmaceutical Co., Ltd	H37022768	Local Anesthesia
Dilatation cannula	Beijing Tianqi Medical technology Co., Ltd., Beijing	ZJ289019	Cannulation
Flurbiprofen axetil	Shandong Hualu Pharmaceutical Co., Ltd.	H20041508	For postoperative pain
Irrigation sleeves	Beijing Sumai Medical Technology Co., Ltd	OS1SPT19	Restricted operating range of the ultrasonic osteotome
Joimax Endoscopy System	Joimax	FS7347171O	TESSYS
Puncture needle	Beijing Tianqi Medical technology Co., Ltd., Beijing	ZJ289033	Puncture
Ultrasonic osteotome	Beijing Sumai Medical Technology Co., Ltd	OT1SPT19	Bone Cutting