Ultrasonic aspirators in minimally invasive laminectomies - a pilot study and technical note on reduced Kerrison rongeur usage without increased blood loss or operative time

Q: What was the aim of the pilot study on ultrasonic aspirators?

To evaluate the safety and efficacy of ultrasonic aspirators as an alternative to high-speed drills and Kerrison rongeurs in minimally invasive laminectomies.

Q: How were patients grouped in the study?

Patients were grouped by decompression tool use: high-speed drill only, ultrasonic aspirator only, or both tools, and Kerrison bites per level were recorded.

Q: What were the main outcomes regarding Kerrison bites, blood loss, and operative time?

Ultrasonic use significantly reduced the mean number of Kerrison bites and reduced estimated blood loss in single-level cases, with no adverse events attributed to ultrasonic use and no increase in operative time.

Sep 30, 2026

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Ultrasonic bone aspirators are evaluated as an alternative to high-speed drills and Kerrison rongeurs during minimally invasive lumbar laminectomies for degenerative spinal stenosis. A pilot cohort of 27 patients underwent 40 levels, grouped by decompression tool use. The study recorded Kerrison bites per level and compared estimated blood loss in selected single-level cases. Ultrasonic use showed a marked reduction in Kerrison bites and lower blood loss without reported adverse events or increased operative time, supporting further prospective assessment.

LanguageEnglish

CategoryResearch & Report

FormatPDF

Pages9

Reading Time23 min

AccessFree to download

Introduction

Methods

Results

Conclusions

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What is known and what is new?

What is the implication, and what should change now?

Ultrasonic aspirators in minimally invasive laminectomies: a pilot study and technical note on reduced Kerrison rongeur usage without increased blood loss or operative time Pravarakhya Puppalla1^, Chase McKevitt2, Diogo P. Moniz Garcia2, Alaa Montaser2, Rodrigo Navarro-Ramirez2, Stephen M. Pirris2 1Department of Neurosurgery, University of Arizona College of Medicine, Tucson, AZ, USA; 2Department of Neurosurgery, Mayo Clinic in Jacksonville, Jacksonville, FL, USA Contributions: (I) Conception and design: R Navarro-Ramirez, SM Pirris; (II) Administrative support: R Navarro-Ramirez, SM Pirris, P Puppalla; (III) Provision of study materials or patients: R Navarro-Ramirez, SM Pirris; (IV) Collection and assembly of data: All authors; (V) Data analysis and interpretation: All authors; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors. Correspondence to: Stephen M. Pirris, MD. Department of Neurosurgery, Mayo Clinic in Jacksonville, 4500 San Pablo Road, Mangurian, 4th Floor, Jacksonville, FL 32224, [USA. Email: Pirris.Stephen@mayo.edu](USA. Email: Pirris.Stephen@mayo.edu). Background: Kerrison rongeurs are frequently used during decompressive procedures but carry risks such as incidental dural tears and occupational strain for spine surgeons. High-speed drills are often used for bony decompression. In other surgical specialties, ultrasonic aspirators have been shown to safely remove bone near critical structures like the dura and nerves. However, their application in spine surgery remains underexplored. The aim of this pilot study was to evaluate the safety and efficacy of ultrasonic aspirators as an alternative to high-speed drills and Kerrison rongeurs in minimally invasive laminectomies. Methods: Twenty-seven patients underwent 40 level of lumbar laminectomies for degenerative spinal stenosis using minimally invasive tubular approaches. Patients were grouped by decompression tool used: high-speed drill only (19 patients, 24 levels), ultrasonic aspirator only (12 patients, 16 levels), or both tools (4 patients) . The number of Kerrison bites per level were recorded. Estimated blood loss (EBL) was compared in single-level cases between the ultrasonic aspirator (n=6) and drill only groups (n=10) . Results: The mean number of Kerrison bites was significantly lower in the ultrasonic group (8.06) compared to the drill group (38.25; P<0.001) . Among single-level cases, mean EBL was reduced in the ultrasonic group (21 mL) versus the drill group (52 mL; P=0.02) . No adverse events were observed with ultrasonic use. Conclusions: This pilot study suggests ultrasonic aspirators may reduce the need for Kerrison rongeur use and intraoperative blood loss in minimally invasive laminectomies, without increasing operative time. These findings support further prospective evaluation. Keywords: Laminectomy; spine surgery; bone scalpel; piezoelectric scalpel; pilot study Submitted Jun 07, 2025. Accepted for publication Aug 15, 2025. Published online Dec 19, 2025. doi: 10.21037/jss-25-92 View this article at: [https://dx.doi.org/10.21037/jss-25-92](https://dx.doi.org/10.21037/jss-25-92) Introduction Ultrasonic bone aspirators, also known as piezoelectric scalpels or bone scalpels, have been utilized for the bone removal near delicate neurovascular structures by dentists, otolaryngologists and skull-base neurosurgeons (1-4) . In contrast, their use in spine surgery is less common, particularly in minimally invasive spine surgery, where ^ ORCID: 0009-0004-7476-8677. © AME Publishing Company. J Spine Surg 2025;11(4):803-811 | [https://dx.doi.org/10.21037/jss-25-92](https://dx.doi.org/10.21037/jss-25-92) 804 Puppalla et al. Ultrasonic aspirators in MIS laminectomies: a pilot study estimated utilization is under 5% of spine surgeries. This is likely the first study to quantitatively evaluate ultrasonic aspiration for minimally invasive spine surgery using a tubular retra

FAQs

What was the aim of the pilot study on ultrasonic aspirators?

To evaluate the safety and efficacy of ultrasonic aspirators as an alternative to high-speed drills and Kerrison rongeurs in minimally invasive laminectomies.

How were patients grouped in the study?

Patients were grouped by decompression tool use: high-speed drill only, ultrasonic aspirator only, or both tools, and Kerrison bites per level were recorded.

What were the main outcomes regarding Kerrison bites, blood loss, and operative time?

Ultrasonic use significantly reduced the mean number of Kerrison bites and reduced estimated blood loss in single-level cases, with no adverse events attributed to ultrasonic use and no increase in operative time.

Sep 30, 2026

Upload by Aditya