Ultrasonic osteotome versus high-speed burr in channel-assisted cervical key hole technology: a clinical retrospective study.

BACKGROUND: Cervical spondylotic radiculopathy (CSR) is a common cause of neck and upper limb pain in adults and often requires surgical intervention. The keyhole technique under cervical endoscopy has gained widespread acceptance in recent years; however, the efficacy of different surgical instruments remains to be fully evaluated. As an emerging tool in spinal surgery, the ultrasonic osteotome offers high cutting precision and reduced intraoperative bleeding, which may provide advantages in endoscopic procedures. OBJECTIVE: To compare the clinical efficacy of the ultrasonic osteotome versus the high-speed drill in endoscopic keyhole surgery for CSR, with a focus on differences in operative time, intraoperative blood loss, postoperative recovery, and complication rates. METHODS: This retrospective study included 85 patients with CSR who underwent posterior cervical endoscopic keyhole surgery at our institution between January 2020 and February 2024. Patients were divided into two groups based on the instrument used: ultrasonic osteotome (Group A, n = 44) and high-speed drill (Group B, n = 41). Perioperative parameters were compared between the groups, including operative time, intraoperative blood loss, length of hospital stay, Visual Analogue Scale (VAS) score, Neck Disability Index (NDI), modified MacNab criteria, and postoperative complications. RESULTS: Group A showed significantly shorter operative time (54.58 ± 3.76 min vs. 62.22 ± 8.19 min, P < 0.05), reduced blood loss (73.21 ± 7.79 ml vs. 88.22 ± 17.60 ml, P < 0.05), and shorter hospital stay (3.37 ± 0.08 days vs. 5.00 ± 0.94 days, P < 0.05) compared to Group B. Both groups exhibited comparable improvement in VAS and NDI scores postoperatively. Group A demonstrated a faster postoperative recovery, and the excellent-to-good rate based on modified MacNab criteria was similar between groups (94.7% vs. 88.8%, P = 0.62). The incidence of complications was comparable, though complications in Group A were milder in nature. CONCLUSION: The ultrasonic osteotome enhances surgical efficiency, minimizes intraoperative bleeding, and accelerates postoperative recovery in cervical endoscopic keyhole procedures, with a favorable safety profile compared with the traditional high-speed drill. Although both instruments yield similar clinical outcomes, the superior precision and hemostatic control of the ultrasonic osteotome support its broader application in spinal surgery. Further multicenter, prospective studies are warranted to validate its clinical utility and long-term safety.