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

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.