Pitfalls of ultrasonic bone scalpel: A case-based discussion

The role of ultrasonic bone scalpel (UBS) in the field of spine surgery is well known. There are numerous studies in the literature advocating its use where bone cutting in the form of laminectomy, laminotomy, foraminotomy, or vertebral body resection is required. Its principal advantage is the relative sparing of the soft tissues. The literature mentioning the complications and technical difficulties of UBS use is scarce and scanty. We report a unique complication encountered during its use and discuss some of the technical difficulties which need to be addressed with the aim and intent to caution the surgeons regarding its proper use. While performing laminectomy we encountered a unique complication of breakage of the blade of UBS. Although well-known for greater accuracy, reduced bleeding, reduced operative time, and en bloc removal of the bone as compared to traditional bone cutting devices even then it has to be used with great caution, and there is a learning curve of the technique which needs to be mastered.