Ultrasonic bone scalpel ‘does not reduce blood loss’ during posterior spinal fusion in patients with adolescent idiopathic scoliosis

Sumeet Garg

Ultrasonic bone scalpel (USBS) does not reduce blood loss during posterior spinal fusion (PSF) in patients with adolescent idiopathic scoliosis (AIS), a randomised controlled trial published in the journal Spine has found.

The study, which was published by Sumeet Garg (Children’s Hospital Colorado, Colorado, USA) et al, sought to compare the efficacy of USBS with standard-of-care surgical instruments (an osteotome) during PSF in patients with AIS, by evaluating the difference in estimated blood loss per level fused (EBL/level).

The single-blinded controlled superiority trial saw 66 patients with AIS undergoing PSF randomised to either the control group (osteotome) or the experimental group (USBS). The primary outcome was intraoperative EBL/level obtained from red blood cell salvage reports. One-year follow-up was available for 57 of 62 (92%) of patients.

The data showed that EBL/level averaged 35ml per level in the experimental group, and 39ml per level in the control group. There was also no difference in curve correction or operative time between the two groups.

Complications requiring change in routine postoperative care were noted in eight patients. Two occurred in patients assigned to the experimental group and six occurred in patients assigned to the control group.

Garg et al wrote that: “There was no clinically significant difference in total blood loss, EBL/level, or complications between the two groups.

“In contrast to reports from other centres, at our high-volume spine centre, USBS did not lead to reduced blood loss during PSF for AIS. These results may not be generalisable to centres with longer baseline operative times or higher baseline average blood loss during PSF for AIS.”

Speaking to Spinal News International, Garg added: “Larger studies at centres with more varied surgical volumes will help better clarify whether the USBS can reduce blood loss during surgery for AIS at places with lower surgical volumes and/or longer average operative time.”


  1. I use a combination of the USBS and osteotome for my
    Decompression and osteotomies.
    Majority of my blood loss is in the exposure of AIS?
    Was there two surgeons opening at the same time
    Or one surgeon opening one side at a time.


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