• Changjiang Ou, Yongjun Tong, Junhui Liu, Zhi Shan, Yilei Chen, Bao Huang, Xuyang Zhang, Yili Chen, and Fengdong Zhao.
• Department of Neurosurgery, the Fourth Affiliated Hospital of School of Medicine, and International School of Medicine, International Institutes of Medicine, Zhejiang University, Yiwu, China, 322000; Department of Orthopaedics, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China, 310000.
• World Neurosurg. 2024 Sep 11.

ObjectiveThis study aims to evaluate the safety and efficacy of the ultrasonic bone burr (UBB) in facilitating C1 pedicle screw placement for atlantoaxial instability (AAI) treatment, compared to the conventional high-speed drill (HSD) technique.MethodsA retrospective analysis was conducted on patients undergoing posterior screw-rod fixation for AAI between December 2017 and July 2023. The patients were divided into two groups based on the tools used for screw placement: UBB and HSD. Data on surgical duration, estimated blood loss, spinal cord and arterial injury incidence, screw placement accuracy, neurological status measured by the Japanese Orthopedic Association (JOA) score and fusion rates, were collected and analyzed.Results13 patients received C1 pedicle screw placement via UBB facilitation, while 8 were treated using the HSD approach. The UBB group showed a significant reduction in blood loss and operation time compared to the HSD group (P=0.002 and P<0.001, respectively). No spinal cord or arterial injuries occurred in either group. Optimal screw placement was confirmed in all UBB cases versus 87.5% in the HSD group (P=0.139). Both groups demonstrated significant improvements in JOA scores with no inter-group difference. The fusion rate was 100% in the UBB group and 87.5% in the HSD group, not statistically different (P=0.381).ConclusionsUBB is a viable alternative for C1 pedicle screw placement, associated with reduced blood loss and shorter operation time, while achieving comparable clinical outcomes to the conventional HSD method. Nevertheless, further research with a larger sample size is needed.Copyright © 2024. Published by Elsevier Inc.

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