Comparative Study of Ultrasonic Bone Scalpel and Drill in Keyhole Spinal Surgery: Efficiency, Safety, and Learning Curve Analysis

Background Minimally invasive spinal surgery has transformed the management of cervical radiculopathy by reducing tissue trauma and enhancing recovery. However, the optimal surgical tool for keyhole spinal procedures—ultrasonic bone scalpel or traditional drill—remains debated. This study aimed to compare these tools regarding operative efficiency, learning curves, clinical outcomes, and complication rates. Methods A prospective cohort study was conducted involving 72 patients with cervical radiculopathy who underwent keyhole spinal surgery at a single tertiary care center. Patients were assigned to the ultrasonic bone scalpel group (n = 36) or the drill group (n = 36). Data on operative time, intraoperative blood loss, clinical outcomes (VAS, JOA scores), complications, and radiological assessments (NR-SCW distance, STE area) were collected preoperatively and at 3 and 6 months postoperatively. Statistical analyses included independent t-tests, repeated measures ANOVA, and CUSUM analysis. Results The ultrasonic bone scalpel group demonstrated significantly shorter operative times (95.72 ± 8.32 vs. 121.97 ± 11.53 minutes, p < 0.001), lower intraoperative blood loss (41.81 ± 2.46 vs. 49.58 ± 2.57 mL, p < 0.001), and smaller postoperative soft tissue edema areas (19.09 ± 6.84 mm² vs. 33.66 ± 15.91 mm², p < 0.001) compared to the drill group. Pain relief (VAS scores) and functional recovery (JOA scores) were superior in the ultrasonic bone scalpel group at both 3 and 6 months. The learning curve analysis revealed that proficiency was achieved after 10 cases in the ultrasonic bone scalpel group, compared to 25 cases in the drill group. No significant differences in complication rates or recurrence were observed between groups. Conclusion The ultrasonic bone scalpel offers significant advantages in operative efficiency, soft tissue preservation, and clinical outcomes while providing a shorter learning curve. These findings support its broader adoption in minimally invasive spinal surgery for cervical radiculopathy.