Ultrasonic bone curette in thoracic spinal decompression: a comprehensive systematic review and meta-analysis

OBJECTIVE: The aim of this study was to compare the efficacy and safety of ultrasonic bone curette (UBC) and conven-tional surgical instruments in thoracic laminec-tomy decompression (TLD) for the treatment of thoracic spinal stenosis (TSS) by meta-analysis. MATERIALS AND METHODS: Two authors independently searched Medline via PubMed, Embase, Cochrane Library, Web of Science, Wanfang Database, and China National Knowl-edge Infrastructure for the period from the es-tablishment of the database until January 2023 to identify the studies on the safety and effica-cy of UBC vs. conventional instruments for TSS. Data extraction and quality assessment were performed by two researchers independently. We used RevMan 5.4 software (Review Manager Web, The Cochrane Collaboration, Copenhagen, Denmark) to analyze the data. RESULTS: Eight retrospective studies were included in the present work. This meta -anal-ysis revealed that no significant differences in the preoperative JOA scores, the JOA scores at the last follow-up, the improvement rate of JOA scores, and the incidence of cerebrospinal fluid leakage/dura injury were detected between the two groups (p>0.05). However, there were sig-nificant differences in the operative time and in-traoperative blood loss during single-level TLD [operative time: MD=-1.47, 95% CI (-1.86,-1.09), p<0.001; intraoperative blood loss: MD=-46.62, 95% CI (-53.83,-39.40), p<0.001], total opera-tive time [MD=-56.88, 95% CI (-69.66,-44.10), p<0.001], total intraoperative blood loss [MD= -143.52, 95% CI (-212.49,-74.54), p<0.001], the in-cidence of neurological deterioration/nerve root injury [RR= 0.29, 95% CI (0.09, 0.91), p=0.03] be-tween the groups. CONCLUSIONS: The application of UBC in TLD to treat TSS is safe and effective. UBC can significantly shorten operation time and reduce intraoperative blood loss compared to tradition-al surgical instruments. Moreover, it has the ad-vantage of reducing perioperative nerve injury.