The ultrasonic osteotome is a tissue-specific device that allows the surgeon to make precise osteotomies while protecting collateral or adjacent soft tissue structures. The recurring impacts pulverize the noncompliant crystalline structure resulting in a precise cut. The more compliant adjacent soft tissue is not affected by the ultrasonic oscillation. The purpose of this study is to present our experience of using this technology in osteotomies. We reviewed 96 patients, both male and female; of different ages in which ultrasonic osteotome was used to perform an osteotomy of different manners (Craniotomy, laminotomy, facetectomy, etc.). Patients with head injury, spine injury, degenerative spine diseases, and brain tumors were included in this study. In all these patients, the bone cut was even with minimal surrounding bone loss. The time required for the osteotomy was reduced to half. There was no damage to underlying dura, cord or nerve structures. Ultrasonic osteotome is a safe and effective ultrasonic bone cutting device that can be used to facilitate osteotomies in various types of cranial and spinal surgeries. This device allows precision bone cutting with minimal surrounding bone loss and obviates the risk associated with the use of high-speed burrs and oscillating saws.