Assessing changes in cervical epidural pressure during biportal endoscopic lumbar discectomy

Taewook Kang MD, Si Young Park MD, PhD, Soon Hyuck Lee MD, PhD, Jong Hoon Park MD, PhD, and Seung Woo Suh MD, PhD
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  • Department of Orthopaedics, Korea University College of Medicine, Anam Hospital, Seoul, Korea
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OBJECTIVE

Biportal endoscopic spinal surgery has been performed for several years, and its effectiveness is well known; however, no studies on its safety, specifically intracranial pressure, have been conducted to date. The authors sought to evaluate the effect of biportal endoscopic lumbar discectomy on intracranial pressure by monitoring cervical epidural pressure (CEP) changes throughout the procedure.

METHODS

Twenty patients undergoing single-level biportal endoscopic lumbar discectomy were enrolled in this study. CEPs were monitored throughout the procedure, consisting of phase 1, establishing the surgical portal and working space; phase 2, performing decompression and discectomy; and phase 3, turning off the fluid irrigation system. After discectomy was completed, the authors evaluated changes in CEP as the irrigation pressure increased serially by adding phase 4, increasing irrigation pressure with outflow open; and phase 5, increasing irrigation pressure with outflow closed.

RESULTS

The mean baseline CEP was measured as 16.65 mm Hg. In phase 1, the mean CEP was 17.3 mm Hg, which was not significantly different from the baseline CEP. In phase 2, the mean CEP abruptly increased up to 35.1 mm Hg when the epidural space was first connected with the working space, followed by stabilization of the CEP at 31.65 mm Hg. In phase 4, the CEP increased as the inflow pressure increased, showing a linear correlation, but not in phase 5. No patients experienced neurological complications.

CONCLUSIONS

It is important to ensure that irrigation fluid is not stagnant and is maintained continuously. More attention must be paid to keeping pressures low when opening the epidural space.

ABBREVIATIONS BELD = biportal endoscopic lumbar discectomy; CEP = cervical epidural pressure; ICP = intracranial pressure; PELD = percutaneous endoscopic lumbar discectomy.

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Contributor Notes

Correspondence Si Young Park: Korea University College of Medicine, Anam Hospital, Seoul, Korea. drspine90@kumc.or.kr.

INCLUDE WHEN CITING Published online October 30, 2020; DOI: 10.3171/2020.6.SPINE20586.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

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