Measuring the pressure changes at spinal epidural and intracranial areas in fresh cadavers during the full endoscopic lumbar spine surgery with continuous irrigation - Preliminary report

Global Spine Congress 2024, Rio De Janeiro, Brezilya, 28 - 31 Mayıs 2025, ss.295, (Özet Bildiri)

Introduction: During the full-endoscopic lumbar discectomy (FELD) procedure, continuous irrigation is employed. However, this continuous irrigation can result in pressure changes within the surgical field. These pressure alterations in the lumbar epidural space may extend to affect higher spinal levels, potentially causing a rise in intracranial pressure (ICP). Especially in the last years, some complications in patients who underwent FELD have been reported such as head-neck pain, seizures, and even retinal hemorrhage. The reason for these complications is considered as the heightened ICP during FELD procedures. Within the scope of our study, our objective is to assess changes in ICP and epidural pressures across different spinal levels induced by continuous irrigation during FELD. Material and Methods: Thus far, our study was conducted using eight fresh cadavers ages 18-75, devoid of cranial or spinal trauma and without any previous spinal surgeries. Initially, we placed a catheter intraventricularly and needles at the epidural space of C2-3, T6-7, and L3-4 levels. Subsequently, these catheters and needles are connected to digital manometers. Different stages of FELD are performed on fresh cadavers, and data is saved instantly. Results: While we are using continuous irrigation systems for the FELD technique, we mainly noticed these irrigation systems can increase pressures in other spinal epidural spaces and even the intracranial area as well as the operation area. Especially, choosing of appropriate irrigation mode and pressure level for this continuous irrigation system during the surgery is highly significant for avoiding these pressure changes. Furthermore, when the measurement results were examined we noticed different brands of endoscopes and their design differences can affect pressure changes. Another consideration is that certain maneuvers, consciously employed to enhance the visualization of the surgical area (such as blocking the irrigation or working channel of the endoscope), can lead to an increase in pressure. These maneuvers can also induce rapid pressure changes in other spinal levels and intracranial areas. Conclusion: During FELD understanding the underlying causes of these pressure fluctuations and implementing strategies to mitigate them are paramount. For instance, use of the maneuvers that can increase pressure in surgical site should be avoided, due to the potential increased risk of complications associated with these sudden pressure changes. This way, potential complications can be avoided by preventing changes in epidural pressure during surgery, making FELD a safe alternative in the treatment of lumbar disc herniation.