New Application of Actuator-Driven Pulsed Water Jet for Spinal Cord Dissection: An Experimental Study in Pigs.

Surgery for intramedullary tumors is technically demanding because it requires surgical resection along with functional preservation of the spinal cord. The water jet dissector is an emerging tool in neurologic surgeries and a novel tool in spinal cord surgeries. This article evaluates the usefulness and safety of water jet dissection in an experimental study.  A pulsed water jet was applied to dissect the posterior median sulcus of the spinal cords of seven anesthetized pigs. In four pigs, the water jet was delivered on the dorsal spinal cord at different input voltages (5, 10, and 15 V) and for durations of either 15 or 30 seconds. The depth and dissected areas were measured histologically and compared. In three separate pigs, somatosensory evoked potentials (SEPs) were recorded before and after dissection (10 V for 30 seconds) to evaluate the function of the dorsal column sensory pathway.  Increased pressure and duration of exposure to the pulsed water jet led to deeper and wider dissection of the dorsal spinal cord. Application of the water jet at 5 or 10 V allowed precise dissection along the dorsal columns along with the preservation of microvasculature. During SEP monitoring, responses were maintained after application of the water jet to the posterior column at 10 V for 30 seconds.  The pulsed water jet is a feasible option for spinal cord dissection. Characteristics of this water jet may help surgeons achieve complete resection of intramedullary tumors along with preserving satisfactory postoperative neurologic functions.