Department of Orthopedic Surgery, Bumin Hospital, Seoul, Republic of Korea.
Department of Orthopedic Surgery, Spine Center, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea.
Spine (Phila Pa 1976). 2020 Oct 15;45(20):E1349-E1356. doi: 10.1097/BRS.0000000000003585.
A prospective study.
To evaluate the change in cervical epidural pressure (CEP) during biportal endoscopic lumbar discectomy (BELD).
In percutaneous uniportal endoscopic lumbar discectomy, irrigation fluid (IF) introduced into the spinal canal during surgery can compress the thecal sac, and act as a potential risk for neurological complications by disturbing cerebrospinal fluid (CSF) circulation and increasing intracranial pressure.
Thirty consecutive patients, who underwent BELD, which was performed under automated pump system, an infusion pressure of 30 mmHg were enrolled. The change in CEP on C7-T1 level was measured. CEP was measured in each of the five phases of the procedure (1st phase-making surgical portals; 2nd phase-creating a workspace; 3rd phase-performing neural decompression and discectomy; 4th phase-factitious increase of pressure by clogging the outflow; 5th phase-dismission from fluid irrigation system). Neurological complications and independent risk factors were evaluated.
In the final 27 patients, changes in CEP during surgery were similar. The baseline CEP was 14.8 ± 2.8 mmHg, and the mean CEP in the 3rd phase 18.8 ± 5.1 mmHg was not significantly higher. In the 4th phase, however, the CEPs rose with linear correlation as the pressure increased. In the 5th phase, the elevated CEP returned to baseline in 2.5 ± 5.6 minutes. No patient had neurological complications. No statistically significant risk factors were observed.
In BELD, which is performed to allow continuous lavage with infusion pressure set to 30 mmHg, CEP does not increase beyond the physiological range. Therefore, BELD may be considered as a potentially safe technique.
前瞻性研究。
评估双入路内窥镜下腰椎间盘切除术（BELD）过程中颈椎硬膜外压力（CEP）的变化。
在经皮单入路内窥镜下腰椎间盘切除术，手术过程中引入椎管的灌洗液（IF）会压迫脊膜囊，通过干扰脑脊液（CSF）循环和增加颅内压，成为神经并发症的潜在风险。
连续纳入 30 例接受 BELD 的患者，该手术在自动泵系统下进行，灌注压力为 30mmHg。测量 C7-T1 水平的 CEP 变化。在手术的五个阶段测量 CEP：1 阶段建立手术通道；2 阶段建立工作空间；3 阶段进行神经减压和椎间盘切除术；4 阶段通过堵塞流出物人为增加压力；5 阶段停止液体冲洗系统。评估神经并发症和独立风险因素。
在最终的 27 例患者中，手术期间 CEP 的变化相似。基线 CEP 为 14.8±2.8mmHg，第 3 阶段的平均 CEP 为 18.8±5.1mmHg，并没有明显升高。然而，在第 4 阶段，CEPs 随着压力的增加呈线性相关升高。在第 5 阶段，升高的 CEP 在 2.5±5.6 分钟内恢复到基线。没有患者出现神经并发症。未观察到统计学上显著的风险因素。
在允许以 30mmHg 的灌注压力持续冲洗的 BELD 中，CEP 不会升高到生理范围以上。因此，BELD 可以被认为是一种潜在安全的技术。
4 级。
