Castel Xavier, ďAstorg Henri, Lonjon Guillaume, Faure Aymeric, Giorgi Hadrien, Ferracci François-Xavier, Lechanoine François, Cristini Joseph, Dhenin Alexandre, Guerin Gilles, Lebhar Jonathan, Simonin Alexandre, Pellet Nicolas, Sabah Yann, Vassal Matthieu, Szadkowski Marc, Dupuy Martin
Centre Orthopédique Santy, Lyon, France.
Clinique Saint-Jean Sud de France, Montpellier, France.
Eur Spine J. 2025 Aug 18. doi: 10.1007/s00586-025-09256-3.
The environmental footprint of healthcare has become a growing concern, but the specific resource consumption associated with spine surgery remains largely unexplored. Despite the widespread use of continuous saline irrigation in endoscopic spine surgery, no study has previously compared the volume of saline consumption across different surgical techniques.
This study aims to compare saline consumption across three surgical techniques for lumbar disc herniation: classical microdiscectomy (MD), uniportal endoscopy (FE), and biportal endoscopy (UBE).
STUDY DESIGN/SETTING: multicenter, international, retrospective observational study.
This study included 722 patients who underwent lumbar disc herniation surgery between March 2023 and September 2024. Patients were grouped based on the surgical technique used: MD (n = 127), FE (n = 253), and UBE (n = 342).
The primary outcome was total saline consumption (Liters). Data collected included also demographic information and surgical duration.
Statistical analyses included Kruskal-Wallis tests, pairwise comparisons with Bonferroni correction, ROC curve analysis, and a fixed-effects model to assess factors influencing saline consumption.
Saline consumption varied significantly across techniques, with a median (IQR) of 0.08 L (0.02-0.15) for MD, 4.00 L (3.00-6.00) for FE, and 9.00 L (6.00-13.00) for UBE (p < 0.0001) FE technique consumes approximately 50 times more saline than MD, and UBE consume more than 112 times more saline than MD. No significant correlation was found between saline consumption and patient age or BMI.
Endoscopic techniques for lumbar disc herniation require substantially more saline than classical MD. This highlights the need for strategies promoting responsible resource stewardship in spine surgery. Future innovations, such as closed-loop fluid management systems, may help optimize both environmental sustainability and economic efficiency.
医疗保健的环境足迹已日益受到关注，但与脊柱手术相关的具体资源消耗在很大程度上仍未得到充分研究。尽管连续生理盐水冲洗在内镜脊柱手术中广泛使用，但此前尚无研究比较不同手术技术的生理盐水消耗量。
本研究旨在比较三种腰椎间盘突出症手术技术的生理盐水消耗量：经典显微椎间盘切除术（MD）、单通道内镜手术（FE）和双通道内镜手术（UBE）。
研究设计/地点：多中心、国际性、回顾性观察研究。
本研究纳入了2023年3月至2024年9月期间接受腰椎间盘突出症手术的722例患者。患者根据所采用的手术技术分组：MD组（n = 127）、FE组（n = 253）和UBE组（n = 342）。
主要观察指标为生理盐水总消耗量（升）。收集的数据还包括人口统计学信息和手术时长。
统计分析包括Kruskal-Wallis检验、采用Bonferroni校正的两两比较、ROC曲线分析以及评估影响生理盐水消耗因素的固定效应模型。
不同技术的生理盐水消耗量差异显著，MD组的中位数（IQR）为0.08升（0.02 - 0.15），FE组为4.00升（3.00 - 6.00），UBE组为9.00升（6.00 - 13.00）（p < 0.0001）。FE技术的生理盐水消耗量约为MD的50倍，UBE的消耗量比MD多112倍以上。生理盐水消耗量与患者年龄或BMI之间未发现显著相关性。
腰椎间盘突出症的内镜技术比经典MD需要更多的生理盐水。这凸显了在脊柱手术中促进资源合理管理策略的必要性。未来的创新，如闭环液体管理系统，可能有助于优化环境可持续性和经济效率。
