E-ISSN: 1019-5157
ISSN: 2651-5024
Research
In-vitro Investigation and the Effect of Endoscopes on Spinal Epidural Pressure Changes with a Dynamic Irrigation Pump
Dolas Ilyas✉ ,
Yorukoglu Ali Guven ,
Unal Tugrul Cem ,
Dolen Burak Duygu ,
Ozturk Metehan ,
Gulsever Cafer Ikbal ,
Sahin Mustafa Selim ,
Pothof Frederick ,
Maul Silas ,
Aydoseli Aydin ,
Sencer Altay
Unal Tugrul Cem ,
Dolen Burak Duygu ,
Ozturk Metehan ,
Gulsever Cafer Ikbal ,
Sahin Mustafa Selim ,
Pothof Frederick ,
Maul Silas ,
Aydoseli Aydin ,
Sencer Altay
Neurosurgery, İstanbul Tıp Fakültesi İstanbul Üniversitesi; Departmant of Neurosurgery, Istanbul University; Neurosurgery, Istanbul University; Depart. of Neurosurgery, I.U. Istanbul Medical School
DOI: 10.5137/1019-5149.JTN.50553-26.8
Article in Press
Corresponding Author:
Dolas Ilyas (dolasilyas@yahoo.com)
Abstract
Aim
Full-endoscopic spinal surgery has been associated with several unique complications that may be related to increased epidural pressure. Reported complications include headache, neck pain, seizures, and intracranial or retinal hemorrhage. This study investigated epidural pressure changes induced by continuous irrigation and evaluated how endoscope design and irrigation pump settings influence pressure variations at different spinal levels.
Material and Methods
Two cryopreserved cadavers were used for this in vitro study. Measurement needles were inserted into the epidural space at predefined spinal levels (L1/L2, Th6/Th7, and C2/C3). Procedures were performed under continuous irrigation using three pump settings and two endoscope designs. Because this pilot study involved a small sample size (n = 2), the data were analyzed descriptively to characterize irrigation-related pressure trends.
Results
Among the three irrigation settings tested, the lowest epidural pressures were observed in Spine mode, ranging from 37 to 42 mmHg. Under Arthro-mode settings, Model-X consistently produced lower pressure values than Model-Y. However, under Spine mode, both endoscope models demonstrated comparable pressure patterns, although Model-X generated slightly higher values.
Conclusion
Changes in epidural pressure represent an important consideration during endoscopic spinal surgery, as excessive pressure may contribute to procedure-related complications. Surgical manipulation, endoscope design, and irrigation pump settings appear to significantly influence these pressure fluctuations. Awareness of these factors may help optimize procedural safety and improve the clinical outcomes of full-endoscopic spinal surgery.
Full-endoscopic spinal surgery has been associated with several unique complications that may be related to increased epidural pressure. Reported complications include headache, neck pain, seizures, and intracranial or retinal hemorrhage. This study investigated epidural pressure changes induced by continuous irrigation and evaluated how endoscope design and irrigation pump settings influence pressure variations at different spinal levels.
Material and Methods
Two cryopreserved cadavers were used for this in vitro study. Measurement needles were inserted into the epidural space at predefined spinal levels (L1/L2, Th6/Th7, and C2/C3). Procedures were performed under continuous irrigation using three pump settings and two endoscope designs. Because this pilot study involved a small sample size (n = 2), the data were analyzed descriptively to characterize irrigation-related pressure trends.
Results
Among the three irrigation settings tested, the lowest epidural pressures were observed in Spine mode, ranging from 37 to 42 mmHg. Under Arthro-mode settings, Model-X consistently produced lower pressure values than Model-Y. However, under Spine mode, both endoscope models demonstrated comparable pressure patterns, although Model-X generated slightly higher values.
Conclusion
Changes in epidural pressure represent an important consideration during endoscopic spinal surgery, as excessive pressure may contribute to procedure-related complications. Surgical manipulation, endoscope design, and irrigation pump settings appear to significantly influence these pressure fluctuations. Awareness of these factors may help optimize procedural safety and improve the clinical outcomes of full-endoscopic spinal surgery.
Keywords
Dynamic irrigation systems
endoscopic techniques
epidural pressure
full-endoscopic spine surgery
spinal surgery