An Experimental Model for Fluid Dynamics and Pressures During Endoscopic Lumbar Discectomy.

IF 3.8 2区 医学 Q1 CLINICAL NEUROLOGY Neurospine Pub Date : 2024-09-01 Epub Date: 2024-09-30 DOI:10.14245/ns.2448350.175
Mazda Farshad, Alexandra Stauffer, Carl Moritz Zipser, Najmeh Kheram, José Miguel Spirig, Jonas Widmer, Vincent Hagel, Jana Felicitas Schader
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Abstract

Objective: Endoscopic spine surgery is an emerging technique of minimally invasive spine surgery. However, headache, seizure, and autonomic dysreflexia are possible irrigation-related complications following full-endoscopic lumbar discectomy (FELD). Pressure elevation through fluid irrigation may contribute to these adverse events. A validated experimental model to investigate parameters for guideline definition is lacking. This study aimed to create an experimental setting for FELD with pressure assessments to prove the concept of repeatable and sensitive measurement of intracranial, intra- and epidural pressures during spine endoscopy.

Methods: To measure intradural pressure, catheters were introduced through a sacral approach and advanced to lumbar, thoracic, and cervical levels in human cadavers. Similarly, lumbar epidural and intracranial probes were placed. The dural sac was filled with Ringer solution to a physiologic pressure of 15 cmH2O. Lumbar endoscopy was performed on 3 human cadavers at the L3-4 level. Pressure changes were measured continuously at all sites and the effects of backflow-occlusion were monitored.

Results: Reproducibility of the experimental model was validated with catheters at the correct locations and stable compartmental pressure baselines at all levels for 3 specimens (mean±standard deviation: 1.3±2.9 mmHg, 9.0±2.0 mmHg, 6.0±1.2 mmHg, respectively). Pressure increase could be detected sensitively by closing the system with backflow-occlusion.

Conclusion: An experimental setup for feasible, repeatable, and precise pressure measurement during FELD in a human cadaveric setup has been developed. This allows investigation of the effects of endoscopic techniques and pump pressures on intra-, epidural and intracranial pressure and enables ranges of safe pump pressures per clinical situations.

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内窥镜腰椎间盘切除术中流体动力学和压力的实验模型。
目的:内窥镜脊柱手术是一种新兴的微创脊柱手术技术。然而,全内窥镜腰椎间盘切除术(FELD)后可能会出现头痛、癫痫发作和自主神经反射障碍等与冲洗相关的并发症。液体冲洗造成的压力升高可能会导致这些不良事件的发生。目前还缺乏一个经过验证的实验模型来研究指南定义的参数。本研究旨在为腰椎间盘切除术(FELD)创建一个压力评估的实验环境,以证明在脊柱内窥镜检查期间对颅内压、硬膜外内压进行可重复和灵敏测量的概念:为了测量硬膜内压力,在人体尸体上通过骶骨方法导入导管,并将导管推进到腰椎、胸椎和颈椎水平。同样,还放置了腰部硬膜外和颅内探针。硬膜囊内充满林格溶液,生理压力为 15 cmH2O。在 3 具尸体的腰椎第 3-4 节处进行了腰椎内窥镜检查。对所有部位的压力变化进行连续测量,并监测回流闭塞的影响:结果:实验模型的可重复性得到了验证,3 个标本的导管位置正确,各级腔室压力基线稳定(平均值±标准偏差:1.3±2.9 毫米):分别为 1.3±2.9 mmHg、9.0±2.0 mmHg、6.0±1.2 mmHg)。通过逆流闭塞关闭系统,可以灵敏地检测到压力升高:结论:在人体尸体装置中进行 FELD 期间可行、可重复和精确测量压力的实验装置已经开发出来。这样就可以研究内窥镜技术和泵压对硬膜内、硬膜外和颅内压力的影响,并根据临床情况确定安全泵压的范围。
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来源期刊
Neurospine
Neurospine Multiple-
CiteScore
5.80
自引率
18.80%
发文量
93
审稿时长
10 weeks
期刊最新文献
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