Clinical Consequences of Incidental Durotomy during Full-Endoscopic Lumbar Decompression Surgery in Relation to Intraoperative Epidural Pressure Measurements
<b>Background</b>: Seizures, neurological deficits, bradycardia, and, in the worst cases, cardiac arrest may occur following incidental durotomy during routine lumbar endoscopy. Therefore, we set out to measure the intraoperative epidural pressure during lumbar endoscopic decompression s...
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MDPI AG
2023-02-01
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| Series: | Journal of Personalized Medicine |
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| Online Access: | https://www.mdpi.com/2075-4426/13/3/381 |
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| author | Roth A. A. Vargas Marco Moscatelli Marcos Vaz de Lima Jorge Felipe Ramírez León Morgan P. Lorio Rossano Kepler Alvim Fiorelli Albert E. Telfeian John Fiallos Ernest Braxton Michael Song Kai-Uwe Lewandrowski |
| author_facet | Roth A. A. Vargas Marco Moscatelli Marcos Vaz de Lima Jorge Felipe Ramírez León Morgan P. Lorio Rossano Kepler Alvim Fiorelli Albert E. Telfeian John Fiallos Ernest Braxton Michael Song Kai-Uwe Lewandrowski |
| author_sort | Roth A. A. Vargas |
| collection | DOAJ |
| description | <b>Background</b>: Seizures, neurological deficits, bradycardia, and, in the worst cases, cardiac arrest may occur following incidental durotomy during routine lumbar endoscopy. Therefore, we set out to measure the intraoperative epidural pressure during lumbar endoscopic decompression surgery. <b>Methods</b>: We conducted a retrospective observational cohort study to obtain intraoperative epidural measurements with an epidural catheter-pressure transducer assembly through the spinal endoscope on 15 patients who underwent lumbar endoscopic decompression of symptomatic lumbar herniated discs and spinal stenosis. The endoscopic interlaminar technique was employed. <b>Results</b>: There were six (40.0%) female and nine (60.0%) male patients aged 49.0667 ± 11.31034, ranging from 36 to 72 years, with an average follow-up of 35.15 ± 12.48 months. Three of the fifteen patients had seizures with durotomy and one of these three had intracranial air on their postoperative brain CT. Another patient developed spinal headaches and diplopia on postoperative day one when her deteriorating neurological function was investigated with a brain computed tomography (CT) scan, showing an intraventricular hemorrhage consistent with a Fisher Grade IV subarachnoid hemorrhage. A CT angiogram did not show any abnormalities. Pressure recordings in the epidural space in nine patients ranged from 20 to 29 mm Hg with a mean of 24.33 mm Hg. <b>Conclusion</b>: Most incidental durotomies encountered during lumbar interlaminar endoscopy can be managed without formal repair and supportive care measures. The intradural spread of irrigation fluid and intraoperatively used drugs and air entrapment through an unrecognized durotomy should be suspected if patients deteriorate in the recovery room. Ascending paralysis may cause nausea, vomiting, upper and lower motor neuron symptoms, cranial nerve palsies, hypotension, bradycardia, and respiratory and cardiac arrest. The recovery team should be prepared to manage these complications. |
| first_indexed | 2024-03-11T06:20:01Z |
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| institution | Directory Open Access Journal |
| issn | 2075-4426 |
| language | English |
| last_indexed | 2024-03-11T06:20:01Z |
| publishDate | 2023-02-01 |
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| series | Journal of Personalized Medicine |
| spelling | doaj.art-52c3e462aa9c43d59e91922f3678d6aa2023-11-17T12:01:33ZengMDPI AGJournal of Personalized Medicine2075-44262023-02-0113338110.3390/jpm13030381Clinical Consequences of Incidental Durotomy during Full-Endoscopic Lumbar Decompression Surgery in Relation to Intraoperative Epidural Pressure MeasurementsRoth A. A. Vargas0Marco Moscatelli1Marcos Vaz de Lima2Jorge Felipe Ramírez León3Morgan P. Lorio4Rossano Kepler Alvim Fiorelli5Albert E. Telfeian6John Fiallos7Ernest Braxton8Michael Song9Kai-Uwe Lewandrowski10RIWO Spine Center of Excellence, Department of Neurosurgery, Foundation Hospital Centro Médico Campinas, Campinas 13101-627, SP, BrazilClinica NeuroLife, Natal 59054-630, RN, BrazilDepartment of Orthopedics and Traumatology, Santa Casa de São Paulo, “Pavilhão Fernandinho Simonsen”, São Paulo 05014-901, SP, BrazilMinimally Invasive Spine Center, Bogotá, D.C., Colombia, Reina Sofía Clinic, Bogotá, D.C., Colombia, Department of Orthopaedics, Fundación Universitaria Sanitas, Bogotá 104-76, D.C., ColombiaAdvanced Orthopedics, 499 E. Central Pkwy, Ste. 130, Altamonte Springs, FL 32701, USADepartment of General and Specialized Surgery, Gaffrée e Guinle University Hospital, Federal University of the State of Rio de Janeiro (UNIRIO), Rio de Janeiro 20270-004, RJ, BrazilDepartment of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, RI 02903, USAMinimally Invasive Spine Center, Bogotá 104-76, D.C., ColombiaVail Summit Orthopaedics & Neurosurgery, Frisco, CO 80443, USAAdvanced Neurosurgery, Reno, NV 89511, USACenter for Advanced Spine Care of Southern Arizona, Tucson, AZ 85712, USA<b>Background</b>: Seizures, neurological deficits, bradycardia, and, in the worst cases, cardiac arrest may occur following incidental durotomy during routine lumbar endoscopy. Therefore, we set out to measure the intraoperative epidural pressure during lumbar endoscopic decompression surgery. <b>Methods</b>: We conducted a retrospective observational cohort study to obtain intraoperative epidural measurements with an epidural catheter-pressure transducer assembly through the spinal endoscope on 15 patients who underwent lumbar endoscopic decompression of symptomatic lumbar herniated discs and spinal stenosis. The endoscopic interlaminar technique was employed. <b>Results</b>: There were six (40.0%) female and nine (60.0%) male patients aged 49.0667 ± 11.31034, ranging from 36 to 72 years, with an average follow-up of 35.15 ± 12.48 months. Three of the fifteen patients had seizures with durotomy and one of these three had intracranial air on their postoperative brain CT. Another patient developed spinal headaches and diplopia on postoperative day one when her deteriorating neurological function was investigated with a brain computed tomography (CT) scan, showing an intraventricular hemorrhage consistent with a Fisher Grade IV subarachnoid hemorrhage. A CT angiogram did not show any abnormalities. Pressure recordings in the epidural space in nine patients ranged from 20 to 29 mm Hg with a mean of 24.33 mm Hg. <b>Conclusion</b>: Most incidental durotomies encountered during lumbar interlaminar endoscopy can be managed without formal repair and supportive care measures. The intradural spread of irrigation fluid and intraoperatively used drugs and air entrapment through an unrecognized durotomy should be suspected if patients deteriorate in the recovery room. Ascending paralysis may cause nausea, vomiting, upper and lower motor neuron symptoms, cranial nerve palsies, hypotension, bradycardia, and respiratory and cardiac arrest. The recovery team should be prepared to manage these complications.https://www.mdpi.com/2075-4426/13/3/381epidural pressureinterlaminar lumbar endoscopyneurological complication |
| spellingShingle | Roth A. A. Vargas Marco Moscatelli Marcos Vaz de Lima Jorge Felipe Ramírez León Morgan P. Lorio Rossano Kepler Alvim Fiorelli Albert E. Telfeian John Fiallos Ernest Braxton Michael Song Kai-Uwe Lewandrowski Clinical Consequences of Incidental Durotomy during Full-Endoscopic Lumbar Decompression Surgery in Relation to Intraoperative Epidural Pressure Measurements Journal of Personalized Medicine epidural pressure interlaminar lumbar endoscopy neurological complication |
| title | Clinical Consequences of Incidental Durotomy during Full-Endoscopic Lumbar Decompression Surgery in Relation to Intraoperative Epidural Pressure Measurements |
| title_full | Clinical Consequences of Incidental Durotomy during Full-Endoscopic Lumbar Decompression Surgery in Relation to Intraoperative Epidural Pressure Measurements |
| title_fullStr | Clinical Consequences of Incidental Durotomy during Full-Endoscopic Lumbar Decompression Surgery in Relation to Intraoperative Epidural Pressure Measurements |
| title_full_unstemmed | Clinical Consequences of Incidental Durotomy during Full-Endoscopic Lumbar Decompression Surgery in Relation to Intraoperative Epidural Pressure Measurements |
| title_short | Clinical Consequences of Incidental Durotomy during Full-Endoscopic Lumbar Decompression Surgery in Relation to Intraoperative Epidural Pressure Measurements |
| title_sort | clinical consequences of incidental durotomy during full endoscopic lumbar decompression surgery in relation to intraoperative epidural pressure measurements |
| topic | epidural pressure interlaminar lumbar endoscopy neurological complication |
| url | https://www.mdpi.com/2075-4426/13/3/381 |
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