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.
Citations
Citations to this article as recorded by
A Systematic Review of Complication Management During Uniportal and Biportal Endoscopic Spine Surgery: Dural Tear and Bleeding Siravich Suvithayasiri, Ju Eun Kim, Facundo Van Isseldyk, Marcus Serra, Christopher Martin, Viswanadha Arunkumar, Sotirios Veranis, Prashanth Rao, Enrico Giordan, Piya Chavalparit, Nelson Astur, Samuel Cho, Jin Sung Kim Global Spine Journal.2026;[Epub] CrossRef
Spinal Cord Perfusion Pressure Monitoring after Traumatic Spinal Cord Injury: Indications, Techniques, and Future Horizons Angela Tang-Tan, David J. Caldwell, Alexander A. Aabedi, Maria C. Velasco, Geoffrey T. Manley, Phiroz E. Tarapore, John K. Yue Journal of Neurotrauma.2026;[Epub] CrossRef
Endoscopic resection of lumbar intradural spinal tumors: A case series on feasibility, safety, and preliminary outcomes Facundo Van Isseldyk, Vincent Hagel Brain and Spine.2026; 6: 106040. CrossRef
Full Endoscopic Excision of a Large Intradural Extramedullary Tumor: A Technical Note Kanthila Mahesha, H. Shatananda Prasad Rao Journal of Minimally Invasive Spine Surgery and Technique.2026; 11(1): 124. CrossRef
Controlled versus gravity-based irrigation in endoscopic spine surgery: pressure stability, thresholds, and safety implications Rajendra Singh, Thomas Cha, Alexander Vaccaro, Alan Hilibrand, Gregory Schroeder, Gregory Kepler, Afshin Razi, Mitchell Ng European Spine Journal.2026;[Epub] CrossRef
Unilateral biportal endoscopic decompression for acute spontaneous spinal epidural hematoma at the cervicothoracic junction: a case report and literature review Longyao Cao, Hui Lu, Dongjie Zhang Frontiers in Surgery.2026;[Epub] CrossRef
Challenges with Spinal Tumor (Intradural Extramedullary) Excision by Full-Endoscopic Mono-Portal Technique Mukesh Kumar, Digvijay Singh, Amit Joshi, Shrish Nalin, Kanika Sharma Indian Journal of Neurosurgery.2026;[Epub] CrossRef
Fluid and thermal dynamics in endoscopic spine surgery: What surgeons need to know Dong Hun Kim, Sang Don Kim, Jin Young Kim, Jae Taek Hong, Jung Woo Hur Journal of Clinical Neuroscience.2025; 136: 111287. CrossRef
Primer on unilateral biportal endoscopic spine surgery: technical overview for beginners Erick R. Kazarian, Jason I. Yang, Gregory S. Kazarian, Yong H. Kim The Spine Journal.2025;[Epub] CrossRef
Intra-, Epidural And Intracranial Pressure Changes During Interlaminar Endoscopy, With and Without Dural Tear Mazda Farshad, Jana Felicitas Schader, Alexandra Stauffer, Carl Moritz Zipser, Najmeh Kheram, José Miguel Spirig, Marie-Rosa Fasser, Jonas Widmer, Vincent Hagel Neurospine.2025; 22(2): 583. CrossRef
Pioneering Promotion in Endoscopic Spine Surgery: Innovation of Fluid Dynamics and Pressure Measurement Models: Commentary on “An Experimental Model for Fluid Dynamics and Pressures During Endoscopic Lumbar Discectomy” Yi-Hao Liang, Facundo Van Isseldyk Neurospine.2024; 21(3): 753. CrossRef
From the Editor-in-Chief: Featured Articles in the September 2024 Issue Inbo Han Neurospine.2024; 21(3): 743. CrossRef
Endoscopic Transforaminal Thoracic Decompression for Removal of a Giant Calcified Thoracic Disc Herniation Mazda Farshad, Christoph Johannes Laux, Lukas Zingg, Florian Wanivenhaus Neurospine.2024; 21(4): 1116. CrossRef
Full-Endoscopic Resection of a Lumbar Intradural Tumor (Schwannoma): Video Case Report and Description of the Surgical Technique Vincent Hagel, Facundo Van Isseldyk Neurospine.2024; 21(4): 1096. CrossRef
First
Prev
