Fluid and thermal dynamics in endoscopic spine surgery: What surgeons need to know

Endoscopic spine surgery (ESS) has revolutionized minimally invasive spinal procedures by enhancing visualization and reducing tissue disruption. Despite these advantages, effective fluid and thermal management remains crucial for procedural safety. Proper irrigation facilitates visualization, hemostasis, debris clearance, and infection prevention; however, excessive pressure may lead to complications such as headaches and seizures. While some surgeons advocate for higher pressures (80-100 mmHg) to ensure adequate visualization in select cases, irrigation pressures of 30-40 mmHg are generally sufficient to achieve effective bleeding control and maintain a clear surgical field. The Venturi effect plays a significant role in pressure dynamics, necessitating careful regulation through pressure-controlled pumps. Thermal management is equally critical when using radiofrequency (RF) energy for tissue manipulation. To prevent neural tissue damage-which may occur at temperatures exceeding 60 °C-continuous irrigation should accompany RF application. Power settings of 7-13 W are typically used with steerable RF probes for coagulation, 15-40 W for more demanding hemostasis, and up to 60 W with 90-degree RF probes for tissue dissection. Short, intermittent RF bursts further reduce thermal spread. This review synthesizes current evidence on fluid and thermal control in ESS, emphasizing proper pressure regulation and precise RF application. Future research should focus on standardized protocols and long-term outcomes. Advances in automated irrigation systems and real-time monitoring promise to enhance surgical precision and patient safety.