Intracranial, Intra-, and Epidural Pressure Changes During Endoscopic Lumbar Discectomy: A Comparison Between...

Area of Science:

• Neurosurgery
• Spinal Surgery
• Minimally Invasive Procedures

Background:

• High-pressure irrigation in endoscopic lumbar discectomy improves visualization but risks increased spinal and intracranial pressures.
• Uncontrolled pressure increases may lead to neurologic complications.

Purpose of the Study:

• To compare intracranial, intradural, and lumbar epidural pressure changes during transforaminal and interlaminar endoscopic lumbar procedures.
• To evaluate effects of gravity vs. pump irrigation with and without outflow occlusion.

Main Methods:

• Cadaveric study using pressure probes in lumbar epidural, intradural (cervical, thoracic, lumbar), and intracranial spaces.
• Transforaminal and interlaminar approaches were tested with varying gravity and pump irrigation settings, with and without outflow occlusion.

Main Results:

• Interlaminar approach yielded higher lumbar epidural pressures without occlusion.
• Transforaminal approach showed higher lumbar epidural and intradural pressures with outflow occlusion at higher pump settings.
• Intracranial pressure increases were modest across all tested conditions.

Conclusions:

• Irrigation pressure responses are compartment- and approach-specific.
• Interlaminar access has higher baseline lumbar epidural pressure; transforaminal access is prone to pressure surges during occlusion.
• Careful irrigation management and avoiding prolonged outflow occlusion are crucial to mitigate risks, especially in susceptible patients.