Postoperative spinal epidural hematoma in a biportal endoscopic spine surgery

Abstract

Biportal endoscopic spine surgery (BESS) is extending its application to most kind of spine surgeries. Postoperative spinal epidural hematoma (POSEH) is one of the major concerns of this emerging technique. Through this study we aim to investigate the incidence of POSEH in BESS comparing to a conventional spine surgery (CSS). The patients who underwent a non-fusion decompressive spine surgery due to degenerative lumbar spinal stenosis (LSS) or herniated lumbar disc (HLD) or both between January 2015 and March 2019 were reviewed retrospectively. The incidence of clinical POSEH that demanded a revision surgery for hematoma evacuation was compared between CSS and BESS. As a second endpoint, the morphometric degree of POSEH was compared between the two groups. The maximal compression of cauda equina by POSEH was measured by 4 grade scale at the T2 axial image and the neurological state was evaluated by 5 grade scale. The indication of hematoma evacuation was more than hG3 with more than nG1. As a subgroup analysis, risk factors of POSEH in BESS were investigated. The 2 groups were homogenous in age, sex, number and level of operated segments. There was significant difference in the incidence of symptomatic POSEH as 2/142 (1.4%) in CSS and 8/95 (8.4%) in BESS (P = .016). The radiological thecal sac compression by hematoma was hG1 65 (61.3%), hG2 35 (33.0%), hG3 5 (4.7%), hG4 1 (0.9%) cases in CSS and hG1 33 (39.8%), hG2 25 (30.1%), hG3 22 (26.5%), hG4 3 cases (3.6%) in BESS. The difference was significant (P < .001). In BESS subgroup analysis, the risk factor of high grade POSEH was bilateral laminectomy (OR = 8.893, P = .023). The incidence of clinical and morphometric POSEH was higher in BESS. In BESS, POSEH developed more frequently in bilateral laminectomy than unilateral laminectomy.

Hemodynamic protective effects of epinephrine containing saline irrigation in biportal endoscopic lumbar surgery

“…In BESS, in the prone position, 2 unilateral portals (1 for endoscopy and the other for instrumental working) were made. [ 4 ] We used a saline infusion pump with a pressure of 50 mm Hg, which is higher than the average venous pressure of 40 mm Hg to prevent venous bleeding. [ 4 ] A vacuum suction drain was placed and connected to a negative pressure bag of 120 ± 30 mm Hg in all cases, and it was removed on day 2 after the operation.…”

“…[ 4 ] A vacuum suction drain was placed and connected to a negative pressure bag of 120 ± 30 mm Hg in all cases, and it was removed on day 2 after the operation. [ 4 ]…”

“…[ 5 , 6 ] In our institute, while performing biportal endoscopic spine surgery (BESS), saline irrigation pressure makes the working space similar to a joint arthroscopic surgery, and 1 mg of epinephrine is added to 3 L of normal saline irrigation fluid, as in knee and shoulder surgery. [ 4 ] We also used a saline infusion pump with a pressure of 50 mm Hg, which is higher than the average venous pressure of 40 mm Hg to prevent venous bleeding for visualization. [ 4 ]…”

“…[ 4 ] We also used a saline infusion pump with a pressure of 50 mm Hg, which is higher than the average venous pressure of 40 mm Hg to prevent venous bleeding for visualization. [ 4 ]…”

Global and Current Research Trends of Unilateral Biportal Endoscopy/Biportal Endoscopic Spinal Surgery in the Treatment of Lumbar Degenerative Diseases: A Bibliometric and Visualization Study

“…Since the start of UBE/BESS technology, the overall number of published studies had shown a steady growth trend, which indicated that UBE/BESS technology research had entered a stage of rapid development and maintained a high degree of heat. As a new surgical technique, UBE/BESS had a short history and less published literature 7,[15][16][17][18] . Literature research showed that only 13 countries and regions had paid attention to it.…”