Trivialization of durotomy can cause complications for endoscopic spine
surgeons when a patient's neurological or cardiovascular status unexpectedly
deteriorates during or after surgery. The literature on fluid management strategies,
irrigation-related risk factors, and clinical consequences of incidental durotomy during
spinal endoscopy is limited. However, it suggests that most patients can be managed
with supportive care without formal dural repair. There is currently no validated
irrigation protocol for endoscopic spine surgery. In this chapter, the authors report
severe complications in several patients, including the spread of irrigation fluid, blood,
and air into the intradural and intracranial spaces. They concluded that patients should
be informed about the risks associated with irrigated spinal endoscopy before surgery.
Infrequent yet not insignificant, adversities encompassing intracranial hemorrhage,
hydrocephalus, cephalalgia, cervical discomfort, convulsive events, and the perilous
autonomic dysreflexia manifesting as hypertensive episodes can transpire should the
irrigation fluid inadvertently enter the spinal cord or dural sac. Adept endoscopic spinal
surgeons postulate an association between durotomy events and equilibration pressures
associated with irrigation, a conjunction that, when amalgamated with copious
irrigation volumes, may prove disconcerting. Further research is needed to determine
whether specific thresholds for pressure, flow, and total volume of irrigation fluid should be established and to identify any additional risk factors beyond incidental
durotomy or prolonged surgery time.
Keywords: Lumbar endoscopic surgery, Irrigation flow- and pressure, Adverse events and complications.
