{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T06:29:24Z","timestamp":1790231364951,"version":"4.1.0"},"reference-count":47,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2023,2,22]],"date-time":"2023-02-22T00:00:00Z","timestamp":1677024000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JPM"],"abstract":"<jats:p>Background: Seizures, neurological deficits, bradycardia, and, in the worst cases, cardiac arrest may occur following incidental durotomy during routine lumbar endoscopy. Therefore, we set out to measure the intraoperative epidural pressure during lumbar endoscopic decompression surgery. Methods: We conducted a retrospective observational cohort study to obtain intraoperative epidural measurements with an epidural catheter-pressure transducer assembly through the spinal endoscope on 15 patients who underwent lumbar endoscopic decompression of symptomatic lumbar herniated discs and spinal stenosis. The endoscopic interlaminar technique was employed. Results: There were six (40.0%) female and nine (60.0%) male patients aged 49.0667 \u00b1 11.31034, ranging from 36 to 72 years, with an average follow-up of 35.15 \u00b1 12.48 months. Three of the fifteen patients had seizures with durotomy and one of these three had intracranial air on their postoperative brain CT. Another patient developed spinal headaches and diplopia on postoperative day one when her deteriorating neurological function was investigated with a brain computed tomography (CT) scan, showing an intraventricular hemorrhage consistent with a Fisher Grade IV subarachnoid hemorrhage. A CT angiogram did not show any abnormalities. Pressure recordings in the epidural space in nine patients ranged from 20 to 29 mm Hg with a mean of 24.33 mm Hg. Conclusion: Most incidental durotomies encountered during lumbar interlaminar endoscopy can be managed without formal repair and supportive care measures. The intradural spread of irrigation fluid and intraoperatively used drugs and air entrapment through an unrecognized durotomy should be suspected if patients deteriorate in the recovery room. Ascending paralysis may cause nausea, vomiting, upper and lower motor neuron symptoms, cranial nerve palsies, hypotension, bradycardia, and respiratory and cardiac arrest. The recovery team should be prepared to manage these complications.<\/jats:p>","DOI":"10.3390\/jpm13030381","type":"journal-article","created":{"date-parts":[[2023,2,22]],"date-time":"2023-02-22T02:57:38Z","timestamp":1677034658000},"page":"381","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":18,"title":["Clinical Consequences of Incidental Durotomy during Full-Endoscopic Lumbar Decompression Surgery in Relation to Intraoperative Epidural Pressure Measurements"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0343-9687","authenticated-orcid":false,"given":"Roth A. A.","family":"Vargas","sequence":"first","affiliation":[{"name":"RIWO Spine Center of Excellence, Department of Neurosurgery, Foundation Hospital Centro M\u00e9dico Campinas, Campinas 13101-627, SP, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Moscatelli","sequence":"additional","affiliation":[{"name":"Clinica NeuroLife, Natal 59054-630, RN, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcos","family":"Vaz de Lima","sequence":"additional","affiliation":[{"name":"Department of Orthopedics and Traumatology, Santa Casa de S\u00e3o Paulo, \u201cPavilh\u00e3o Fernandinho Simonsen\u201d, S\u00e3o Paulo 05014-901, SP, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jorge Felipe","family":"Ram\u00edrez Le\u00f3n","sequence":"additional","affiliation":[{"name":"Minimally Invasive Spine Center, Bogot\u00e1, D.C., Colombia, Reina Sof\u00eda Clinic, Bogot\u00e1, D.C., Colombia, Department of Orthopaedics, Fundaci\u00f3n Universitaria Sanitas, Bogot\u00e1 104-76, D.C., Colombia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Morgan P.","family":"Lorio","sequence":"additional","affiliation":[{"name":"Advanced Orthopedics, 499 E. Central Pkwy, Ste. 130, Altamonte Springs, FL 32701, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rossano Kepler Alvim","family":"Fiorelli","sequence":"additional","affiliation":[{"name":"Department of General and Specialized Surgery, Gaffr\u00e9e e Guinle University Hospital, Federal University of the State of Rio de Janeiro (UNIRIO), Rio de Janeiro 20270-004, RJ, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Albert E.","family":"Telfeian","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, RI 02903, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Fiallos","sequence":"additional","affiliation":[{"name":"Minimally Invasive Spine Center, Bogot\u00e1 104-76, D.C., Colombia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ernest","family":"Braxton","sequence":"additional","affiliation":[{"name":"Vail Summit Orthopaedics & Neurosurgery, Frisco, CO 80443, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Song","sequence":"additional","affiliation":[{"name":"Advanced Neurosurgery, Reno, NV 89511, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7842-2914","authenticated-orcid":false,"given":"Kai-Uwe","family":"Lewandrowski","sequence":"additional","affiliation":[{"name":"Center for Advanced Spine Care of Southern Arizona, Tucson, AZ 85712, USA"},{"name":"Orthopaedic Surgery, Department of Orthopaedics, Fundaci\u00f3n Universitaria Sanitas, Bogot\u00e1 104-76, D.C., Colombia"},{"name":"Department of Orthopedics at Hospital Universit\u00e1rio Gaffre e Guinle, Universidade Federal do Estado do Rio de Janeiro, Rio de Janeiro 20270-004, RJ, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,2,22]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"S197","DOI":"10.21037\/jss.2019.10.03","article-title":"Navigating the learning curve of spinal endoscopy as an established traditionally trained spine surgeon","volume":"6","author":"Ransom","year":"2020","journal-title":"J. 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