Analysis of the causes of spinal cord hypertension-like syndrome and its preventive measures during percutaneous transforaminal endoscopic lumbar discectomy

WANG Qi-lin; WANG Yue-ran; GOU Yu-wei; JIA Yu-hao; XIE Xian-song; ZHANG Ying-bo

doi:10.3969/j.issn.2095-252X.2025.01.006

Abstract：Objective To investigate the risk factors and preventive measures of spinal cord hypertension-like syndrome during percutaneous transforaminal endoscopic lumbar discectomy (PTELD). Methods We retrospectively analyzed the data of patients with lumbar disc herniation who underwent PTELD under local anesthesia in our hospital from August 2019 to August 2023. The patients were divided into the complication group (20 cases) and control group (422 cases) according to the occurrence of spinal cord hypertension-like syndrome during PTELD. The height of water pressure,operation time,dura mater rupture,intervertebral space and other related clinical indicators were recorded and compared between the two groups. The independent variables with statistical significance in univariate analysis were included in the binary Logistic regression analysis to study the independent influencing factors of spinal cord hypertension-like syndrome. Finally,the critical values of the independent influencing factors were determined by receiver operating characteristic (ROC) curve analysis to predict the risk of spinal cord hypertension-like syndrome. Results There was a significant positive correlation between the height of water pressure,operation time,dura mater rupture and the risk of spinal cord hypertension-like syndrome. The height of intervertebral space was negatively correlated with the risk of spinal cord hypertension-like syndrome. The highest sensitivity and specificity were obtained,while water pressure 94.25 cm,operation time 59.55 min and intervertebral space 7.55 mm as threshold values to predict the spinal cord hypertension-like syndrome respectively. The combined model had better clinical predictive value. Conclusions On the premise of ensuring the safety and quality of the operation,lower the height of irrigation fluid to less than 94.25 cm,shorten the operation time to less than 59.55 min,and avoid the rupture of dura mater can effectively reduce the risk of myeloid hypertension,improving the comfort,tolerance and safety of patients during operation and the clinical efficacy of surgery. For patients with severe spinal degeneration,more attention should be paid to the possibility of spinal cord hypertension syndrome.