• Young-Ho Hong, Seung-Kook Kim, Juyoung Hwang, Jin-Hwa Eum, Dong-Hwa Heo, Dong-Won Suh, and Su-Chan Lee.
• Department of Spine Center, Barun-sesang Hospital, Kyung-ki, South Korea.
• World Neurosurg. 2021 May 1; 149: e836-e843.

BackgroundStable water dynamics during endoscopic spine surgery improves the surgeon's comfort and patient's outcomes. We aimed to measure the water dynamics during spinal surgery and identify the factors that facilitate stable water dynamics.MethodsThis open-label, prospective, proficiency-matched, in vivo study included patients with single-level degenerative spinal disease. After assessing their heights and balancing the matched instrument, we measured the irrigation fluid pressure in various situations. We performed multiple regression analysis based on odds ratio (OR), confidence interval (CI), and relationships (proficiency-matched) with possible instrumental and physical characteristics. The instrumental factors were the presence and length of a rigid cannulation, and the physical characteristics were body mass index (body mass index [BMI]), skin-to-dura depth, height (interaction with BMI), and body weight (interaction with BMI).ResultsOf the 36 patients, 29 were included. The mean pressure of the operation cavity was 16.66 ± 9.12 cm H2O (12.25 ± 6.71 mm Hg). Water pressure with the rigid cannulation (9.41 ± 2.94 cm H2O [6.92 ± 2.16 mm Hg]) was significantly lower than that without cannulation (23.43 ± 7.57 cm H2O [17.26 ± 5.57 mm Hg], P < 0.01). Water pressure correlated with cannular length (OR = -1.08, CI = -1.79, -0.37, P < 0.01) and BMI (OR = 0.56, CI = 0.12, 0.99, P < 0.01). BMI showed a proportional relationship (r = 0.84, P < 0.01).ConclusionsDuring biportal endoscopy, we suggest maintaining water pressure between 4.41 cm H2O (2.41 mm Hg) and 31.00 cm H2O (22.83 mm Hg). Compared to physical characteristics, placement of the cannula and appropriate cannula length are important factors that affect water dynamics.Copyright © 2021 Elsevier Inc. All rights reserved.

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