Prevention of Nerve Root Thermal Injury Caused by Bipolar Cauterization Near the Nerve Roots.
Journal
Spine
ISSN: 1528-1159
Titre abrégé: Spine (Phila Pa 1976)
Pays: United States
ID NLM: 7610646
Informations de publication
Date de publication:
15 03 2019
15 03 2019
Historique:
pubmed:
22
8
2018
medline:
25
12
2019
entrez:
22
8
2018
Statut:
ppublish
Résumé
This was a controlled, interventional animal study. This study aimed to investigate the thermal injury of nerve root by cauterization near the nerve root and to identify the prevention or rescue procedure of nerve root injury. In spine surgery, bipolar cauterization of epidural venous plexus near the nerve root is an essential procedure to control bleeding. Although a potential risk of neurological thermal damage exists, the underlying mechanism and prevention have not been elucidated. Temperature measurement and histological evaluation after bipolar cauterization near the posterior branch of the nerve root were performed using a rabbit model. Subsequently, the effect of saline irrigation or changing the direction of bipolar forceps to reduce thermal elevation during bipolar cauterization was evaluated. Finally, the effectiveness of locally injected corticosteroid after bipolar cauterization was evaluated. After bipolar cauterization, temperature of the surrounding site reached 60.9 °C, and 47.8% of the nerves were histologically injured. Using saline irrigation, thermal elevation was significantly suppressed up to 42.7 °C (P < 0.01), and no nerve was histologically injured. When bipolar cauterization was performed in the perpendicular direction, temperature of the surrounding site reached only 40.4 °C (P < 0.01). Locally injected corticosteroid reduced the incidence of nerve injury to 25.0%. However, a significant increase in nerve damage remained compared with the sham group (P < 0.01). Bipolar cauterization near the nerve roots can increase the temperature of nerve roots and cause thermal nerve root injury, despite no accidental direct nerve root injury. Using saline irrigation, or setting bipolar forceps perpendicular to nerve roots, thermal elevation could be suppressed and nerve injury could be prevented. Therefore, it is recommended that surgeons set bipolar forceps perpendicular to nerve roots or use saline irrigation for the prevention of nerve root injury. N/A.
Sections du résumé
STUDY DESIGN
This was a controlled, interventional animal study.
OBJECTIVE
This study aimed to investigate the thermal injury of nerve root by cauterization near the nerve root and to identify the prevention or rescue procedure of nerve root injury.
SUMMARY OF BACKGROUND DATA
In spine surgery, bipolar cauterization of epidural venous plexus near the nerve root is an essential procedure to control bleeding. Although a potential risk of neurological thermal damage exists, the underlying mechanism and prevention have not been elucidated.
METHODS
Temperature measurement and histological evaluation after bipolar cauterization near the posterior branch of the nerve root were performed using a rabbit model. Subsequently, the effect of saline irrigation or changing the direction of bipolar forceps to reduce thermal elevation during bipolar cauterization was evaluated. Finally, the effectiveness of locally injected corticosteroid after bipolar cauterization was evaluated.
RESULTS
After bipolar cauterization, temperature of the surrounding site reached 60.9 °C, and 47.8% of the nerves were histologically injured. Using saline irrigation, thermal elevation was significantly suppressed up to 42.7 °C (P < 0.01), and no nerve was histologically injured. When bipolar cauterization was performed in the perpendicular direction, temperature of the surrounding site reached only 40.4 °C (P < 0.01). Locally injected corticosteroid reduced the incidence of nerve injury to 25.0%. However, a significant increase in nerve damage remained compared with the sham group (P < 0.01).
CONCLUSION
Bipolar cauterization near the nerve roots can increase the temperature of nerve roots and cause thermal nerve root injury, despite no accidental direct nerve root injury. Using saline irrigation, or setting bipolar forceps perpendicular to nerve roots, thermal elevation could be suppressed and nerve injury could be prevented. Therefore, it is recommended that surgeons set bipolar forceps perpendicular to nerve roots or use saline irrigation for the prevention of nerve root injury.
LEVEL OF EVIDENCE
N/A.
Identifiants
pubmed: 30130335
doi: 10.1097/BRS.0000000000002846
pii: 00007632-201903150-00003
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
E321-E328Références
Phan K, Mobbs RJ. Minimally invasive versus open laminectomy for lumbar stenosis: a systematic review and meta-analysis. Spine (Phila Pa 1976) 2016; 41:E91–E100.
Yang Y, Liu B, Rong LM, et al. Microendoscopy-assisted minimally invasive transforaminal lumbar interbody fusion for lumbar degenerative disease: short-term and medium-term outcomes. Int J Clin Exp Med 2015; 8:21319–21326.
Soman SM, Modi JV, Chokshi J. Feasibility of endoscopic discectomy by inter laminar approach at a high volume tertiary public hospital in a developing country. J Spine Surg 2017; 3:38–43.
Thirumala P, Zhou J, Natarajan P, et al. Perioperative neurologic complications during spinal fusion surgery: incidence and trends. Spine J 2017; 17:1611–1624.
Nagayama R, Nakamura H, Yamano Y, et al. An experimental study of the effects of nerve root retraction on the posterior ramus. Spine (Phila Pa 1976) 2000; 25:418–424.
Tamai K, Suzuki A, Takahashi S, et al. The incidence of nerve root injury by high-speed drill can be reduced by chilled saline irrigation in a rabbit model. Bone Joint J 2017; 99-B:554–560.
Sokolowski MJ, Garvey TA, Perl J 2nd, et al. Prospective study of postoperative lumbar epidural hematoma: incidence and risk factors. Spine (Phila Pa 1976) 2008; 33:108–113.
Awad JN, Kebaish KM, Donigan J, et al. Analysis of the risk factors for the development of post-operative spinal epidural haematoma. J Bone Joint Surg Br 2005; 87:1248–1252.
Tirelli G, Camilot D, Bonini P, et al. Harmonic scalpel and electrothermal bipolar vessel sealing system in head and neck surgery: a prospective study on tissue heating and histological damage on nerves. Ann Otol Rhinol Laryngol 2015; 124:852–858.
Chen RK, Than KD, Wang AC, et al. Comparison of thermal coagulation profiles for bipolar forceps with different cooling mechanisms in a porcine model of spinal surgery. Surg Neurol Int 2013; 4:113.
Lee IH, Yoon YC, Cho EY, et al. Perineural air injection as a means of prevention of thermal injury of the sciatic nerve during radio frequency ablation: a preliminary experimental study in rabbits. J Ultrasound Med 2008; 27:1221–1227.
Carriel V, Garzón I, Alaminos M, et al. Evaluation of myelin sheath and collagen reorganization pattern in a model of peripheral nerve regeneration using an integrated histochemical approach. Histochem Cell Biol 2011; 136:709–717.
Kilkenny C, Browne WJ, Cuthill IC, et al. Improving bioscience research reporting: the ARRIVE guidelines for reporting animal research. PLoS Biol 2010; 8:e1000412.
Smith AJ, Clutton RE, Lilley E, et al. PREPARE: guidelines for planning animal research and testing. Lab Anim 2018; 52:135–141.
Kanda Y. Investigation of the freely available easy-to-use software ’EZR’ for medical statistics. Bone Marrow Transplant 2013; 48:452–458.
Konno S, Olmarker K, Byrod G, et al. The European Spine Society AcroMed Prize 1994. Acute thermal nerve root injury. Eur Spine J 1994; 3:299–302.
Mikami T, Wanibuchi M, Mikuni N. Bumping phenomenon during continuous coagulation with bipolar forceps. Neurol Med Chir (Tokyo) 2012; 52:731–735.
Habermann W, Muller W. Tissue penetration of bipolar electrosurgical currents: Joule overheating beyond the surface layer. Head Neck 2013; 35:535–540.
Donzelli J, Leonetti JP, Wurster RD, et al. Neuroprotection due to irrigation during bipolar cautery. Arch Otolaryngol Head Neck Surg 2000; 126:149–153.
Malis L. Bipolar coagulation in microsurgery. Micro-Vascular Surgery. 1967; Stuttgart, Germany: Thieme, 126–130.
Keshavarzi S, Bolour A, Yarbrough C, et al. Thermal properties of contemporary bipolar systems using infrared imaging. World Neurosurg 2015; 83:376–381.
Shintani K, Uemura T, Takamatsu K, et al. Protective effect of biodegradable nerve conduit against peripheral nerve adhesion after neurolysis. J Neurosurg 2017; 1–10.
Sieker JT, Ayturk UM, Proffen BL, et al. Immediate administration of intraarticular triamcinolone acetonide after joint injury modulates molecular outcomes associated with early synovitis. Arthritis Rheumatol 2016; 68:1637–1647.
Shibayama M, Kuniyoshi K, Suzuki T, et al. The effects of locally injected triamcinolone on entrapment neuropathy in a rat chronic constriction injury model. J Hand Surg Am 2014; 39:1714–1721.
Elliott-Lewis EW, Jolette J, Ramos J, et al. Thermal damage assessment of novel bipolar forceps in a sheep model of spinal surgery. Neurosurgery 2010; 67:166–171. discussion 171-172.
Carlander J, Johansson K, Lindstrom S, et al. Comparison of experimental nerve injury caused by ultrasonically activated scalpel and electrosurgery. Br J Surg 2005; 92:772–777.
Fukui D, Kawakami M, Nakao SI, et al. Reduced blood loss and operation time in lumbar posterolateral fusion using a bipolar sealer. Eur Spine J 2017; 26:726–732.
Nishida K, Kakutani K, Maeno K, et al. Efficacy of hemostasis for epidural venous plexus and safety for neural structure using soft coagulation system in spinal surgery: a laboratory investigation using a porcine model. J Spinal Disord Tech 2013; 26:E281–E285.