Risk Analysis of Neurological Deterioration Associated With Fluid Insufflation in Uniportal Spine Endoscopy: A Case Series and Literature Review

BACKGROUND: Uniportal spine endoscopy is a minimally invasive technique gaining widespread popularity, but fluid insufflation during the procedure poses risks of neurological deterioration. The present study examines these risks through a case series and literature review. METHODS: A review of the literature was conducted to identify reported complications related to fluid insufflation. Additionally, we present a case series of 3 patients who experienced neurological deterioration associated with irrigation pressures. RESULTS: Key findings from the literature include complications such as raised intracranial pressure, seizures, durotomy-induced injuries, and unintended fluid migration. This case series describes novel complications, including transient ipsilateral weakness and lumbosacral plexopathy, linked to high irrigation pressures. CONCLUSION: Neurological deterioration, though rare, is a significant risk in uniportal spine endoscopy. Future research should focus on defining optimal irrigation parameters and pressure management strategies. Clinical Relevance By understanding the mechanisms in which fluid insufflation may cause neurological deterioration and by consequently adopting preventive strategies, surgeons can reduce complications and improve patient outcomes. LEVEL OF EVIDENCE: 4.