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Objective <p>Spinal cord hypertension syndrome (SCHS) is a unique iatrogenic complication associated with water-mediated spinal endoscopic surgery. This study aimed to determine the incidence of SCHS in thoracic and lumbar procedures through a single-center retrospective analysis and to systematically summarize effective preventive and management strategies.</p> Methods <p>A single‑center retrospective study was conducted, consecutively enrolling patients who underwent water‑mediated uniportal spinal endoscopic surgery at our hospital between January 2021 and June 2025. Collected data included baseline patient characteristics, surgical level, intraoperative positioning, surgical technique, operative time, blood loss, intraoperative dural tear, postoperative drainage placement, and total length of hospital stay, and postoperative neurological assessments.</p> Results <p>A total of 960 patients including 346 thoracic and 614 lumbar surgeries were enrolled. The cohort included 512 males (53.3%) and 448 females (46.7%), with a mean age of 55.4 years. The overall incidence of SCHS was 3.64% (35/960). SCHS occurred significantly more frequently in thoracic (5.5%) than in lumbar procedures (2.6%; <i>P</i> &lt; 0.001). In thoracic surgeries, the prone position was associated with a higher incidence (6.3%) than the lateral position (2.7%; <i>P</i> &lt; 0.05), whereas in lumbar surgeries, the lateral position carried a higher risk (3.3%) compared with the prone position (0.6%; <i>P</i> &lt; 0.05). Unilateral laminotomy for bilateral decompression (ULBD) was more frequently associated with SCHS, accounting for 62.9% of affected cases. Patients were divided into the SCHS group (<i>n</i> = 35) and the control group (<i>n</i> = 925). The mean operative duration and length of hospital stay in the SCHS group were 99.2&#xa0;min and 6.8 days, respectively, which were significantly longer than those in the control group 65.2&#xa0;min and 6.4 days; <i>P</i> &lt; 0.05). The incidence of intraoperative dural tear was significantly higher in the SCHS group (49%) than in the control group (3%; <i>P</i> &lt; 0.001). The most common clinical manifestations of SCHS were severe headache/neck stiffness (91.4%), nausea/vomiting (60.0%), and marked intraoperative hypertension (51.4%). Following interventions, symptoms resolved within 5–15&#xa0;min in all patients and disappeared completely within 24–72&#xa0;h, with no permanent neurological deficits.</p> Conclusion <p>SCHS is a not‑uncommon complication of water‑mediated spinal endoscopic surgery, closely associated with surgical level, intraoperative positioning, surgical technique, operative duration, and dural tear.</p>

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Epidemiology of spinal cord hypertension syndrome in water-mediated uniportal full endoscopic thoracolumbar surgery: a single-center experience

  • 期刊论文

  • 发表日期：

    2026年4月29日

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  • Haiyang Wu,
  • Luyang Wang,
  • Yiping Zheng,
  • Xizhong Zhu,
  • Wanqi Ren,
  • Ziheng Li,
  • Shoule Ma,
  • Mingwang Zhao,
  • Xingchen Li,
  • Yusheng Xu

摘要

Objective

Spinal cord hypertension syndrome (SCHS) is a unique iatrogenic complication associated with water-mediated spinal endoscopic surgery. This study aimed to determine the incidence of SCHS in thoracic and lumbar procedures through a single-center retrospective analysis and to systematically summarize effective preventive and management strategies.

Methods

A single‑center retrospective study was conducted, consecutively enrolling patients who underwent water‑mediated uniportal spinal endoscopic surgery at our hospital between January 2021 and June 2025. Collected data included baseline patient characteristics, surgical level, intraoperative positioning, surgical technique, operative time, blood loss, intraoperative dural tear, postoperative drainage placement, and total length of hospital stay, and postoperative neurological assessments.

Results

A total of 960 patients including 346 thoracic and 614 lumbar surgeries were enrolled. The cohort included 512 males (53.3%) and 448 females (46.7%), with a mean age of 55.4 years. The overall incidence of SCHS was 3.64% (35/960). SCHS occurred significantly more frequently in thoracic (5.5%) than in lumbar procedures (2.6%; P < 0.001). In thoracic surgeries, the prone position was associated with a higher incidence (6.3%) than the lateral position (2.7%; P < 0.05), whereas in lumbar surgeries, the lateral position carried a higher risk (3.3%) compared with the prone position (0.6%; P < 0.05). Unilateral laminotomy for bilateral decompression (ULBD) was more frequently associated with SCHS, accounting for 62.9% of affected cases. Patients were divided into the SCHS group (n = 35) and the control group (n = 925). The mean operative duration and length of hospital stay in the SCHS group were 99.2 min and 6.8 days, respectively, which were significantly longer than those in the control group 65.2 min and 6.4 days; P < 0.05). The incidence of intraoperative dural tear was significantly higher in the SCHS group (49%) than in the control group (3%; P < 0.001). The most common clinical manifestations of SCHS were severe headache/neck stiffness (91.4%), nausea/vomiting (60.0%), and marked intraoperative hypertension (51.4%). Following interventions, symptoms resolved within 5–15 min in all patients and disappeared completely within 24–72 h, with no permanent neurological deficits.

Conclusion

SCHS is a not‑uncommon complication of water‑mediated spinal endoscopic surgery, closely associated with surgical level, intraoperative positioning, surgical technique, operative duration, and dural tear.