Analysis of Myeloid Hypertension in the Treatment of Lumbar Disc Herniation by Uni-portal Bi-channel & Dual-media Spinal Endoscope Lumbar Discectomy

Background: The Uni-portal Bi-channel & Dual-media Spinal Endoscope (UBD) is a recently developed, minimally invasive spinal endoscopic technique. This article reviews the mechanism, clinical manifestations, diagnosis, treatment, and prevention of UBD-induced myeloid hypertension-like syndrome (MHI). Case presentation: A 44-year-old man was admitted for low back pain lasting >2 years and progressive left-leg pain for 3 months. Under general anaesthesia, L5/S1 discectomy was performed via an interlaminar approach using the UBD system. Fifteen minutes after extubation he developed head-and-neck and low-back pain, lower-limb numbness, immobility, and agitation. Intravenous midazolam 5 mg, dexmedetomidine 1 μg/kg, methylprednisolone sodium succinate, and mannitol were given for sedation and oedema control. Within 1 h the symptoms improved; they resolved completely after 3 h. Twelve hours post-operatively VAS scores were 1 for low back pain and 0 for leg pain. One month later both VAS scores were 0 and the patient reported no dizziness. Conclusions: MHI is a rare but potentially serious complication of water-medium spinal endoscopy. Prevention, early recognition, and prompt symptomatic and supportive care usually produce symptom relief within 1 h and complete resolution within 24 h. The UBD technique, which allows switching between air and water media, appears effective in preventing and treating MHI.