Destructive effect of monopolar electrocautery knife usage on femoral artery endothelium during spine surgery: experimental study.

ABSTRACT

OBJECTIVE: Circulatory disorders are observed in the lower extremities of some patients after spinal surgery when a monopolar electrocautery knife (MEK) is used. Despite known the knowledge that electric currents can be hazardous to living tissues, MEK has been widely used in spine surgery. In this study, we investigated if MEK can cause endothelial injury in femoral arteries (FA). MATERIALS AND METHODS: Eighteen rabbits were included in this study, two of which were used as the reference group. The remaining animals were subjected to paravertebral soft tissue dissection along levels L1-L4. Half of the animals were dissected with MEK, and the other half were dissected with scissors and bipolar cautery. One month after the surgery, endothelial changes of the FAs were examined stereologically. RESULTS: Endothelial desquamation, cytoplasmic and nuclear condensations, cellular shrinkage and cellular loss were developed in the FAs of the MEK group. The endothelial cell density was 270 cells/mm2 in normal animals, 240 cells/mm2 in the non- MEK group and 190 cells/mm2 in the MEK group. The difference between the non-MEK and normal groups was not meaningful (P>0.05). The difference between the MEK and non-MEK groups was statistically significant (P<0.05); differences between the MEK and normal animals were even more significant (P<0.001). CONCLUSION: Sharp dissection with MEK can have a detrimental effect on the endothelial cells of the FAs and cause postoperative circulatory disorders in the lower extremities. Therefore, long-term high-voltage electrocauterization should be avoided during spinal surgery unless absolutely necessary.