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Endoscopic trans-iliac approach to L5-S1 disc and foramen - a report on clinical experience.

Osman SG, Sherlekar S, Malik A, Winters C, Grewal PK, Narayanan M, Gemechu N - Int J Spine Surg (2014)

Bottom Line: The ODI dropped by more than 50%.Endoscopic trans-iliac approach to the L5-S1 disc and foramen is feasible and safe.Decompression can be performed safely via trans-iliac access with minimal blood loss, and in a short operative time.

View Article: PubMed Central - PubMed

Affiliation: American Spine, Germantown, MD.

ABSTRACT

Background: The lumbosacral junction is a difficult area for spine surgery because of the complex anatomy. In the era of minimally invasive spine surgery, the presence of the iliac wing has, at the level of lumbosacral junction, created a major obstacle in the paths of two of the major approaches, namely, the direct lateral and percutaneous posterolateral endoscopic approaches. A trans-iliac cadaver study published by the senior author and co-workers in 1997, suggested the possibility of an alternative approach to the lumbosacral junction.

Purpose: To determine the feasibility of percutaneous, endoscopic trans-iliac approach to the L5-S1 disc and foramen.

Study design: Prospective case series study.

Materials and methods: 15 consecutive patients undergoing the transiliac approach to L5-S1 disc and foramen were included in the study. Pre- and postoperative visual analogue scale (VAS); Oswestry Disability Index (ODI); and intra-operative blood loss and operative time, were obtained for the study. Preoperative MRI or CT scan was used to determine the need for trans-iliac access. The procedure was performed with the patient in prone position and under monitored sedation for decompression. Endotracheal anesthesia was used for fusion cases. The transiliac access was established with a cannulated drill or core drill through the iliac wing. Once the trans-iliac window had been created, the rest of the procedure proceeded as for percutaneous endoscopic transforaminal decompression and fusion.

Results: 15 patients (9 male and 6 female) participated in the study. The VAS for back and leg pain significantly improved in all patients. The ODI dropped by more than 50%. There was minimal blood loss, and transient post-operative dysesthesia in 2 cases which resolved after 3 weeks.

Conclusion: Endoscopic trans-iliac approach to the L5-S1 disc and foramen is feasible and safe. Decompression can be performed safely via trans-iliac access with minimal blood loss, and in a short operative time.

No MeSH data available.


Related in: MedlinePlus

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Mentions: Preoperative X-rays and MRIs were studied. Using the axial view of the L5-S1 on the MRI, a line is drawn from the target lesion on the disc to exit the skin posterolaterally as shown on Figure 2. Measurement of the portal site from the midline, and the angle of instrumentation relative to the sagittal plane of the spine were measured and recorded as preoperative planning.


Endoscopic trans-iliac approach to L5-S1 disc and foramen - a report on clinical experience.

Osman SG, Sherlekar S, Malik A, Winters C, Grewal PK, Narayanan M, Gemechu N - Int J Spine Surg (2014)

© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4325494&req=5

Mentions: Preoperative X-rays and MRIs were studied. Using the axial view of the L5-S1 on the MRI, a line is drawn from the target lesion on the disc to exit the skin posterolaterally as shown on Figure 2. Measurement of the portal site from the midline, and the angle of instrumentation relative to the sagittal plane of the spine were measured and recorded as preoperative planning.

Bottom Line: The ODI dropped by more than 50%.Endoscopic trans-iliac approach to the L5-S1 disc and foramen is feasible and safe.Decompression can be performed safely via trans-iliac access with minimal blood loss, and in a short operative time.

View Article: PubMed Central - PubMed

Affiliation: American Spine, Germantown, MD.

ABSTRACT

Background: The lumbosacral junction is a difficult area for spine surgery because of the complex anatomy. In the era of minimally invasive spine surgery, the presence of the iliac wing has, at the level of lumbosacral junction, created a major obstacle in the paths of two of the major approaches, namely, the direct lateral and percutaneous posterolateral endoscopic approaches. A trans-iliac cadaver study published by the senior author and co-workers in 1997, suggested the possibility of an alternative approach to the lumbosacral junction.

Purpose: To determine the feasibility of percutaneous, endoscopic trans-iliac approach to the L5-S1 disc and foramen.

Study design: Prospective case series study.

Materials and methods: 15 consecutive patients undergoing the transiliac approach to L5-S1 disc and foramen were included in the study. Pre- and postoperative visual analogue scale (VAS); Oswestry Disability Index (ODI); and intra-operative blood loss and operative time, were obtained for the study. Preoperative MRI or CT scan was used to determine the need for trans-iliac access. The procedure was performed with the patient in prone position and under monitored sedation for decompression. Endotracheal anesthesia was used for fusion cases. The transiliac access was established with a cannulated drill or core drill through the iliac wing. Once the trans-iliac window had been created, the rest of the procedure proceeded as for percutaneous endoscopic transforaminal decompression and fusion.

Results: 15 patients (9 male and 6 female) participated in the study. The VAS for back and leg pain significantly improved in all patients. The ODI dropped by more than 50%. There was minimal blood loss, and transient post-operative dysesthesia in 2 cases which resolved after 3 weeks.

Conclusion: Endoscopic trans-iliac approach to the L5-S1 disc and foramen is feasible and safe. Decompression can be performed safely via trans-iliac access with minimal blood loss, and in a short operative time.

No MeSH data available.


Related in: MedlinePlus