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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: Light sedation and local anesthetic infiltration of the access track was adequate for most patients. Neuromonitor was used to record MEPs and EMGs. Anti-embolic stockings and SCD devices are routinely used to prevent deep venous thrombosis. The patient is placed in prone position on radiolucent operating table on Kambin or Wilson frame. After sterile preparation, transparent drape is used to permit visualization of foot pedals with the fluoroscope in lateral position. Under antero-posterior fluoroscopic guidance, the midline of the spine was marked on the skin, and while visualizing with Ferguson projection the disc line was marked on the skin (Figure 3).


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: Light sedation and local anesthetic infiltration of the access track was adequate for most patients. Neuromonitor was used to record MEPs and EMGs. Anti-embolic stockings and SCD devices are routinely used to prevent deep venous thrombosis. The patient is placed in prone position on radiolucent operating table on Kambin or Wilson frame. After sterile preparation, transparent drape is used to permit visualization of foot pedals with the fluoroscope in lateral position. Under antero-posterior fluoroscopic guidance, the midline of the spine was marked on the skin, and while visualizing with Ferguson projection the disc line was marked on the skin (Figure 3).

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