Anatomical considerations of the iliac crest on percutaneous endoscopic discectomy using a transforaminal approach

Tezuka, Fumiaki; Sakai, Toshinori; Abe, Mitsunobu; Yamashita, Kazuo; Takata, Yoichiro; Higashino, Kosaku; Chikawa, Takashi; Nagamachi, Akihiro; Sairyo, Koichi

doi:10.1016/j.spinee.2017.06.012

Cited by 29 publications

(29 citation statements)

References 19 publications

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“…Despite the evolution, transforaminal PELD cannot be adopted in all patients due to narrow foraminal area and high iliac crest hindered by the L5 transverse process. It was reported that transforaminal PELD could be performed at the L4-5 level in 94.4% (right) and 90.4% (left) patients and only 24.1% and 19.2% at the L5-S1 level [34]. The patients who performed the interlaminar approach were not included here.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Transforaminal Percutaneous Endoscopic Lumbar Discectomy with and without Foraminoplasty for Lumbar Disc Herniation: A 2-Year Follow-Up

Gao

Tian

et al. 2019

Pain Research and Management

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Background Both transforaminal percutaneous endoscopic lumbar discectomy with foraminoplasty (TF PELF) and transforaminal percutaneous endoscopic lumbar discectomy without foraminoplasty (TF PELD) were developed for lumbar disc herniation (LDH) patients. However, the safety and effectiveness between the TF PELF and TF PELD have not been investigated. Methods Of the included 140 LDH patients, 62 patients received TF PELF (PELF group) and 78 patients received TF PELD (PELD group). The operation time, the duration of staying at the hospital, and complication incidences were recorded. All patients were followed up for 2 years, where low back and leg visual analogue scale (VAS) pain ratings and Oswestry Disability Index (ODI) were compared between the 2 groups before and after surgery. Modified Macnab criterion was estimated for all patients at postoperative 2 years. Results There were no significant difference of the operation time, number of days staying at the hospital, and the incidence of complications between the 2 groups (P > 0.05). Two cases in the PELF group and 1 case in the PELD group received a second surgery due to unrelieved symptoms postoperatively. Low back and leg VAS and ODI scores decreased in both groups after operation (P < 0.01), respectively, but were not significant between the 2 groups over time (P > 0.05). Six patients in the PELF group and 3 patients in the PELD group did not continue the follow-up; thus, only 131 patients completed Macnab evaluation. The satisfactory rate was reported as 80.4% in the PELF group and 90.7% in the PELD group (P > 0.05). Conclusions This study suggested that the safety and effectiveness of TF PELF are comparable to TF PELD for LDH patients.

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Section: Discussionmentioning

confidence: 99%

Comparison of Transforaminal Percutaneous Endoscopic Lumbar Discectomy with and without Foraminoplasty for Lumbar Disc Herniation: A 2-Year Follow-Up

Gao

Tian

et al. 2019

Pain Research and Management

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“…The situation of the high iliac crest leads to the increased inclination of the trajectory, which makes the cannula toward a more ventral aspect and away from the centrally herniated disc. 14 Choi and Park 12 reported a series of the L5-S1 TELD in 100 patients and simplified the relation of iliac crest height and L5-S1 disc level with 2-dimensional radiography. By supra-iliac entry, TELD at L5-S1 can achieve a good outcome in 92% of the patients.…”

Section: Discussionmentioning

confidence: 99%

“…While using the supra-iliac entry at L5–S1 TELD, high iliac crest might be a significant concern in the procedure. The situation of the high iliac crest leads to the increased inclination of the trajectory, which makes the cannula toward a more ventral aspect and away from the centrally herniated disc [ 14 ]. Choi and Park [ 12 ] reported a series of the L5–S1 TELD in 100 patients and simplified the relation of iliac crest height and L5–S1 disc level with 2-dimensional radiography.…”

Section: Discussionmentioning

confidence: 99%

Transforaminal Endoscopic Lumbar Discectomy for L5–S1 Disc Herniation With High Iliac Crest: Technical Note and Preliminary Series

et al. 2020

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With the trend of minimally invasive spine surgery, full-endoscopic lumbar discectomy (FELD) has evolved with the advancement of the optics and instruments. Regarding the techniques, the transforaminal and interlaminar approach remain the major accesses in FELD. Transforaminal endoscopic lumbar discectomy (TELD) is an effective and safe treatment for herniation of the lumbar disc. More and more evidence supports the TELD in enhancing recovery and decreasing surgical complications. However, the learning curve of TELD remains steep, especially at the L5-S1 level. The iliac crest height is an essential factor in the operability of TELD at the L5-S1 level. In the situation of the high iliac crest, TELD is technically challenging even for an experienced surgeon. Therefore, the authors report their techniques of TELD with foraminoplasty step-by-step and the preliminary results in this report.

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“…Lee et al[ 16 ] also proposed the foraminoplastic approach in order to facilitate the insertion of the cannula. Tezuka et al[ 17 ] indicated that treatment for the central type of LDH at the L5-S1 disc level is more difficult than at the L4-L5 due to the iliac crest. This can be solved by using a more perpendicular approach with the possible addition of a foraminoplasty[ 17 ].…”

Section: Patient-related Conditionsmentioning

confidence: 99%

“…Tezuka et al[ 17 ] indicated that treatment for the central type of LDH at the L5-S1 disc level is more difficult than at the L4-L5 due to the iliac crest. This can be solved by using a more perpendicular approach with the possible addition of a foraminoplasty[ 17 ]. Interlaminar approach can escape the blockade of crista iliaca, and offer several advantages including a faster puncture orientation, a shorter operation time, and less intraoperative radiation exposure[ 18 ].…”

Section: Patient-related Conditionsmentioning

confidence: 99%

Transforaminal Percutaneous Endoscopic Discectomy using Transforaminal Endoscopic Spine System technique: Pitfalls that a beginner should avoid

Kapetanakis

Gkasdaris

Angoules

et al. 2017

WJO

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Transforaminal Percutaneous Endoscopic Discectomy (TPED) is a minimally invasive technique mainly used for the treatment of lumbar disc herniation from a lateral approach. Performed under local anesthesia, TPED has been proven to be a safe and effective technique which has been also associated with shorter rehabilitation period, reduced blood loss, trauma, and scar tissue compared to conventional procedures. However, the procedure should be performed by a spine surgeon experienced in the specific technique and capable of recognizing or avoiding various challenging conditions. In this review, pitfalls that a novice surgeon has to be mindful of, are reported and analyzed.

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Anatomical considerations of the iliac crest on percutaneous endoscopic discectomy using a transforaminal approach

Cited by 29 publications

References 19 publications

Comparison of Transforaminal Percutaneous Endoscopic Lumbar Discectomy with and without Foraminoplasty for Lumbar Disc Herniation: A 2-Year Follow-Up

Comparison of Transforaminal Percutaneous Endoscopic Lumbar Discectomy with and without Foraminoplasty for Lumbar Disc Herniation: A 2-Year Follow-Up

Transforaminal Endoscopic Lumbar Discectomy for L5–S1 Disc Herniation With High Iliac Crest: Technical Note and Preliminary Series

Transforaminal Percutaneous Endoscopic Discectomy using Transforaminal Endoscopic Spine System technique: Pitfalls that a beginner should avoid

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