Application of transiliac approach to intervertebral endoscopic discectomy in L5/S1 intervertebral disc herniation

Abstract

ObjectiveTo discuss the significance and the short-term effect of bone puncture technique in transiliac approach to intervertebral endoscopic discectomy for the treatment of L5/S1 intervertebral disc herniation.MethodsNineteen patients were diagnosed as L5/S1 disc herniation and treated using transiliac approach to endoscopic discectomy (group I), and 20 patients were diagnosed as non-L5/S1 disc herniation and underwent conventional approach (group R). Leg pain was evaluated by VAS. MacNab ratings of the last follow-up were recorded to evaluate early clinical efficacy, and postoperative complications were recorded to evaluate surgical safety. The imaging changes of the patients 3 months after surgery were observed.ResultsOne patient in group I, who felt abnormal in nerve roots, underwent symptomatic treatments, such as rehydration and hormone, and the abnormalities disappeared 3 days after treatment. There were no significant significances in operative time and intraoperative fluoroscopy times between groups I and R (p > 0.05), but there was a higher tendency in group I. The VAS scores of post-operation were significantly lower than that of pre-operation in the two groups (p < 0.05), but there were no significant differences between the two groups (p > 0.05). The MacNab score of the last follow-up showed excellent rate (95%) and good rate (90%) in groups I and R, respectively.ConclusionsBone puncture-combined transiliac approach to intervertebral endoscopic surgery could locate iliac puncture point individually, and establish a good iliac channel, which is safe, effective, and minimally invasive.

Preoperative Design for the Posterolateral Approach in Full-Endoscopic Spine Surgery for the Treatment of L5/S1 Lumbar Disc Herniation

“…The SAP only eliminates endoscope insertion. Several investigators reported that a high IC disturbed the transforaminal approach (TFA) in L5/S1 LDH [8,16,17]. The entry angle of TFA is generally 25°–35°, and the skin entry point is 10–13 cm from the midline.…”

Lumbar Disc Herniation

“…There are several recognized percutaneous endoscopic approaches to LDHs: interlaminar, transforaminal, posterolateral, and transiliac [77,78]. As an aggregate group, endoscopic discectomy is associated with decreased operative time and less blood loss with no increase in overall complications, reoperation rates, or wound infection when compared to open discectomy [79].…”

“…Given the difficulty in utilizing the endoscopic approach with high iliac crests, Bai et al applied a transiliac approach to endoscopic discectomy [77]. In comparison to the conventional transforaminal approach, there was no difference in 12-month outcomes, usage of fluoroscopy, or perioperative neurovascular injury.…”

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

“…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 ]. Application of transiliac approach to intervertebral endoscopic discectomy in L5/S1 LDH has also been suggested[ 19 ]. Additionally, it is reported that compared with the L5/S1 level, the L4/5 level might be easier to master after short-term professional training[ 20 ].…”