Endoscopic Trans-iliac Approach to L5-S1 Disc and Foramen - A report on clinical experience
Said Osman
Sky Spine Endoscopy Institute, USA
: J Spine Neurosurg
Abstract
Background: The lumbosacral junction is a difficult area for spine surgery because of its 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 transforaminal endoscopic approaches. A trans-iliac cadaver study published by the author and co-workers in 1997, suggested the possibility of an alternative approach to the lumbosacral junction. Purpose: To determine the feasibility of a percutaneous, endoscopic trans-iliac approach to the L5-S1 disc and foramen. Study Design: Prospective case series study. Materials and Methods: The study included 45 consecutive patients undergoing the transiliac approach to L5-S1 disc and foramen. Pre- and postoperative VAS; ODI; intra-operative blood loss; and operative time, were obtained for the study. A preoperative MRI or CT scan was used to determine the need for trans-iliac access. The procedure was performed with the patient in the prone position and under monitored sedation. Endotracheal anesthesia was used for fusion cases. The transiliac access was established with a cannulated drill through the iliac wing. Once the trans-iliac window had been created, the rest of the procedure proceeded as for transforaminal endoscopic decompression +/- fusion. Results: 15 patients (31 male and 14 female) participated in the study. The VAS for back and leg pain significantly improved in all patients. The ODI dropped by more than 70%. There was minimal blood loss and transient postoperative dysesthesia in 5 cases which resolved after 2 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.
Biography
Said Osman is an Orthopedic Surgeon with more than 20 years of experience specializing in Spine Surgery. He is the Founder of Sky Spine Endoscopy Institute, where he provides Complex and Minimally Invasive Spine Surgery. In addition, He trains surgeons across the world in Endoscopic and Endoscopically-Assisted Spine Surgery. He has been published in numerous peer-reviewed journals and holds eight patents for various medical devices
