A novel preoperative trajectory evaluation method for l5-s1 transforaminal percutaneous endoscopic lumbar discectomy

Publication date: Available online 28 February 2018
Source:The Spine Journal
Author(s): Sang Soo Eun, Sang-Ho Lee, Wei Chiang Liu, H. Yener Erken
Background contextL5-S1 transforaminal PELD is a demanding procedure due to structures like iliac crest, L5 transverse process, hypertrophic L5-S1 facet joint, and sacral ala. There has been no definite preoperative evaluation method to evaluate the surgical validity of L5-S1 transforaminal PELD.PurposeAuthors report a new preoperative trajectory evaluation method for L5-S1 transforaminal PELD using magnetic resonance imaging (MRI) or computed tomography (CT) examinationsStudy design/settingTechnical ReportsPatient samplePatients who were diagnosed as L5-S1 soft disc herniationOutcome measuresSuccess rate of transforaminal PELD according to height of iliac crestMethodsTwelve patients who were diagnosed L5-S1 disc herniation were preoperatively evaluated with this new method. Skin marker is attached to patient's back as a tentative skin entry point which was determined by usual preoperative MRI or CT. A new tilted axial and coronal MRI or CT scan is performed according to axis of L5S1 transforaminal working channel. These images will show good relationship between working channel and iliac crest.ResultsSix patients were decided to undergo a transforaminal PELD and results were successful. The other six patients were considered to be "unsuitable" for transforaminal PELD because of the probable blockade by iliac crest.ConclusionThe tilted MRI or CT can provide precise evaluation for L5S1 transforaminal PELD trajectory and may achieve good outcome.



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