S G Osman1, E B Marsolais. 1. Department of Orthopaedic Surgery, Case Western Reserve University, Cleveland, Ohio, USA.
Abstract
STUDY DESIGN: The toros of fresh cadavers were used to create endoscopic channels through the iliac wings to gain access to the L5-S1 disc and foramen. The spine and pelvis then were dissected out en bloc, and the anatomic relationships were studied. OBJECTIVES: To determine the feasibility of a transiliac approach to the L5-S1 disc and foramen and to assess the safety of this approach by studying the anatomic relationships of the transiliac track. SUMMARY OF BACKGROUND DATA: Because of its location deep in the pelvis, the L5-S1 disc and foramen are not easily accessible via a supra-iliac portal. A laparoscopic approach violates the abdominal cavity, and makes major vessels and viscera at risk for injury. METHODS: A core drill was inserted over a guide wire into the iliac wing under fluoroscopy to obtain a core of bone, which then was removed to create a transiliac channel. An arthroscope was inserted through the channel to perform discoscopy or foraminoscopy. The spine was dissected out en bloc to study the relationships of the track. RESULTS: It was possible to use a transiliac approach to L5-S1 in all the experiments. There was no damage of neural structures in any of the experiments. CONCLUSIONS: The results of this study suggest that it is possible to access the L5-S1 disc and foramen through the ilium without injuring important structures. It would be necessary to conduct a study based on an animal model and to evaluate the results before using this procedure in a clinical situation.
STUDY DESIGN: The toros of fresh cadavers were used to create endoscopic channels through the iliac wings to gain access to the L5-S1 disc and foramen. The spine and pelvis then were dissected out en bloc, and the anatomic relationships were studied. OBJECTIVES: To determine the feasibility of a transiliac approach to the L5-S1 disc and foramen and to assess the safety of this approach by studying the anatomic relationships of the transiliac track. SUMMARY OF BACKGROUND DATA: Because of its location deep in the pelvis, the L5-S1 disc and foramen are not easily accessible via a supra-iliac portal. A laparoscopic approach violates the abdominal cavity, and makes major vessels and viscera at risk for injury. METHODS: A core drill was inserted over a guide wire into the iliac wing under fluoroscopy to obtain a core of bone, which then was removed to create a transiliac channel. An arthroscope was inserted through the channel to perform discoscopy or foraminoscopy. The spine was dissected out en bloc to study the relationships of the track. RESULTS: It was possible to use a transiliac approach to L5-S1 in all the experiments. There was no damage of neural structures in any of the experiments. CONCLUSIONS: The results of this study suggest that it is possible to access the L5-S1 disc and foramen through the ilium without injuring important structures. It would be necessary to conduct a study based on an animal model and to evaluate the results before using this procedure in a clinical situation.
Authors: Said G Osman; Sandeep Sherlekar; Atif Malik; Charles Winters; P K Grewal; Malini Narayanan; Nigussie Gemechu Journal: Int J Spine Surg Date: 2014-12-01