Anatomical considerations of the iliac crest on percutaneous endoscopic discectomy using a transforaminal approach.
Background Context: Percutaneous endoscopic discectomy is a minimally invasive procedure for the surgical treatment of lumbar disc herniation (LDH). It can be performed under local anesthesia and requires a skin incision of only 8 mm, with minimal disruption of the spinal structures including ligame...
| Publicado en: | Spine Journal Vol. 17; no. 12; pp. 1875 - 1881 |
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| Autores principales: | , , , , , , , , |
| Formato: | research Journal Article |
| Publicado: |
Elsevier B.V.
Dec2017
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=126911196&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 126911196 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 15299430 KJX jtl: Spine Journal issn: 15299430 maglogo: N pubinfo: dt: Dec2017 vid: 17 iid: 12 pid: 467 pub: Elsevier B.V. place: New York, New York artinfo: ui: 126911196 126911196 NLM28645675 126911196 10.1016/j.spinee.2017.06.012 NLM28645675 126911196 ppf: 1875 ppct: 6 formats: tig: atl: Anatomical considerations of the iliac crest on percutaneous endoscopic discectomy using a transforaminal approach. aug: au: Tezuka, Fumitake Sakai, Toshinori Abe, Mitsunobu Yamashita, Kazuta Takata, Yoichiro Higashino, Kosaku Chikawa, Takashi Nagamachi, Akihiro Sairyo, Koichi affil: Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15 Kuramoto, Tokushima 770-8503, Japan sug: subj: Intervertebral Disk Displacement Surgery Spinal Diseases Surgery Endoscopy Methods Diskectomy Methods Ilium Intervertebral Disk Displacement Spinal Diseases Middle Age Male Adult Tomography, X-Ray Computed Female Back Surgery Aged Aged, 80 and Over Adolescence Postoperative Complications Epidemiology Back Ilium Surgery Human Middle Aged: 45-64 years Adult: 19-44 years Aged: 65+ years Aged, 80 & over Adolescent: 13-18 years Male Female ab: Background Context: Percutaneous endoscopic discectomy is a minimally invasive procedure for the surgical treatment of lumbar disc herniation (LDH). It can be performed under local anesthesia and requires a skin incision of only 8 mm, with minimal disruption of the spinal structures including ligaments and muscles. However, performing percutaneous endoscopic discectomy with a transforaminal approach (TF-PED) for the lower lumbar spine is associated with some anatomical problems, such as interference from the iliac crest. This study sought to assess the operability of TF-PED for the lower lumbar spine.Purpose: The purpose of this study was to assess a three-dimensional relationship between the trajectory of TF-PED and the iliac crest, and the operability of TF-PED at the lower lumbar disc levels (L4-L5 and L5-S1) using CT images.Study Design: This is a retrospective study using 323 multiplanar abdominal computed tomography (CT) scans.Patient Sample: We retrospectively reviewed contrast-enhanced multiplanar abdominal CT scans of 323 consecutive patients (203 male and 120 female) in our hospital from April 2009 to March 2013. The mean age was 66.5 (range 15-89) years old.Outcome Measures: The operability of the TF-PED was the outcome measure.Materials and Methods: We defined the tangent line in the iliac crest and the superior articular process of the caudal spine as the trajectory line of TF-PED, and evaluated the maximum inclination angle of the trajectory of the TF-PED (α angle) at the L4-L5 and the L5-S1 disc levels. Assuming the use of an oblique viewing endoscope at 25°, we defined α angle≥65° as the operability of TF-PED.Results: (1) Relationship between iliac crest and disc level: The trajectory of the TF-PED interfered with the iliac crest at L4-L5 in 40.2% (right) and 54.5% (left) of the subjects, and at L5-S1 in 99.7% and 100% of the subjects. (2) The maximum inclination angle of the trajectory of TF-PED: the α angles were 84.3° and 82.3° at the L4-L5, and 56.8° and 55.2° at L5-S1. (3) Laterality of the α angle: At both disc levels, the mean age of the subjects with a laterality of ≥10° was significantly higher than that of subjects with a laterality of <10°. (4) Operability of TF-PED: At L4-L5, TF-PED could be performed in 94.4% and 90.4% of the subjects. In contrast, at L5-S1 the procedure could be performed in 24.1% and 19.2% of the subjects (male: 15.8% and 10.8%, female: 38.3% and 33.3%).Conclusions: From the results of this study, the trajectory of TF-PED can be limited by the surrounding anatomical structures. The maximum inclination angle indicated that treatment for the central type of LDH at the L5-S1 disc level was considered more difficult than that at the L4-L5 disc level because of the iliac crest. In the clinical setting, such anatomical particularities can be overcome by using a more perpendicular approach (hand-down technique) with the possible addition of a foraminoplasty. Moreover, we found that we must consider the laterality of the trajectory of TF-PED in terms of the patients' age or sex. pubtype: Academic Journal doctype: research Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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