Open AccessCan the Novel Lumbo-Iliac Triangle Technique Based on Biplane Oblique Fluoroscopy Facilitate Transforaminal Percutaneous Endoscopic Lumbar Discectomy for Patients with L5-S1 Disc Herniation Combined with High Iliac Crest? A Case-Control Study of 100 Patients
Author(s) -
Jun-Song Yang,
Kaixuan Liu,
Praveen Kadimcherla,
Lei Chu,
ZhongLiang Deng,
Yun-Kai Chan,
Peng Liu,
Tuan-Jiang Liu,
Dingjun Hao
Publication year - 2020
Publication title -
pain physician
Language(s) - English
Resource type - Journals
eISSN - 2150-1149
pISSN - 1533-3159
DOI - 10.36076/ppj.2020/23/305
Subject(s) - medicine , oswestry disability index , fluoroscopy , percutaneous , visual analogue scale , lumbar , diskectomy , iliac crest , foramen , surgery , radiology , intervertebral foramen , retrospective cohort study , low back pain , lumbar vertebrae , alternative medicine , pathology
Background: Percutaneous endoscopic lumbar discectomy (PELD) via the transforaminalapproach is difficult at L5-S1 in patients presenting with high iliac crests (HIC). The conventionalwisdom is that measurement using lumbar radiography, computed tomography (CT), or magneticresonance imaging (MRI) is necessary.Objectives: The objective of this study was to introduce a lumbo-iliac triangular (LI-Tri) techniquebased on biplane oblique fluoroscopy and verify whether it facilitated transforaminal PELD forpatients with L5-S1 lumbar disc herniation (LDH) combined with HIC.Study Design: A retrospective analysis.Setting: All data were from Honghui Hospital in Xi’an.Methods: One hundred patients with L5-S1 LDH combined with HIC were treated with PELD.The LI-Tri technique was used in the first 50 patients (applied group). The other 50 patients wereclassified as the nonapplied group, in which the conventional technique was performed. Clinicaloutcome evaluation included Oswestry Disability Index (ODI) and Visual Analog Scale (VAS) scores.The intervals of follow-up were scheduled at 1 day and 1, 3, 6, 12, and 24 months postoperatively.Results: No significant difference was observed with respect to demographic information (P <.05, respectively). There were 8 patients in the nonapplied group with difficult punctures. Togetherwith the remaining 50 patients, the puncture was successful with the LI-Tri technique. The meanoperative duration was shorter in the applied group (55 vs 70 min, P < .01). Compared to thepreoperative data, only the back pain VAS and ODI in the nonapplied group were nonsignificantlylower at one day postoperatively (P > .05, respectively). With the exception of the back pain VASand ODI at one day postoperatively, no significant differences were observed in the 3 parametersat other time points postoperatively between 2 groups (P > .05, respectively).Limitations: The study is limited by its retrospective, nonrandomized controlled design.Conclusions: For patients with L5-S1 LDH combined with HIC treated by transforaminal PELD,the LI-Tri technique is simple and effective in preoperative evaluations, locating the skin entrypoint and guiding the puncture trajectory. Compared to the conventional technique, it showsadvantages in terms of reducing intraoperative surgical duration and promoting fast postoperativerecovery.Key words: Endoscopic discectomy, iliac crest, L5-S1 disc, PELD, percutaneous, transforaminal.