title: Endoscopic trans-iliac approach to L5-S1 disc and foramen - a report on clinical experience.
abstract: BACKGROUND
  The lumbosacral junction is a difficult area for spine surgery because of the 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 percutaneous posterolateral endoscopic approaches. A trans-iliac cadaver study published by the senior author and co-workers in 1997, suggested the possibility of an alternative approach to the lumbosacral junction.
  
  
  OBJECTIVE
  To determine the feasibility of percutaneous, endoscopic trans-iliac approach to the L5-S1 disc and foramen.
  
  
  METHODS
  Prospective case series study.
  
  
  METHODS
  15 consecutive patients undergoing the transiliac approach to L5-S1 disc and foramen were included in the study. Pre- and postoperative visual analogue scale (VAS); Oswestry Disability Index (ODI); and intra-operative blood loss and operative time, were obtained for the study. Preoperative MRI or CT scan was used to determine the need for trans-iliac access. The procedure was performed with the patient in prone position and under monitored sedation for decompression. Endotracheal anesthesia was used for fusion cases. The transiliac access was established with a cannulated drill or core drill through the iliac wing. Once the trans-iliac window had been created, the rest of the procedure proceeded as for percutaneous endoscopic transforaminal decompression and fusion.
  
  
  RESULTS
  15 patients (9 male and 6 female) participated in the study. The VAS for back and leg pain significantly improved in all patients. The ODI dropped by more than 50%. There was minimal blood loss, and transient post-operative dysesthesia in 2 cases which resolved after 3 weeks.
  
  
  CONCLUSIONS
  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.
authors.affiliation: American Spine, Germantown, MD.
authors.forename: Said G
authors.initials: SG
authors.lastname: Osman
authors.affiliation: American Spine, Germantown, MD.
authors.forename: Sandeep
authors.initials: S
authors.lastname: Sherlekar
authors.affiliation: American Spine, Germantown, MD.
authors.forename: Atif
authors.initials: A
authors.lastname: Malik
authors.affiliation: American Spine, Germantown, MD.
authors.forename: Charles
authors.initials: C
authors.lastname: Winters
authors.affiliation: American Spine, Germantown, MD.
authors.forename: P K
authors.initials: PK
authors.lastname: Grewal
authors.affiliation: American Spine, Germantown, MD.
authors.forename: Malini
authors.initials: M
authors.lastname: Narayanan
authors.affiliation: American Spine, Germantown, MD.
authors.forename: Nigussie
authors.initials: N
authors.lastname: Gemechu
keywords: Endoscopic; Iliac crest; Percutaneous; trans-foraminal; trans-iliac