Endoscopic transiliac approach to L5-S1 disc and foramen. A cadaver study.

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.