• Jun-Song Yang, Kai-Xuan Liu, Praveen Kadimcherla, Lei Chu, Zhong-Liang Deng, Yun-Kai Chan, Peng Liu, Tuan-Jiang Liu, and Ding-Jun Hao.
• Department of Spinal Surgery Hong-Hui Hospital Xi'an Jiaotong University.
• Pain Physician. 2020 Jun 1; 23 (3): 305-314.

BackgroundPercutaneous endoscopic lumbar discectomy (PELD) via the transforaminal approach is difficult at L5-S1 in patients presenting with high iliac crests (HIC). The conventional wisdom is that measurement using lumbar radiography, computed tomography (CT), or magnetic resonance imaging (MRI) is necessary.ObjectivesThe objective of this study was to introduce a lumbo-iliac triangular (LI-Tri) technique based on biplane oblique fluoroscopy and verify whether it facilitated transforaminal PELD for patients with L5-S1 lumbar disc herniation (LDH) combined with HIC.Study DesignA retrospective analysis.SettingAll data were from Honghui Hospital in Xi'an.MethodsOne 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 were classified as the nonapplied group, in which the conventional technique was performed. Clinical outcome 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.ResultsNo significant difference was observed with respect to demographic information (P < .05, respectively). There were 8 patients in the nonapplied group with difficult punctures. Together with the remaining 50 patients, the puncture was successful with the LI-Tri technique. The mean operative duration was shorter in the applied group (55 vs 70 min, P < .01). Compared to the preoperative data, only the back pain VAS and ODI in the nonapplied group were nonsignificantly lower at one day postoperatively (P > .05, respectively). With the exception of the back pain VAS and ODI at one day postoperatively, no significant differences were observed in the 3 parameters at other time points postoperatively between 2 groups (P > .05, respectively).LimitationsThe study is limited by its retrospective, nonrandomized controlled design.ConclusionsFor 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 entry point and guiding the puncture trajectory. Compared to the conventional technique, it shows advantages in terms of reducing intraoperative surgical duration and promoting fast postoperative recovery.Key WordsEndoscopic discectomy, iliac crest, L5-S1 disc, PELD, percutaneous, transforaminal.

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