• World Neurosurg · Jul 2023

    Transforaminal endoscopic access to L5S1: Imaging characterization of the lower lumbar spine and pelvis for surgical planning.

    • José Miguel Sousa, António Serrano, Afonso Nave, Vasco Mascarenhas, Paulo Nogueira, Joao Gamelas, and José Guimarães Consciência.
    • CHRC, NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade NOVA de Lisboa, Lisboa, Portugal; Centro Hospitalar Lisboa Ocidental, Orthopaedics Department, Lisbon, Portugal. Electronic address: josemiguelsousa.spine@gmail.com.
    • World Neurosurg. 2023 Jul 1; 175: e809e817e809-e817.

    ObjectiveTo determine and compare pelvic and lumbosacral reference parameters with computed tomography in patients with low back pain (LBP) and a control group of asymptomatic patients to provide quantification data and morphological correlations for L5S1 transforaminal endoscopic approach (L5S1TEA).MethodsWe prospectively evaluated 100 patients with LBP and a control group of 100 individuals, with spinopelvic computed tomography. We measured lumbopelvic and L5S1 transforaminal approach parameters: maximum approach angle (maxAA) and minimum approach angle (minAA) and skin incision (maxSI and minSI), iliac crest (IC) projection at intersection point (ICPi), distance between the projected intersection of maxAA with the ilium (ICi) and the posterior limit of the IC (ΔICi-ICpost), and distance between ICi and spinous process (ΔICi-SP).ResultsFemales and ICPi were increased in the LBP group: maxAA: 48.38° ± 5.09°; minAA:32.5° ± 3.90°; maxSI: 11.39 ± 1.86 cm; and minSI: 8.30 ± 1.48 cm. Ilium intersection was increased in males; IC projection at the highest point (ICPh) was higher than ICPi; maxAA intersected the ilium in 28% and minAA in 1.5% of cases; ICi was positively correlated with facet angle, ICPh, and ICPi and negatively with ΔICi-SP.ConclusionsOur results set preliminary reference values for L5S1TEA surgical planning. Besides higher ICPi, there were no differences between groups in measured parameters. Traditional IC height (ICPh) does not correspond to the point of intersection of the approach and is significantly higher than ICPi. ICi correlated to higher facet angle values, ICPh and ICPi grades, and lower ΔICi-SP. Potential conflict with the ilium is increased in the male population. IC is not impeditive of L5S1TEA in most cases.Copyright © 2023 The Author(s). Published by Elsevier Inc. All rights reserved.

      Pubmed     Copy Citation     Plaintext  

      Add institutional full text...

    Notes

     
    Knowledge, pearl, summary or comment to share?
    300 characters remaining
    help        
    You can also include formatting, links, images and footnotes in your notes
    • Simple formatting can be added to notes, such as *italics*, _underline_ or **bold**.
    • Superscript can be denoted by <sup>text</sup> and subscript <sub>text</sub>.
    • Numbered or bulleted lists can be created using either numbered lines 1. 2. 3., hyphens - or asterisks *.
    • Links can be included with: [my link to pubmed](http://pubmed.com)
    • Images can be included with: ![alt text](https://bestmedicaljournal.com/study_graph.jpg "Image Title Text")
    • For footnotes use [^1](This is a footnote.) inline.
    • Or use an inline reference [^1] to refer to a longer footnote elseweher in the document [^1]: This is a long footnote..

    hide…