Percutaneous endoscopic lumbar discectomy by transiliac approach: a case report.

Spine. 2009 May 20; 34(12): E443-6Choi G, Kim JS, Lokhande P, Lee SHSTUDY DESIGN: Case report. OBJECTIVE: The authors report a new percutaneous endoscopic lumbar discectomy (PELD) technique for the treatment of lumbar disc herniation with a high iliac crest via a transiliac approach. SUMMARY OF BACKGROUND DATA: When the iliac crest is high, the L4-L5 and L5-S1 disc spaces are located deep in the pelvis, so they are not easily accessible via a suprailiac route. METHODS: A 51-year-old man manifested left gluteal and leg pain due to an up-migrated soft disc herniation at the L4-L5 level. Transforaminal PELD via a transiliac approach was performed to remove the herniated fragment, achieving complete decompression of the nerve root. RESULTS: The symptom was relieved and the patient was discharged the next day. CONCLUSION: When a conventional transforaminal PELD is impossible due to the presence of a high iliac crest, PELD via a transiliac route could be a alternative option in selected cases.