8.5. Specific Features of the Right-Sided L5–S1 Approach
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At L5–S1, the approach has specific features determined by the anatomy. The iliac crest limits lateral displacement from the lateral pedicle line and instrument movement. We therefore plan the incisions correctly from the outset and create the endoscopic and working portals.
We plan the endoscopic portal incision over the edge of the slope of the iliac crest, at the level of the distal border of the transverse process. We move 20–25 mm cranial from the center of the planned endoscopic portal and mark the working portal incision. The instrument meeting point is the junction of the lateral mass of the sacrum and the S1 superior articular process.
References
1. Kim JE, Choi DJ. Unilateral biportal endoscopic spinal surgery using a 30° arthroscope for L5-S1 foraminal decompression. Clin Orthop Surg. 2018;10(4):508–512. doi:10.4055/cios.2018.10.4.508.
2. Choi DJ, Kim JE, Jung JT, et al. Biportal endoscopic spine surgery for various foraminal lesions at the lumbosacral lesion. Asian Spine J. 2018;12(3):569–573. doi:10.4184/asj.2018.12.3.569.
3. Ahn JS, Lee HJ, Choi DJ, Lee KY, Hwang SJ. Extraforaminal approach of biportal endoscopic spinal surgery: a new endoscopic technique for transforaminal decompression and discectomy. J Neurosurg Spine. 2018;28(5):492–498. doi:10.3171/2017.8.SPINE17771.
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