Journal of Shandong University (Health Sciences) ›› 2024, Vol. 62 ›› Issue (2): 75-82.doi: 10.6040/j.issn.1671-7554.0.2023.1079

• Clinical Medicine • Previous Articles    

Impact of iliac crest on the placement of L5-S1 transforaminal endoscopic surgical channel based on three-dimensional CT reconstruction

WANG Jinjin1,2, LIU Xiaoyang2, GE Zhongpeng2, CUI Xingang1,2   

  1. 1. Cheeloo College of Medicine, Shandong University, Jinan 250012, Shandong, China;
    2. Department of Spine Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, Shandong, China
  • Published:2024-03-29

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Abstract: Objective To analyze the impact of iliac crest on the feasibility of puncture placement of surgical channels. Methods The imaging data of 75 patients who underwent lumbar spine CT and lumbar spine DR examination at Shandong Provincial Hospital during Jan. 1, 2022 and Dec. 31, 2022 were retrospectively analyzed. Mimics 21.0 software was used to perform three-dimensional reconstruction of CT images and simulate surgical channel placement to evaluate the feasibility of channel placement in percutaneous endoscopic transforaminal lumbar discectomy(PETD)in patients’ L5-S1 segment. Based on the results, the patients were divided into two groups. In the implantable group, the channel could be placed; in the non-implantable group, the channel could not be placed. The relative height classification of the iliac crest, height of the iliac crest, inclination angle of the iliac crest, inclination angle of the articular process, distance from the highest point of the iliac crest to the midline, and the cohesion angle of the iliac crest were compared between the two groups to analyze the effects of iliac crest on the channel placement of the L5-S1 segment. Results The measurement results showed that height of the iliac crest, inclination angle of the iliac crest, and the cohesion angle of the iliac crest were significantly lower in the implantable group than in the non-implantable group ［23.65(29.33-18.50)vs 38.20(39.80-34.40), P<0.001; 20.20(24.30-16.08)vs 29.15(31.98-26.65), P<0.001; 45.35(48.03-40.70)vs 47.75(49.98-45.33), P=0.003］. As the height of the iliac crest increased, the success rate of channel placement decreased. The success rate of channel establishment of high iliac crest(the relative height of the iliac crest was grade 2)was only 10%. When height of the iliac crest was higher than 31.95 mm, inclination angle of the iliac crest was greater than 24.35°, and the cohesion angle of the iliac crest was greater than 47.2°, the channel placement was prone to failure. Conclusion The iliac crest has a significant impact on the feasibility of the L5-S1 PETD surgical channel placement. Patients with higher and steeper iliac crest(greater iliac crest inclination angle and cohesion angle)are less likely to have the channel successfully placed. Patients with “high iliac crest”(iliac crest above the lower edge of the L4 pedicle)are often difficult to place the channel.

Key words: CT, Three-dimensional reconstruction, Iliac crest, L5-S1, Intervertebral foramen endoscope

CLC Number: 

  • R681.5
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