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Research ArticleFull Length Article
Open Access

Description of a transosseous approach to the L5-S1 disc and 2 clinical case reports

Michael MacMillan, John McCormick and James W. Rice
International Journal of Spine Surgery January 2012, 6 178-183; DOI: https://doi.org/10.1016/j.ijsp.2012.06.001
Michael MacMillan
Department of Orthopaedics, University of Florida, Gainesville, FL
MD
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  • For correspondence: macmim@ortho.ufl.edu
John McCormick
Department of Orthopaedics, University of Florida, Gainesville, FL
MD
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James W. Rice
Department of Orthopaedics, University of Florida, Gainesville, FL
MD
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  • Article
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Article Figures & Data

Figures

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  • Fig. 1
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    Fig. 1

    Axial view of transosseous pathway.

  • Fig. 2
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    Fig. 2

    Dorsal view of transosseous pathway.

  • Fig. 3
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    Fig. 3

    CT scan visualizing transosseous tunnel at level of isthmus and disc space.

  • Fig. 4
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    Fig. 4

    The specimen has been sectioned perpendicular to the transosseous tunnel (arrow), indicating that the tunnel is within bone within its entirety. The S1 endplate is visualized (oval), and the tunnel can be seen posterior to the sacroiliac joint (asterisk).

  • Fig. 5
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    Fig. 5

    CT scan, sagittal view, of patient presenting with dislodged interbody spacer and infection.

  • Fig. 6
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    Fig. 6

    Lateral X-ray showing infected hardware removed, clearance of infection, reinstrumentation, and fusion of spine.

  • Fig. 7
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    Fig. 7

    Sagittal CT myelogram showing post-laminectomy spine.

  • Fig. 8
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    Fig. 8

    StealthStation navigation image with curette in L5-S1 disc.

  • Fig. 9
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    Fig. 9

    Lateral postoperative radiograph.

  • Fig. 10
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    Fig. 10

    Postoperative axial CT image of interbody device position.

Tables

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    Table 1

    Measures of canal length and intervertebral disc space

    Canal length (mm)Axial width of isthmus (mm)Coronal width of isthmus (mm)Sagittal width of isthmus (mm)
    Pelvis 1
     Right70212722
     Left75202721
    Pelvis 2
     Right68182626
     Left68192619
    Pelvis 3
     Right68182521
     Left67172419
    • NOTE. Each isthmus was the narrowest point of the pathway and an indication of maximal pathway size.

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    Table 2

    Angles required to obtain transosseous canal from iliac crest to intervertebral disc space

    Axial angle (°)Coronal angle (°)
    Pelvis 1
     Right4525
     Left4525
    Pelvis 2
     Right4325
     Left4523
    Pelvis 3
     Right4322
     Left4325
    • View popup
    Table 3

    Dimensions of first sacral superior vertebral endplate and angle between L5 and S1

    S1 endplate dimensions (mm)L5-S1 endplate angle (°)
    Pelvis 115
     AP68
     Lateral45
    Pelvis 210
     AP56
     Lateral31
    Pelvis 318
     AP60
     Lateral39
    • Abbreviation: AP, anteroposterior.

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International Journal of Spine Surgery
Vol. 6
1 Jan 2012
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Description of a transosseous approach to the L5-S1 disc and 2 clinical case reports
Michael MacMillan, John McCormick, James W. Rice
International Journal of Spine Surgery Jan 2012, 6 178-183; DOI: 10.1016/j.ijsp.2012.06.001

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Description of a transosseous approach to the L5-S1 disc and 2 clinical case reports
Michael MacMillan, John McCormick, James W. Rice
International Journal of Spine Surgery Jan 2012, 6 178-183; DOI: 10.1016/j.ijsp.2012.06.001
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Keywords

  • spine
  • Lumbosacral fusion
  • L5-S1
  • Sacral ala
  • minimally invasive surgery

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