Percutaneous Endoscopic Lumbar Discectomy via Sacral Ala-Transverse Process Approach for the Treatment of Far-Lateral Disc Herniation at L5/S1: A Technical Note and Case Series.

Abstract

Far lateral L5/S1 disc herniations are challenging due to the high iliac crest and enlarged L5 transverse process blocking the transforaminal corridor. This study introduces a percutaneous endoscopic discectomy via the sacral ala-transverse process approach to overcome these challenges while preserving spinal stability. Patients with far-lateral L5/S1 disc herniations underwent percutaneous endoscopic discectomy through the sacral ala-transverse process approach under fluoroscopic guidance. Key steps included targeting the sacral ala-transverse process approach with minimal resection of bone to access the extraforaminal fragment, followed by endoscopic removal of the herniation. Pain and disability were evaluated using the visual analog scale and Oswestry Disability Index preoperatively and postoperatively. Operative time and complications were also recorded. All procedures were completed successfully. Patients achieved significant improvement: mean leg visual analog scale decreased from 7.8 to 2.2, and mean Oswestry Disability Index dropped from 52.8 to 16.9. The average operative time was 64.33 ± 3.96 minutes. No major complications occurred, with no neurological deficits. The sacral ala-transverse process approach enabled effective decompression of far-lateral L5/S1 disc herniations, addressing the anatomical constraints of this level. The technique provided excellent pain relief and functional recovery, offering a safe, effective alternative to traditional open surgery at L5/S1.