In Response to Re: Choi KC, Park CK. Percutaneous Endoscopic Lumbar Discectomy

摘要

We read with interest the article ‘‘Percutaneous Endoscopic Lumbar Discectomy for L5-S1 Disc Herniation:Consideration of the Relation between the Iliac Crestand L5-S1 Disc’ by Choi and Park (1). The authors firstproposed a grading system for high iliac crest based onthe relationship between the highest point of the iliaccrest and the adjacent bony markers. They considered asuprailiac or transiliac approach provided direct visualization of the extruded disc. However, the suprailiac approach is not above the highest point of the iliac crest.Actually, the posterosuperior margin of the iliac crest,lower than the top of the iliac crest, is the real positionwhere puncture needle and working cannula contactto the ilium (Figure). The grading system indirectly reflects the relationship between the ilium and punctureneedle, that explained why the puncture is available inthe patient with the relative high iliac crest (grade ≥ 5)in clinical practice.