1. 2004;7;323-325Mini-Surgical Approach for Spinal Endoscopy in the Presence of Stenosis of the Sacral Hiatus
   A Technical Report
   Standiford Helm II, MD, Jeffrey D. Gross, MD, and Kenneth G. Varley, MD.

Spinal endoscopy is a useful tool for the management of intractable low back or radicular pain originating from post lumbar laminectomy syndrome, epidural scarring, or disc protrusions, and non-responsive to conservative modalities and other interventional techniques including fluoroscopically directed epidural steroid injections and percutaneous adhesiolysis. Spinal endoscopy requires that the caudal canal be entered via the sacral hiatus. However, in a very small proportion of patients, access to the caudal canal is restricted because of stenosis or cartilaginous overgrowth of the hiatus. In such cases, the procedure is stopped because of the absence of an alternative approach to enter the epidural space with the spinal endoscope, resulting in non-availability of this treatment.

This report describes a novel method of dealing with the problem of cartilaginous obstruction of the sacral hiatus, using a mini-surgical approach to decompress the hiatus, allowing access into the caudal canal.

Keywords: Spinal endoscopy, adhesiolysis, epidural steroids, sacral hiatus