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Objective: To describe a technique for treating L5S 1 disc herniation with high iliac crest to pose an alternative to overcome those routine percutaneous endoscopic lumbar discectomy (PELD) can not deal with and explore the best indication of this new surgical technique.Back ground: PELD which has more advantages than conventional surgical treatments such as minimal invasive, visualized , shorter hospital stay, earlier physical exercises and so on becomes more popular around the world.It has two surgical approaches, transforaminal and interlaminal, these two supply each other for treating almost all lumbar disc herniations, but for some type of lumbar disc herniation with high iliac crest, especial for recurrent L5S1 disc herniation after conventional surgical treatments which cannot be treated by PELD through interlaminal approach for the scar tissue around operative region, and L5S1 herniation spreaded from intraforaminal zone to the lateral or central zone of the spinal canal, which still seems a great challenge for routine PELD and usually turn to open surgery.Material and method: 12 cases with high iliac crest underwent transforaminal PELD via transiliac approach under the epidural anesthesia.The Lumbar MRI and reconstrctuion CT were done for all cases before and after operation.Pre/post-operative nerve function and pain score of lower extremity were evaluated by neurological Frankel grade and visual analogue scale(VAS).Result: Postoperatively radicular symptoms has completely relieved in all cases(male 7, female 5).VAS of lower extremity were improved from 7.2±1.3 score preoperatively, to 0.4±0.7 score on postoperative.has no neural injury complications.Lumbar MRI and reconstrctuion CT postoperatively showed that the disc herniation were removed completely.The patient was discharged the next day after operation.Conclusion: Transforaminal PELD via transiliac approach under the epidural anesthesia is an effective and safe surgical procedure and its proper indications may be for L5S1 herniation spreaded from intraforaminal zone to the lateral or central zone of the spinal canal, with high iliac crest, and for recurrent L5S1 disc herniation after conventional surgical treatments, with high iliac crest.The indication of this technique may be expanded if the skill of the establishment of iliac canal and foraminolpasty has been mastered proficiently.