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J Neurol Surg A Cent Eur Neurosurg 2022; 83(04): 308-313
DOI: 10.1055/s-0041-1730970
Original Article

Full-Endoscopic Trans-Kambin Triangle Lumbar Interbody Fusion: Surgical Technique and Nomenclature

Yoshihiro Ishihama
1   Department of Orthopedics, Tokushima University Hospital, Tokushima, Japan
,
Masatoshi Morimoto
2   Department of Orthopedics, Tokushima University Graduate School, Tokushima, Japan
,
Fumitake Tezuka
2   Department of Orthopedics, Tokushima University Graduate School, Tokushima, Japan
,
Kazuta Yamashita
2   Department of Orthopedics, Tokushima University Graduate School, Tokushima, Japan
,
Hiroaki Manabe
2   Department of Orthopedics, Tokushima University Graduate School, Tokushima, Japan
,
Kosuke Sugiura 
3   Department of Orthopedics, University of Tokushima Graduate School of Biomedical Sciences, Tokushima, Japan
,
Makoto Takeuchi
2   Department of Orthopedics, Tokushima University Graduate School, Tokushima, Japan
,
Yoichiro Takata
1   Department of Orthopedics, Tokushima University Hospital, Tokushima, Japan
,
Toshinori Sakai
2   Department of Orthopedics, Tokushima University Graduate School, Tokushima, Japan
,
Toru Maeda
3   Department of Orthopedics, University of Tokushima Graduate School of Biomedical Sciences, Tokushima, Japan
,
Akihiro Nagamachi
1   Department of Orthopedics, Tokushima University Hospital, Tokushima, Japan
,
Koichi Sairyo
2   Department of Orthopedics, Tokushima University Graduate School, Tokushima, Japan
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Abstract

Background Full-endoscopic lumbar surgery is used for decompression of lumbar spinal canal stenosis. Now, a cage can be inserted through Kambin's triangle for lumbar interbody fusion (LIF). We have been performing full-endoscopic trans-Kambin triangle LIF (KLIF) at our institution since 2018. In this article, we describe this technique and present our results.

Methods We performed full-endoscopic one-level KLIF in 10 patients. The procedure is as follows. First, percutaneous pedicle screws are inserted. Listhesis is reduced if necessary. The endoscope is inserted in Kambin's triangle. Next, the superior articular process is partially removed, enlarging Kambin's triangle to allow safe insertion of the cage. A cannula is inserted into the disk to avoid damaging the exiting nerve. The disk material is shaved and curetted. Finally, the harvested bone is packed in a cage and inserted into the disk space. We analyze the complications, visual analog scores (VAS), and MacNab's criteria.

Results One patient had an irritation in the exiting nerve at L4–L5. The VAS for back pain and leg pain decreased from 69 to 9 and from 60 to 9, respectively. The clinical outcome was considered excellent in eight and good in two patients.

Conclusions Kambin's triangle lies immediately behind the psoas major. Therefore, we consider KLIF as a lateral LIF procedure comparable with oblique or extreme LIF. However, unlike oblique or extreme LIF, there are no major vessels and organs in the surgical field; therefore, KLIF is the safest type of lateral LIF. Furthermore, using the endoscope, we can perform decompression directly using the facetectomy technique.

Keywords

full endoscopy - lumbar intervertebral fusion - kambin's triangle - KLIF


Publication History

Received: 01 August 2020

Accepted: 16 December 2020

Article published online:
22 November 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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