Kambin’s Triangle Approach versus Traditional Safe Triangle Approach for Percutaneous Transforaminal Epidural Adhesiolysis Using an Inflatable Balloon Catheter: A Pilot Study

Abstract

Spinal stenosis is a common condition in elderly individuals. Many patients are unresponsive to the conventional treatment. If the transforaminal epidural block does not exert a sufficient treatment effect, percutaneous transforaminal epidural adhesiolysis (PTFA) through the safe-triangle approach using an inflatable balloon catheter can reduce the patients’ pain and improve their functional capacity. We aimed to evaluate the safety and efficacy of the Kambin’s-triangle approach for PTFA using an inflatable balloon catheter and compare this approach to the traditional safe-triangle approach. Thirty patients with chronic unilateral L5 radiculopathy were divided into two groups: the safe-triangle-approach and Kambin’s-triangle-approach groups, with 15 patients each. The success rate of the procedure was assessed. Pain and dysfunction were assessed using the Numerical Rating Scale and Oswestry Disability Index, respectively, before the procedure and at 1 and 3 months after the procedure. The success rate of the procedure was high in both the groups, with no significant difference between the groups. The Numerical Rating Scale and Oswestry Disability Index scores significantly decreased 3 months after the procedure in both the groups, with no significant difference between the groups. For patients in whom the safe-triangle approach for PTFA is difficult, the Kambin’s-triangle approach could be an alternative.

A comparative evaluation of kambin’s triangle approach versus safe triangle approach for lumbar transforaminal epidural injection in patients with lumbar radiculopathy - A prospective, randomized, double blind study

“…31 Gil HY et al, showed that kambin's triangle approach can be beneficial in patients where entry through safe triangle is difficult. 32 In our study, there was a single case of spinal nerve root pricking in the subpedicular approach whereas no pricking was reported in the Kambin's triangle approach but this difference was not statistically significant.…”

Efficacy of Two Approaches of Transforaminal Epidural Injections in Patients of Lumbar Radiculopathy

“…The sample size was calculated from a previous published study using WHO sample size calculator with power of study 80% and level of significance 5% (considering fall in NRS from 5.3 ± 1.89 to 4.0 ± 2.58) 10 , which came out to be 80.…”

Interventional non-operative management of low back and neck pain

“…The conventional target lies immediately below the 6 o'clock portion of the pedicle (Dog's eye), within the so-called safe triangle [59]. An alternative window for injection is the Kambin's triangle which adopts a lower location of injection within the intervertebral foramen and proved to be equivalent to the traditional safe triangle in efficacy [60]. Owing to its lower location within the neural foramen, it may be preferable to use Kambin's triangle for thoracolumbar injections to avoid injuring the artery of Adamkiewicz which almost invariably course within the upper and middle portions of the neural foramen, the injury of which can result in rare but devastating complications like paraplegia [61] (Fig.…”