Percutaneous Lumbar Interbody Fusion With an Expandable Titanium Cage Through Kambin’s Triangle: A Case Series With Initial Clinical and Radiographic Results

Abstract

Background: There has been an increased interest in lumbar interbody fusions through Kambin's triangle. In this study, we describe percutaneous access to the lumbar disc and insertion of an expandable titanium cage through Kambin's triangle without facetectomy. The objective of this study is to determine the feasibility as well as clinical and radiographical outcomes of completely percutaneous lumbar interbody fusion (percLIF) using an expandable titanium cage through Kambin's triangle.Methods: A retrospective review of patients undergoing single-level percLIF for grade 1 lumbar spondylolisthesis via Kambin's triangle using an expandable titanium cage was performed. Demographic information, Oswestry Disability Index (ODI), preoperative and postoperative radiographic factors, perioperative data, and complications were recorded. Fusion was assessed with 1-year postoperative computed tomography scan or lumbar spine x-ray and defined as bridging disc or posterolateral fusion without evidence of hardware fracture or perihardware lucency.Results: A total of 16 patients (3 males) were included in this study. Spondylolisthesis, anterior disc height, and posterior disc height were significantly improved at 6 weeks, 6 months, and 12 months, postoperatively (P < 0.05). ODI was significantly improved by 24.4% at 12 months postoperatively (P = 0.0036). One patient was readmitted within 30 days for pain control but otherwise there were no complications including permanent neurological injury, infection, deep vein thrombosis, pulmonary embolism, or cardiac events. Fifteen (93.8%) patients had radiographic fusion at their 1-year postoperative imaging.Conclusion: Our initial experiences have shown that percLIF can be performed using an expandable titanium cage through Kambin's triangle with excellent radiographic and clinical results. In this series, percLIF is a safe and clinically efficacious procedure for reducing grade 1 lumbar spondylolisthesis and improving radiculopathy. This procedure is completed percutaneously without the use of an endoscope.Clinical Relevance: This study highlights improvements in outcomes of minimally invasive surgery.

Current and Future Applications of the Kambin’s Triangle in Lumbar Spine Surgery

“…The full-endoscopic technique was able to not only perform LIF using an interbody cage but to use the endoscope to achieve decompression via facetectomy, with excellent (80%) and good (20%) outcomes in patients [42]. Shortly after, Wang et al published a case series discussing the use of percutaneous lumbar interbody fusion (percLIF) with an expandable titanium cage, the first to demonstrate the use of the percutaneous approach, which, unlike minimally invasive techniques, does not require an endoscope or facetectomy [43]. This study reported that percLIF could be used to treat grade 1 lumbar spondylolisthesis, reducing blood loss (when compared to MIS) and thus reducing the length of hospital stay (thereby reducing cost).…”

“…This study reported that percLIF could be used to treat grade 1 lumbar spondylolisthesis, reducing blood loss (when compared to MIS) and thus reducing the length of hospital stay (thereby reducing cost). Previous studies found high rates of postoperative complications when using traditional techniques to treat lumbar pathologies; however, with the use of free-running electromyography (EMG), the authors demonstrated 90% fusion one-year postoperative with minimal complications [43]. It has also been previously shown that the percLIF approach can even be used for the same procedure under awake anesthesia, reducing costs and improving patient outcomes further [44].…”

Beyond Placement of Pedicle Screws - New Applications for Robotics in Spine Surgery: A Multi-Surgeon, Single-Institution Experience

“…A procedure that has gained popularity in the care of patients with degenerative spondylolisthesis or disc disease is percLIF through Kambin’s triangle ( 11 , 12 ). Kambin’s triangle is defined as the exiting nerve root, superior endplate of the caudal vertebral body, and superior articulating process (SAP) ( 13 ).…”

Comparison of the efficacy of expandable interbody fusion cage (EXP-IFC) and non-expandable interbody fusion cage (NE-IFC) in MIS-TLIF for lumbar degenerative diseases: A systematic retrospective study on 62 patients

“…In MIS-TLIF, direct unilateral laminectomy and resection of the inferior articular process into the intervertebral space are performed to decompress the nerve roots. In the procedure, an autogenous cancellous or allogeneic bone fusion cage were placed into the intervertebral space to provide anterior column support, restore the height of intervertebral space so as to achieve the effect of nerve root canal decompression and provide mechanical stability for the lumbar spine ( 4 , 5 ).…”