Two-Year Clinical and Radiographic Outcomes for Percutaneous Lumbar Interbody Fusion With an Expandable Titanium Cage Through Kambin's Triangle Without Facetectomy.



There has been heightened interest in performing percutaneous lumbar interbody fusions (percLIFs) through Kambin's triangle, an anatomic corridor allowing entrance into the disc space. However, due to its novelty, there are limited data regarding the long-term benefits of this procedure. Our objective was to determine the long-term efficacy and durability of the percutaneous insertion of an expandable titanium cage through Kambin's triangle without facetectomy.


A retrospective review of patients undergoing percLIF via Kambin's triangle using an expandable titanium cage was performed. Demographics, visual analog scale (VAS) scores, Oswestry Disability Index (ODI), radiographic measurements, perioperative variables, and complications were recorded. VAS, ODI, and radiographic measurements were compared with baseline using the generalized estimating equations assuming normally distributed data. Fusion was assessed with computed tomography (CT) at 1 and 2 years after the procedure.


A total of 49 patients were included. Spondylolisthesis, lumbar lordosis (LL), sacral slope, pelvic tilt, and anterior/posterior disc space height were all significantly improved postoperatively at each time point of 3, 6, 12, and 24 months (P < 0.001). Pelvic incidence-LL mismatch decreased significantly at each follow-up (P < 0.001) with a mean reduction of 4° by 24 months. VAS back scores reduced by >2 points at the 6, 12, and 24 month follow-ups. ODI scores reduced by >15 points at the 12- and 24-month follow-ups. Of the patients who had 1- and 2-year CT images, fusion rates at those time points were 94.4% (17/18) and 87.5% (7/8), respectively. The mean annual rate of surgically significant adjacent segment disease was 2.74% through an average follow-up of 2.74 years.


These results highlight that percLIF, a procedure done without an endoscope or facetectomy, can be performed using an expandable titanium cage through Kambin's triangle with excellent radiographic and clinical results.

Clinical relevance

percLIF via Kambin's triangle is a safe and succesful procedure with long-term improvements in both clinical and radiographic outcomes.

Level of evidence: 3





Published Version (Please cite this version)


Publication Info

Tabarestani, Troy Q, Timothy Y Wang, David AW Sykes, Vikram A Mehta, Lexie Z Yang, Shein-Chung Chow, Christopher I Shaffrey, Walter F Wiggins, et al. (2023). Two-Year Clinical and Radiographic Outcomes for Percutaneous Lumbar Interbody Fusion With an Expandable Titanium Cage Through Kambin's Triangle Without Facetectomy. International journal of spine surgery, 17(6). pp. 760–770. 10.14444/8540 Retrieved from

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Lexie Zidanyue Yang

Biostatistician II

Education: Masters Degree, Biostatistics.  Duke University School of Medicine. 2018

Overview: Lexie graduated from the master’s program in biostatistics at Duke in 2018. Over the past five years, she has collaborated with doctors, residents, fellows, and medical students in the Department of Neurosurgery and Pharmacy. Additionally, she is currently working with a faculty member in Surgery to investigate the impact of environmental factors on certain diseases. Lexie has extensive experience in data management with large databases, including MarketScan, HCUP, and CMS Medicare. She has also worked with EHR data and has experience with data extraction from DEDUCE and CRDM. Her statistical interests include longitudinal analysis, mediation analysis, survival analysis and latent class analysis.

Educational Background
Master of Biostatistics
Duke University (Durham, NC, USA) 2016-2018

Bachelor of Science
Mathematics, Statistics
University of Wisconsin-Madison (Madison, WI, USA) 2013-2016
Shandong University (Shandong, China) 2011-2013


Shein-Chung Chow

Professor of Biostatistics & Bioinformatics

My research interest includes statistical methodology development and application in the area of biopharmaceutical/clinical statistics such as bioavailability and bioequivalence, clinical trials, bridging studies, medical devices, and translational research/medicine. Most recently, I am interested in statistical methodology development for the use of adaptive design methods in clinical trials and methodology development for assessment of biosimilarity of follow-on biologics. In addition, I am also interested in methodology development for statistical evaluation of traditional Chinese medicine (TCM) clinical trials.


Walter Wiggins

Adjunct Assistant Professor in the Department of Radiology

Muhammad Abd-El-Barr

Associate Professor of Neurosurgery

As a Neurosurgeon with fellowship training in Spine Surgery, I have dedicated my professional life to treating patients with spine disorders. These include spinal stenosis, spondylolisthesis, scoliosis, herniated discs and spine tumors. I incorporate minimally-invasive spine (MIS) techniques whenever appropriate to minimize pain and length of stay, yet not compromise on achieving the goals of surgery, which is ultimately to get you back to the quality of life you once enjoyed. I was drawn to medicine and neurosurgery for the unique ability to incorporate the latest in technology and neuroscience to making patients better. I will treat you and your loved ones with the same kind of care I would want my loved ones to be treated with. In addition to my clinical practice, I will be working with Duke Bioengineers and Neurobiologists on important basic and translational questions surrounding spinal cord injuries (SCI), which we hope to bring to clinical relevance.

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