A Novel Approach to Percutaneous Lumbar Surgeries via Kambin's Triangle - A Radiographic and Surgical Planning Analysis with Nerve Segmentation Technology.

Abstract

Objective

While Kambin's triangle has become an ever more important anatomic window given its proximity to the exiting nerve root, there have been limited studies examining the effect of disease on the corridor. Our goal was to better understand how pathology can affect Kambin's triangle thereby altering laterality of approach for percutaneous lumbar interbody fusion (percLIF).

Methods

The authors performed a single-center retrospective review of patients evaluated for percLIF. The areas of Kambin's triangle were measured without and with nerve segmentation. For the latter, the lumbosacral nerve roots on 3D T2 MRI were manually segmented. Next, the borders of Kambin's triangle were delineated ensuring no overlap between the area and the nerve above.

Results

15 patients (67.5 ± 9.7 years, 46.7% female) were retrospectively reviewed. 150 Kambin's triangles were measured. The mean areas from L1-S1 were 50.0 ± 12.3 mm2, 73.8 ± 12.5 mm2, 83.8 ± 12.2 mm2, 88.5 ± 19.0 mm2, and 116 ± 29.3 mm2, respectively. When pathology was present, the areas significantly decreased at L4-L5 (p = 0.046) and L5-S1 (p = 0.049). Higher spondylolisthesis and smaller posterior disc heights were linked with decreased areas via linear regression analysis (p < 0.05). When nerve segmentation was used, the areas were significantly smaller from L1-L5 (p < 0.05). Among 11 patients who underwent surgery, none suffered from postoperative neuropathies.

Conclusion

These results illustrate the feasibility of pre-operatively segmenting lumbosacral nerves and measuring Kambin's triangle to help guide surgical planning and determine the ideal laterality of approach for percLIF.

Department

Description

Provenance

Subjects

3D imaging segmentation, Exiting nerve root, Kambin’s triangle, MRI/CT fusion, disc space height, dorsal root ganglion, lumbar interbody fusion, minimally invasive, percutaneous, spondylolisthesis

Citation

Published Version (Please cite this version)

10.1016/j.wneu.2023.06.061

Publication Info

Tabarestani, Troy Q, David AW Sykes, Romaric W Kouam, David S Salven, Timothy Y Wang, Vikram A Mehta, Christopher I Shaffrey, Walter F Wiggins, et al. (2023). A Novel Approach to Percutaneous Lumbar Surgeries via Kambin's Triangle - A Radiographic and Surgical Planning Analysis with Nerve Segmentation Technology. World neurosurgery. p. S1878-8750(23)00830-6. 10.1016/j.wneu.2023.06.061 Retrieved from https://hdl.handle.net/10161/28322.

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