Study Design: Surgical technique presentation. Objectives: To introduce a novel full-percutaneous trans-Kambin transforaminal lumbar interbody fusion (pTLIF) procedure for placing a large-footprint interbody cage with manual reamers and optional endoscopic foraminoplasty. Background: Currently, full-endoscopic/percutaneous trans-Kambin TLIF procedures present with limitations that comprise the requirement to use endoscopic visualization during foraminoplasty; a small footprint and expensive endoscopic interbody cage; and a low surgical time-efficiency due to small and fragile disk preparation instruments. We propose a newly developed trans-Kambin approach system and instrumentation that should allow overcoming these limitations. Methods: A 73-year-old female presents with persistent low-back pain, bilateral radiating pain, and neurogenic claudication. Preoperative imaging of the lumbar spine shows a spondylolisthesis at L4/L5 and degenerative disks at L3/L4 and L5/S1 with a vacuum sign and severe foraminal and central canal stenosis. Full-endoscopic/percutaneous trans-Kambin TLIF was performed at L5/S1 with a large-footprint expandable interbody cage with posterior screw fixation from L3 to S1. Results: Postoperatively, the patient showed clinical and functional improvement and was discharged from the hospital after 24 hours without opioid medication. Clinical and radiologic outcome after 1 year postoperative follow-up was favorable. Conclusions: A novel trans-Kambin procedure and instrumentation allows overcoming most limitations of current, full-endoscopic trans-Kambin fusion procedures, by allowing a time-efficient insertion of a large-footprint interbody cage with standard open-surgery disk preparation instruments under fluoroscopic control only, with optional endoscopic visualization.
Morgenstern et al. (Thu,) studied this question.
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