IntroductionKambin’s Triangle is a right triangle over the dorsolateral disc. The area of this right triangle currently serves as a strategic site of posterolateral, minimally invasive access to the nerve root for delivery of epidural steroid injections. This posterolateral approach has also been considered a safe area of access to the intervertebral disc space and, thus, an effective approach in reducing complications, such as violation of the thecal sac, the nerve root, or the bony elements of the spine during minimally invasive spinal surgery. No published studies have been performed to characterize the dimensions of the Kambin's Triangle. Our aim is to characterize its dimensions at the lumbar levels and determine its efficacy and safety as a site of access for minimally invasive spinal surgery.MethodsTwo randomly chosen adult male cadavers were used for this study. The measurements were made bilaterally at their lumbar levels (L1–L5), which equates to 16 total measurements (eight bilateral disc spaces on two cadavers). The disc space was first accessed using a Kirschner wire in a standard oblique approach. With the assistance of fluoroscopy, a Kirschner wire was passed into the disc through the Kambin’s Triangle. The procedure was performed on the cadavers bilaterally at four levels, followed by open dissection. The calculations of the area were made by measuring the exiting nerve root, the superior border of the caudal vertebra, and the superior articulating facet—the borders of the Kambin's Triangle.ResultsThe Kambin’s Triangle height and width respectively averaged at 12 mm and 10 mm (L1–L2), 13 mm and 11 mm (L2–L3), 17 mm and 11 mm (L3–L4), and 18 mm and 12 mm (L4–L5). Thus, the area at each level was 60 mm2 (L1–L2), 71.5 mm2 (L2–L3), 93.5 mm2 (L3–L4), and 108 mm2 (L4–L5). All dissected levels demonstrated adequate anchoring of the Kirschner wire into the disc space with no evidence of nerve injury. Following this, a retractor was placed and complete discectomies were performed. All exiting nerves were protected in this safe zone and the thecal sac remained inviolate.ConclusionUnderstanding the Kambin’s Triangle will assist surgeons in the minimally invasive approach to spinal surgeries, with potentially safe placement of interbody cages through this strategic space.
Purpose: The purpose of this study is to define an algorithm that will predict the success of indirect decompression without the need for direct decompression in patients undergoing lateral lumbar interbody fusions.Methods and Materials: A prospective cohort study was undertaken for patients undergoing indirect decompression with lateral lumbar interbody fusion. Patients had to meet the following criteria prior to indirect fusion: lack of facet fusion on CT, absence of free disc fragment or compressive facet joint cyst on MRI, absence of frank osteoporosis, lack of congenital and/or severe spinal stenosis on MRI, and significant reduction (greater than 50%) in leg and back pain at rest. We then assessed which patients at follow-up required a second stage open decompression procedure because of continued back and/or leg pain. Results: Our series included 28 patients who underwent indirect decompression with extreme lateral lumbar interbody fusion. Of the 28 patients, one patient required a second stage open decompression at follow-up. The most common level operated on was the L4-L5 level. Twelve patients underwent more than a single level fusion. Average preoperative lumbar lordosis was 29 degrees and average postoperative lordosis was 45 degrees. The average patient age was 66.3 years and average follow-up was 1.21 years. Conclusions: Our algorithm can be used as an aid to assess which patients may benefit from indirect decompression alone, compared to indirect decompression combined with posterior decompression procedures.
The efficacy of glucocorticoid for treatment of acute spinal cord injuries remains a controversial topic. Differing medical societies have issued conflicting recommendations in this regard. Here we review the available randomized, controlled trial (RCT) data on this subject and offer a synthesis of these data sets.
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