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

Tabarestani, Troy Q.; Sykes, David A.W.; Waguia-Kouam, Romaric; Salven, David S.; Wang, Timothy Y.; Mehta, Vikram A.; Shaffrey, Christopher I.; Wiggins, Walter F.; John, H.; Abd-El-Barr, Muhammad M.

doi:10.1016/j.wneu.2023.06.061

Cited by 6 publications

(5 citation statements)

References 25 publications

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“…Further, the insertion of these devices requires less nerve root retraction and potentially reduces postoperative complications such as cage subsidence [21]. Similarly, the MIS-TLIF platform has become a cornerstone for integrating cutting-edge imaging technologies such as robotic assistance, 3D neurosegmentation, and augmented reality [24][25][26]. These advancements have solidified the role of the MIS-TLIF as a fundamental framework for ongoing research and development in spine surgery.…”

Section: Minimally Invasive Transforaminal Lumbar Interbody Fusionmentioning

confidence: 99%

“…The initial implementation of spine segmentation technology was primarily aimed at helping surgeons avoid nerve roots during percutaneous TLIF [25]. However, its application has since expanded to include both anatomic studies of Kambin's Triangle and delineating borders for the TF-LIF.…”

Section: Three-dimensional Neurosegmentationmentioning

confidence: 99%

“…By comparing contralateral areas, the surgeon was able to decide on the 'ideal' laterality of their approach, entering the largest, safest triangle with the greatest distance from the exiting nerve root. Further applying this same methodology, the same research group examined how various pathologies affect Kambin's Triangle; they discovered that higher levels of spondylolisthesis, with decreased posterior disc space heights, minimize the safe area of entry for the percLIF [25]. Further work is required to similarly describe how certain pathology might favorably augment other access planes.…”

Section: Three-dimensional Neurosegmentationmentioning

confidence: 99%

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Evolution of the Transforaminal Lumbar Interbody Fusion (TLIF): From Open to Percutaneous to Patient-Specific

Drossopoulos,

Ononogbu-uche,

Tabarestani

et al. 2024

JCM

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The transforaminal lumbar interbody fusion (TLIF) has seen significant evolution since its early inception, reflecting advancements in surgical techniques, patient safety, and outcomes. Originally described as an improvement over the posterior lumbar interbody fusion (PLIF), the TLIF began as an open surgical procedure, that notably reduced the need for the extensive neural retractation that hindered the PLIF. In line with the broader practice of surgery, trending toward minimally invasive access, the TLIF was followed by the development of the minimally invasive TLIF (MIS-TLIF), a technique that further decreased tissue trauma and postoperative complications. Subsequent advancements, including Trans-Kambin’s Triangle TLIF (percLIF) and transfacet LIF, have continued to refine surgical access, minimize surgical footprint, and reduce the risk of injury to the patient. The latest evolution, as we will describe it, the patient-specific TLIF, is a culmination of the aforementioned adaptations and incorporates advanced imaging and segmentation technologies into perioperative planning, allowing surgeons to tailor approaches based on individual patient anatomy and pathology. These developments signify a shift towards more precise methods in spine surgery. The ongoing evolution of the TLIF technique illustrates the dynamic nature of surgery and emphasizes the need for continued adaptation and refinement.

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Section: Minimally Invasive Transforaminal Lumbar Interbody Fusionmentioning

confidence: 99%

Section: Three-dimensional Neurosegmentationmentioning

confidence: 99%

Section: Three-dimensional Neurosegmentationmentioning

confidence: 99%

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Evolution of the Transforaminal Lumbar Interbody Fusion (TLIF): From Open to Percutaneous to Patient-Specific

Drossopoulos,

Ononogbu-uche,

Tabarestani

et al. 2024

JCM

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“…This precision relies on both meticulous preoperative planning and exact intraoperative execution. High-resolution MRI enables surgeons to delineate the nerve root and measure safe surgical corridors preoperatively [91]. Integrating this detailed preoperative planning with intraoperative navigation systems has shown promising results, as evidenced in a recent study on percutaneous lumbar interbody fusion, which concluded that such integration leads to safer and more successful surgeries [92].…”

Section: Patient-specific Surgical Planningmentioning

confidence: 99%

Evolution of Cervical Endoscopic Spine Surgery: Current Progress and Future Directions—A Narrative Review

Huang,

Fitts,

Huie

et al. 2024

JCM

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Cervical endoscopic spine surgery is rapidly evolving and gaining popularity for the treatment of cervical radiculopathy and myelopathy. This approach significantly reduces muscular damage and blood loss by minimizing soft tissue stripping, leading to less postoperative pain and a faster postoperative recovery. As scientific evidence accumulates, the efficacy and safety of cervical endoscopic spine surgery are continually affirmed. Both anterior and posterior endoscopic approaches have surfaced as viable alternative treatments for various cervical spine pathologies. Newer techniques, such as endoscopic-assisted fusion, the anterior transcorporeal approach, and unilateral laminotomy for bilateral decompression, have been developed to enhance clinical outcomes and broaden surgical indications. Despite its advantages, this approach faces challenges, including a steep learning curve, increased radiation exposure for both surgeons and patients, and a relative limitation in addressing multi-level pathologies. However, the future of cervical endoscopic spine surgery is promising, with potential enhancements in clinical outcomes and safety on the horizon. This progress is fueled by integrating advanced imaging and navigation technologies, applying regional anesthesia for improved and facilitated postoperative recovery, and incorporating cutting-edge technologies, such as augmented reality. With these advancements, cervical endoscopic spine surgery is poised to broaden its scope in treating cervical spine pathologies while maintaining the benefits of minimized tissue damage and rapid recovery.

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“…Likewise, recent studies have highlighted the importance of visualizing these corridors prior to surgery since the majority of triangles will not permit the necessary cannula diameter for discectomy or adequate cage placement [ 11 ]. Even though multiple studies have demonstrated the necessity of pre-operatively measuring these corridors in order to define the safest trajectory for each patient’s specific spinal anatomy, a surgeon must also be prepared to alter their operative course if those corridors will not provide enough room for a successful interbody fusion [ 12 , 13 ]. For that reason, other minimally invasive approaches, such as the relatively novel transfacet approach, have begun to gain popularity as alternatives routes to the disc space since they provide better working areas for endplate preparation and larger cage dimensions [ 14 , 15 ].…”

Section: Introductionmentioning

confidence: 99%

Using Augmented Reality Technology to Optimize Transfacet Lumbar Interbody Fusion: A Case Report

Bardeesi,

Tabarestani,

Bergin

et al. 2024

JCM

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The transfacet minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) is a novel approach available for the management of lumbar spondylolisthesis. It avoids the need to manipulate either of the exiting or traversing nerve roots, both protected by the bony boundaries of the approach. With the advancement in operative technologies such as navigation, mapping, segmentation, and augmented reality (AR), surgeons are prompted to utilize these technologies to enhance their surgical outcomes. A 36-year-old male patient was complaining of chronic progressive lower back pain. He was found to have grade 2 L4/5 spondylolisthesis. We studied the feasibility of a trans-Kambin or a transfacet MIS-TLIF, and decided to proceed with the latter given the wider corridor it provides. Preoperative trajectory planning and level segmentation in addition to intraoperative navigation and image merging were all utilized to provide an AR model to guide us through the surgery. The use of AR can build on the safety and learning of novel surgical approaches to spine pathologies. However, larger high-quality studies are needed to further objectively analyze its impact on surgical outcomes and to expand on its application.

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

Cited by 6 publications

References 25 publications

Evolution of the Transforaminal Lumbar Interbody Fusion (TLIF): From Open to Percutaneous to Patient-Specific

Evolution of the Transforaminal Lumbar Interbody Fusion (TLIF): From Open to Percutaneous to Patient-Specific

Evolution of Cervical Endoscopic Spine Surgery: Current Progress and Future Directions—A Narrative Review

Using Augmented Reality Technology to Optimize Transfacet Lumbar Interbody Fusion: A Case Report

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