A Novel Full-percutaneous Trans-Kambin Lumbar Interbody Fusion (pTLIF) With a Large-footprint Interbody Cage: Step-by-Step Surgical Technique.

Abstract

<h4>Study design</h4>Surgical technique presentation.<h4>Objectives</h4>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.<h4>Background</h4>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.<h4>Methods</h4>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.<h4>Results</h4>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.<h4>Conclusions</h4>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.