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      The endoscopic aspect of foraminal anatomy and dorsal root ganglion in percutaneous transforaminal endoscopic discectomy

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          Abstract

          Percutaneous Transforaminal Endoscopic Discectomy (PTED) offers an exceptional visualization of foraminal anatomy. Dorsal root ganglion and adjacent foraminal structures are satisfactorily visualized, thereby minimizing the risk of their intraoperative injury.

          Abstract

          Percutaneous Transforaminal Endoscopic Discectomy (PTED) offers an exceptional visualization of foraminal anatomy. Dorsal root ganglion and adjacent foraminal structures are satisfactorily visualized, thereby minimizing the risk of their intraoperative injury

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          Cadaveric Analysis of the Kambin's Triangle

          Reid Hoshide, Erica Feldman, William Taylor (2016)
          Introduction Kambin’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. Methods Two 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. Results The 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. Conclusion Understanding 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.
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            Clinical anatomy and significance of the lumbar intervertebral foramen: A review

            Grigorios Gkasdaris, Stylianos Kapetanakis (2015)
            Article 0 comments Cited 2 times – based on 0 reviews     Review now
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              Author and article information

              Contributors
              Stylianos Kapetanakis:
              ORCID: https://orcid.org/0000-0001-6276-2447
              stkapetanakis@yahoo.gr
              Journal
              Journal ID (nlm-ta): Clin Case Rep
              Journal ID (iso-abbrev): Clin Case Rep
              Journal ID (doi): 10.1002/(ISSN)2050-0904
              Journal ID (publisher-id): CCR3
              Title: Clinical Case Reports
              Publisher: John Wiley and Sons Inc. (Hoboken )
              ISSN (Electronic): 2050-0904
              Publication date (Electronic): 18 September 2020
              Publication date Collection: December 2020
              Volume: 8
              Issue: 12 ( doiID: 10.1002/ccr3.v8.12 )
              Pages: 3616-3618
              Affiliations
              [ 1 ] Spine Department and Deformities Interbalkan European Medical Center Thessaloniki Greece
              [ 2 ] Department of Minimally Invasive and Endoscopic Spine Surgery Athens Medical Center Athens Greece
              Author notes
              [*] [* ] Correspondence

              Stylianos Kapetanakis, Spine Department and Deformities, Interbalkan European Medical Center, Thessaloniki, Greece, and Athens Medical Center, Athens, Greece.

              Email: stkapetanakis@ 123456yahoo.gr

              Author information
              https://orcid.org/0000-0001-6276-2447
              Article
              Publisher ID: CCR33347
              DOI: 10.1002/ccr3.3347
              PMC ID: 7752575
              SO-VID: 9c4861b6-bf29-4546-9b7f-aa0f00967ee9
              Copyright © © 2020 The Authors. Clinical Case Reports published by John Wiley & Sons Ltd
              License:

              This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

              History
              Date received : 14 April 2020
              Date revision received : 02 July 2020
              Date accepted : 20 August 2020
              Page count
              Figures: 5, Tables: 0, Pages: 3, Words: 645
              Categories
              Subject: Clinical Image
              Subject: Clinical Images
              Custom metadata
              source-schema-version-number 2.0
              cover-date December 2020
              details-of-publishers-convertor Converter:WILEY_ML3GV2_TO_JATSPMC version:5.9.6 mode:remove_FC converted:21.12.2020

              Keywords: neurosurgery,orthopaedics
              Data availability:
              Keywords: neurosurgery, orthopaedics

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