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

Abstract

Surgical technique presentation. 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. 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. 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. 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. 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.