Asian Spine J.  2016 Oct;10(5):821-827. 10.4184/asj.2016.10.5.821.

Anatomic Considerations of Intervertebral Disc Perspective in Lumbar Posterolateral Approach via Kambin's Triangle: Cadaveric Study

• Lertudomphonwanit T
• Keorochana G
• Kraiwattanapong C
• Chanplakorn P
• Leelapattana P
• Wajanavisit W

• KMID: 2354804
• DOI: http://doi.org/10.4184/asj.2016.10.5.821

Abstract

STUDY DESIGN: Anatomical study. PURPOSE: To evaluate the anatomy of intervertebral disc (IVD) area in the triangular working zone of the lumbar spine based on cadaveric measurements. OVERVIEW OF LITERATURE: The posterolateral percutaneous approach to the lumbar spine has been widely used as a minimally invasive spinal surgery. However, to our knowledge, the actual perspective of disc boundaries and areas through posterolateral endoscopic approach are not well defined.
METHODS
Ninety-six measurements for areas and dimensions of IVD in Kambin's triangle on bilateral sides of L1-S1 in 5 fresh human cadavers were studied.
RESULTS
The trapezoidal IVD area (mean±standard deviation) for true working space was 63.65±14.70 mm2 at L1-2, 70.79±21.88 mm2 at L2-3, 99.03±15.83 mm2 at L3-4, 116.22±20.93 mm2 at L4-5, and 92.18±23.63 mm2 at L5-S1. The average dimension of calculated largest ellipsoidal cannula that could be placed in IVD area was 5.83×11.02 mm at L1-2, 6.97×10.78 mm at L2-3, 9.30×10.67 mm at L3-4, 8.84×13.15 mm at L4-5, and 6.61×14.07 mm at L5-S1.
CONCLUSIONS
The trapezoidal perspective of working zone of IVD in Kambin's triangle is important and limited. This should be taken into consideration when developing the tools and instruments for posterolateral endoscopic lumbar spine surgery.

Keyword

Working zone; Intervertebral disc; Posterolateral approach; Lumbar spine; Endoscopic approach

MeSH Terms

Cadaver*
Catheters
Humans
Intervertebral Disc*
Spine