Anat Cell Biol.  2024 Dec;57(4):523-534. 10.5115/acb.24.112.

Anatomical assessment of the Kambin’s triangle for percutaneous posterolateral transforaminal endoscopic surgery of lumbar intervertebral discs: a magnetic resonance imaging based study

• Nikpour N
• Fazelinejad Z
• Sametzadeh M
• Lordjani MA
• Moghadam ARE

• KMID: 2562500
• DOI: http://doi.org/10.5115/acb.24.112

Abstract

The aim of the present study was to utilize magnetic resonance imaging (MRI) as a noninvasive tool for evaluation of the Kambin’s triangle safe zone. Lumbar MRIs of 67 healthy subjects were analyzed. On the coronal plane, the distance from the superior endplate to the nerve root exiting from the dura (distance a), the distance from the lateral aspect of the dura to the medial aspect of the nerve root (distance b), and the angle between the nerve root and plane of the corresponding disc (angle α) was measured. On the axial plane, the vertical distance from the upper facet surface to the exiting nerve root and rootdisc distance was also measured. On the sagittal plane, foraminal height, diameter, nerve root-disc distance, and nerve rootpedicle distance were measured. On the coronal plane, right and left α angle was 50.78±4.43 (range, 48.52–51.84 degrees) and 51.07±4.08 (range, 49.25–51.91) degrees, respectively. Distance of right ‘a’ was 17.86±3.86 mm (range, 10.56–24.84 mm) and left ‘a’ was 18.03±3.73 mm (range, 10.98–24.82 mm), distance of right ‘b’ was 15.57±2.61 mm (range, 10.54–20.70 mm) and left ‘b’ was 15.46±2.68 mm (range, 10.93–19.23 mm). All these measurements increased as the spine level went down. Foraminal height and diameter decreased caudally. Nerve root-facet distance did not show change as the level went down. The study indicated that radiologic measurement is feasible to evaluate the anatomy of the Kambin’s triangle. At lower lumbar levels, the exiting nerve root is at risk of injury.

Keyword

Kambin’s triangle; Endoscopic discectomy; Magnetic resonance imaging; Lumbosacral regions; Spinal nerve

Figure

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  Fig. 1 Schematic diagram of the Kambin’s triangle (triangular safe zone) on the sagittal plane. The hypotenuse is bordered medially by the associated spinal nerve, posteriorly by the lateral edge of the superior articular process of the subsequent inferior vertebra, and inferiorly by the rim of the vertebral plate. KT, Kambin’s triangle.

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  Fig. 2 The magnetic resonance image shows the measurements related to the left side safety working zone at L4–L5 on the coronal plane. Distance a: the distance from the superior endplate to the nerve root exiting from the dura. Distance b: the distance from the lateral aspect of the dura to the medial aspect of the nerve root along the superior endplate. Angle α: the angle between the exiting nerve root and the plane of the corresponding disc.

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  Fig. 3 Examples of the parameters that are calculated at the middle of the pedicle on the T1-weighted magnetic resonance imaging sagittal section. A, foramina height; B, middle foraminal diameter.

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  Fig. 4 T2-weighted magnetic resonance image showing the parameters measured on the transverse plane at the superior margin of the disc. Gs, foraminal width; Hs, nerve root-disc distance; Ii, nerve root-facet distance.

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  Fig. 5 (A) The severity of the correlation between the factors affecting alpha and (B) the model’s goodness of fit in prediction. GENDER=0, female; BMI, body mass index.

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  Fig. 6 (A) The intensity of the correlation between the factors affecting a and (B) the model’s goodness of fit in prediction. GENDER=0, female; BMI, body mass index.

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  Fig. 7 (A) The intensity of the correlation between the factors affecting b and (B) the model’s goodness of fit in prediction. GENDER=0, female; BMI, body mass index.

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  Fig. 8 (A) The intensity of the correlation between the factors affecting h and (B) the model’s goodness of fit in prediction. GENDER=0, female; BMI, body mass index.

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  Fig. 9 (A) The intensity of the correlation between the factors affecting w and (B) the model’s goodness of fit in prediction. GENDER=0, female; BMI, body mass index.

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  Fig. 10 (A) The intensity of the correlation between the factors affecting Gs and (B) the model’s goodness of fit in prediction. GENDER=0, female; BMI, body mass index. Gs, foraminal width.

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  Fig. 11 (A) The intensity of the correlation between the factors affecting Hs and (B) the model’s goodness of fit in prediction. GENDER=0, female; BMI, body mass index. Hs, nerve root-disc distance.

Reference

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