Tumialán Luis M, Madhavan Karthik, Godzik Jakub, Wang Michael Y
Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA.
World Neurosurg. 2019 Mar;123:402-408. doi: 10.1016/j.wneu.2018.10.221. Epub 2018 Nov 9.
The transforaminal corridor in the lumbar spine allows access to the traversing and exiting nerve roots, the thecal sac, and the intervertebral disc space. Surgeons performing midline and minimally invasive approaches for lumbar interbody fusion access the disc space within the boundaries created by the exiting root of a segment and the traversing root after a complete facetectomy and removal of the pars interarticularis and lamina. Endoscopic surgeons and interventional pain management physicians approach the lumbar segment through a similar corridor, but with the bony anatomy intact. Although the boundaries of the corridor may seem the same, the angle of the trajectory and the bone work between the two differ. The overlap between these 2 distinct access corridors has led to an openhanded application of the term Kambin's triangle. Initially described for endoscopic approaches to the lumbar spine for microdiscectomy, this working triangle has been grafted into the transforaminal lumbar interbody fusion literature. Given the similarities between these corridors, it is understandable how the lines of this nomenclature have blurred. The result has been an interchangeable application of the term Kambin's triangle for a variety of procedures in the spine literature. The objective of the current work is to add clarity to the various lumbar transforaminal corridors. The term Kambin's triangle should be limited to percutaneous access to the disc space for endoscopic procedures in the intact spine and should not be applied to transforaminal lumbar interbody fusion after laminectomy and facetectomy. Instead, the term expanded transforaminal corridor should be applied.
腰椎的椎间孔通道可通向横过和穿出的神经根、硬脊膜囊及椎间盘间隙。实施腰椎椎间融合术的中线和微创入路的外科医生，在完全切除小关节突、关节突间部和椎板后，可在一个节段的穿出神经根和横过神经根所形成的边界内进入椎间盘间隙。内镜外科医生和介入疼痛管理医生通过类似的通道进入腰椎节段，但骨骼解剖结构保持完整。尽管通道的边界看似相同，但两者的轨迹角度和骨质操作有所不同。这两条不同的入路通道之间的重叠导致了“坎宾三角”这一术语的随意应用。最初该术语用于描述腰椎内镜下微椎间盘切除术的入路，现在这一工作三角已被引入到经椎间孔腰椎椎间融合术的文献中。鉴于这些通道之间的相似性，也就不难理解这个命名法的界限是如何变得模糊的。结果是，在脊柱文献中，“坎宾三角”这一术语被用于各种手术，相互混淆。当前这项工作的目的是明确各种腰椎椎间孔通道。“坎宾三角”这一术语应仅限于在完整脊柱中经皮进入椎间盘间隙的内镜手术，而不应应用于椎板切除和小关节突切除后的经椎间孔腰椎椎间融合术。相反，应使用“扩大椎间孔通道”这一术语。
