Tabarestani Troy Q, Sykes David A W, Kouam Romaric W, Salven David S, Wang Timothy Y, Mehta Vikram A, Shaffrey Christopher I, Wiggins Walter F, Chi John H, Abd-El-Barr Muhammad M
Duke University School of Medicine, Durham, North Carolina, USA.
Duke University School of Medicine, Durham, North Carolina, USA.
World Neurosurg. 2023 Sep;177:e385-e396. doi: 10.1016/j.wneu.2023.06.061. Epub 2023 Jun 22.
While Kambin's Triangle has become an ever more important anatomic window given its proximity to the exiting nerve root, there have been limited studies examining the effect of disease on the corridor. Our goal was to better understand how pathology can affect Kambin's Triangle, thereby altering the laterality of approach for percutaneous lumbar interbody fusion (percLIF).
The authors performed a single-center retrospective review of patients evaluated for percLIF. The areas of Kambin's Triangle were measured without and with nerve segmentation. For the latter, the lumbosacral nerve roots on 3-dimensional T2 magnetic resonance imaging were manually segmented. Next, the borders of Kambin's Triangle were delineated, ensuring no overlap between the area and nerve above.
Fifteen patients (67.5 ± 9.7 years, 46.7% female) were retrospectively reviewed. We measured 150 Kambin's Triangles. The mean areas from L1-S1 were 50.0 ± 12.3 mm, 73.8 ± 12.5 mm, 83.8 ± 12.2 mm, 88.5 ± 19.0 mm, and 116 ± 29.3 mm, respectively. When pathology was present, the areas significantly decreased at L4-L5 (P = 0.046) and L5-S1 (P = 0.049). Higher spondylolisthesis and smaller posterior disk heights were linked with decreased areas via linear regression analysis (P < 0.05). When nerve segmentation was used, the areas were significantly smaller from L1-L5 (P < 0.05). Among 11 patients who underwent surgery, none suffered from postoperative neuropathies.
These results illustrate the feasibility of preoperatively segmenting lumbosacral nerves and measuring Kambin's Triangle to help guide surgical planning and determine the ideal laterality of approach for percLIF.
鉴于坎宾三角（Kambin's Triangle）靠近穿出的神经根，已成为一个越来越重要的解剖窗口，但研究疾病对该通道影响的研究有限。我们的目标是更好地了解病理状况如何影响坎宾三角，从而改变经皮腰椎椎间融合术（percLIF）的入路侧别。
作者对接受percLIF评估的患者进行了单中心回顾性研究。在有和没有神经分割的情况下测量坎宾三角的面积。对于后者，在三维T2磁共振成像上手动分割腰骶神经根。接下来，划定坎宾三角的边界，确保该区域与上方神经不重叠。
对15例患者（67.5±9.7岁，46.7%为女性）进行了回顾性研究。我们测量了150个坎宾三角。L1-S1的平均面积分别为50.0±12.3平方毫米、73.8±12.5平方毫米、83.8±12.2平方毫米、88.5±19.0平方毫米和116±29.3平方毫米。存在病理状况时，L4-L5（P = 0.046）和L5-S1（P = 0.049）的面积显著减小。通过线性回归分析，更高的椎体滑脱和更小的椎间盘后高度与面积减小有关（P < 0.05）。使用神经分割时，L1-L5的面积显著更小（P < 0.05）。在11例接受手术的患者中，无一例出现术后神经病变。
这些结果说明了术前分割腰骶神经并测量坎宾三角以帮助指导手术规划和确定percLIF理想入路侧别的可行性。
