用于全内镜经坎宾三角腰椎椎间融合及反向斜外侧椎间融合器植入的新型器械：病例报告与技术说明
Novel Instruments for Full Endoscopic Trans-Kambin Triangle Lumbar Interbody Fusion With Reverse Oblique Lateral Cage Insertion: A Case Report and Technical Note.
作者信息
Chang Wei-Lun, Wang Jou-Hua, Yeh Ming-Long, Yang Jui-Ming
机构信息
Department of Surgery, Division of Orthopedics, National Cheng Kung University Hospital DouLiou Branch, National Cheng Kung University, Yunlin, Taiwan.
Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan.
出版信息
Int J Spine Surg. 2025 Mar 6;19(1):63-69. doi: 10.14444/8695.
BACKGROUND
Lumbar interbody fusion with screw fixation is a standard treatment for lumbar degenerative diseases. While full-endoscopic lumbar interbody fusion is minimally invasive, it utilizes smaller cages compared with the oblique lateral interbody fusion (OLIF) technique, which offers superior biomechanical support. To merge full-endoscopic lumbar interbody fusion minimal invasiveness with OLIF's advantages, we developed a novel instrument, the Single Beak Adjustable Cage Glider, to facilitate OLIF cage insertion via the full-endoscopic trans-Kambin triangle approach. This note and case report introduce this alternative solution.
CASE PRESENTATION
In a case of L4 to L5 spondylolisthesis, we performed fluoroscopy-guided uniportal facet-preserving trans-Kambin endoscopic fusion surgery. We initially installed percutaneous pedicle screws and rods to correct the anterolisthesis, then established the endoscopic trans-Kambin approach. After releasing the disc-endplate junction, the nerve root was mobilized and protected by the beak of the cage glider. The disc space was cleared, and a 22 × 40 × 12 mm interbody device was inserted through the cage glider under fluoroscopic guidance. The integrity of the exiting nerve root was confirmed with an endoscope.
RESULTS
Postoperatively, the patient experienced significant improvements in both low back pain and bilateral lower limb numbness. Muscle strength in both lower limbs returned to baseline, and the patient was able to walk independently without assistive devices. Follow-up radiographs and computed tomography scans showed a well-reduced regional lordotic angle, and the axial computed tomography view confirmed adequate decompression of the spinal canal while preserving the facet joints.
CONCLUSIONS
The Single Beak Adjustable Cage Glider enables precise positioning of the OLIF cage through the Kambin triangle lumbar interbody fusion approach, avoiding nerve root injury and preserving facet joints. This technique reduces surgical trauma and maintains spine biomechanics, potentially improving patient outcomes.
CLINICAL RELEVANCE
This technique potentially reduces the cage subsidence rate.
背景
腰椎椎间融合术联合螺钉固定是治疗腰椎退行性疾病的标准方法。虽然全内镜下腰椎椎间融合术是微创的，但与斜外侧椎间融合术（OLIF）相比，它使用的椎间融合器较小，而OLIF提供了更好的生物力学支撑。为了将全内镜下腰椎椎间融合术的微创性与OLIF的优势相结合，我们开发了一种新型器械——单喙可调式融合器滑行器，以通过全内镜下经坎宾三角入路方便OLIF椎间融合器的插入。本笔记和病例报告介绍了这种替代解决方案。
病例介绍
在一例L4至L5椎体滑脱病例中，我们进行了荧光透视引导下的单通道保留小关节经坎宾内镜融合手术。我们首先安装经皮椎弓根螺钉和棒以纠正椎体前滑脱，然后建立内镜下经坎宾入路。在松解椎间盘-终板连接处后，神经根通过融合器滑行器喙部进行松动和保护。清除椎间盘间隙，在荧光透视引导下通过融合器滑行器插入一个22×40×12毫米的椎间融合装置。用内镜确认出口神经根的完整性。
结果
术后，患者的下腰痛和双侧下肢麻木均有显著改善。双下肢肌力恢复至基线水平，患者能够独立行走而无需辅助装置。随访X线片和计算机断层扫描显示局部前凸角良好复位，轴向计算机断层扫描视图证实椎管减压充分，同时保留了小关节。
结论
单喙可调式融合器滑行器能够通过坎宾三角腰椎椎间融合入路实现OLIF椎间融合器的精确定位，避免神经根损伤并保留小关节。该技术减少了手术创伤并维持了脊柱生物力学，可能改善患者预后。
临床意义
该技术可能降低椎间融合器下沉率。
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