Anatomic Considerations Of Intervertebral Disc Perspective In Lumbar Posterolateral Approach Via Kambin'S Triangle: Cadaveric Study

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 mm(2) at L1-2, 70.79 +/- 21.88 mm(2) at L2-3, 99.03 +/- 15.83 mm(2) at L3-4, 116.22 +/- 20.93 mm(2) at L4-5, and 92.18 +/- 23.63 mm(2) at L5-S1. The average dimension of calculated largest ellipsoidal cannula that could be placed in IVD area was 5.83x11.02 mm at L1-2, 6.97x10.78 mm at L2-3, 9.30x10.67 mm at L3-4, 8.84x13.15 mm at L4-5, and 6.61x14.07 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.