Percutaneous Lumbar Interbody Fusion through Kambin's Triangle is Associated with Superior Perioperative Outcomes compared to MIS or Open TLIF

Introduction: Percutaneous lumbar interbody fusion (percLIF) through Kambin's triangle is an emerging technique for performing spinal fusion. Its relative efficacy is not yet clear, nor are its relative strengths and weakness compared to other techniques. The authors set out to perform an analysis of literature describing percLIF through Kambin’s triangle to describe its current indications, safety, and efficacy.

Methods: The authors performed a search of the multiple databases using various combinations of the words, Kambin’s triangle, lumbar fusion, percutaneous fusion, minimally invasive, and endoscopic. Publications in which patients underwent percLIF through Kambin’s triangle were retained. Results were compared to a prior meta-analysis to determine the relative efficacy of percLIF through Kambin’s triangle when compared to other minimally invasive (MIS) and open (O) transforaminal lumbar interbody fusion (TLIF).

Results: 18 studies were included, encompassing 749 patients and 953 vertebral levels. Pathologies included spondylolisthesis and degenerative disc disease. L4-L5 was the most represented level. Mean (SD) operative time, estimated blood loss, time to ambulation, and length of stay were 115.9±33.9 minutes, 84.5±109.9 mL, 1.6±0.9 days, and 2.9±1.5 days, respectively. Long-term outcomes include a 45.0% ODI reduction (p < 0.0001), 78.0% VAS-leg reduction (p < 0.0001), and a 70.6% VAS-back reduction (p < 0.0001). SF-36 scores also improved. Complications were minimal. Compared to MIS-TLIF and OTLIF, percLIF through Kambin’s triangle was associated with reduced operative time (p < 0.0001), reduced blood loss (p < 0.0001), and reduced length of stay (p < 0.0001).

Conclusion : percLIF through Kambin’s triangle is a safe, efficacious surgical approach that is associated with excellent patient outcomes. percLIF through Kambin’s triangle has demonstrated superiority to MIS TLIF and OTLIF with respect to perioperative outcomes, and likely has comparable long-term efficacy.