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Research ArticleNovel Techniques & Technology

Technical Note on the Role of Kambin’s Triangle in the Evolution of Total Joint Replacement of the Lumbar Spine

S. Craig Humphreys, Louis J. Nel, Jon E. Block and Scott D. Hodges
International Journal of Spine Surgery June 2024, 18 (3) 336-342; DOI: https://doi.org/10.14444/8611
S. Craig Humphreys
1 Kenai Spine, Soldotna, AK, USA
MD
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Louis J. Nel
2 Zuid Afrikaans Hospital, Muckleneuk, Pretoria, South Africa
MD
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Jon E. Block
3 Indepedent Consultant, San Francisco, CA, USA
PʜD
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  • For correspondence: jb@drjonblock.com
Scott D. Hodges
4 Center for Sports Medicine and Orthopedics, Chattanooga, TN, USA
DO
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Figures

  • Figure 1
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    Figure 1

    Anatomical rendering of Kambin’s triangle.

  • Figure 2
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    Figure 2

    Transforaminal lumbar interbody fusion (TLIF). Abbreviation: IVD, intervertebral disc.

  • Figure 3
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    Figure 3

    Specialized surgical rasp used for endplate preparation for total joint replacement. The shorter rasp is for the inferior endplate of the superior vertebrae. The longer rasp is for the superior endplate of the inferior vertebrae.

  • Figure 4
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    Figure 4

    Lateral view illustrating the creation of a wedge osteotomy of the superior pedicle and contiguously into the posterior disc space.

  • Figure 5
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    Figure 5

    Lateral view illustrating the pedicle vertebral body osteotomy, which entails leveling the upper endplate of the caudal level to allow the implant to be inserted horizontally.

  • Figure 6
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    Figure 6

    Distractor is in place; on the contralateral side, an oscillating rasp is being used to resect the superior S1 pedicle and posterior vertebral body to create a wedge-shaped osteotomy with the apex in the anterior disc space.

  • Figure 7
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    Figure 7

    Specialized surgical cutters are used to create keel cuts to anchor, in “press-fit” fashion, the implant. The shorter keel cutter is for the inferior endplate of the superior vertebra (no pedicle). The inferior keel cutter is for the superior endplate of the inferior vertebrae (including pedicle).

  • Figure 8
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    Figure 8

    The MOTUS device.

  • Figure 9
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    Figure 9

    Final implant placement showing the rectangular implant resting on posterior superior L5 with the L4 to L5 segment in lordosis. The wedge-shaped pedicle vertebral body osteotomy of L5 allows the rectangular implant to rest in the disc space while maintaining segmental lordosis.

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International Journal of Spine Surgery
Vol. 18, Issue 3
1 Jun 2024
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Technical Note on the Role of Kambin’s Triangle in the Evolution of Total Joint Replacement of the Lumbar Spine
S. Craig Humphreys, Louis J. Nel, Jon E. Block, Scott D. Hodges
International Journal of Spine Surgery Jun 2024, 18 (3) 336-342; DOI: 10.14444/8611

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Technical Note on the Role of Kambin’s Triangle in the Evolution of Total Joint Replacement of the Lumbar Spine
S. Craig Humphreys, Louis J. Nel, Jon E. Block, Scott D. Hodges
International Journal of Spine Surgery Jun 2024, 18 (3) 336-342; DOI: 10.14444/8611
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  • Article
    • Abstract
    • Introduction
    • Kambin’s Triangle: Identifying Posterior Intradiscal Access
    • Development of the Transforaminal Corridor
    • Pedicle and Vertebral Body Osteotomy
    • Discussion
    • Footnotes
    • References
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  • Total Joint Replacement of the Lumbar Spine: The Future of Motion Preservation
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  • Circumferential Correction of Severe Thoracolumbar Kyphosis by Utilizing an Articulating Rod and Lateral Interbody Device: A Technical Note
  • Lumbar Intramuscular Myxoma: Microsurgical Resection With Assistance From an Endoscopic Microinspection Tool
  • Axial Lumber Interbody Fusion as an Alternative “Salvage” Approach to Lumbosacral Fixation: A Case Series
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Keywords

  • Kambin’s
  • Motus
  • joint replacement
  • spinal stenosis
  • osteotomy

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