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How dimensions can guide surgical planning and training: a systematic review of Kambin's triangle.

Publication ,  Journal Article
Waguia Kouam, R; Tabarestani, TQ; Sykes, DAW; Gupta, N; Futch, BG; Kakmou, E; Goodwin, CR; Foster, NA; Than, KD; Wiggins, WF; Abd-El-Barr, MM
Published in: Neurosurg Focus
January 2023

OBJECTIVE: The authors sought to analyze the current literature to determine dimensional trends across the lumbar levels of Kambin's triangle, clarify the role of imaging techniques for preoperative planning, and understand the effect of inclusion of the superior articular process (SAP). This compiled knowledge of the triangle is needed to perform successful procedures, reduce nerve root injuries, and help guide surgeons in training. METHODS: The authors performed a search of multiple databases using combinations of keywords: Kambin's triangle, size, measurement, safe triangle, and bony triangle. Articles were included if their main findings included measurement of Kambin's triangle. The PubMed, Scopus, Ovid, Cochrane, Embase, and Medline databases were systematically searched for English-language articles with no time frame restrictions through July 2022. RESULTS: Eight studies comprising 132 patients or cadavers were included in the study. The mean ± SD age was 66.69 ± 9.6 years, and 53% of patients were male. Overall, the size of Kambin's triangle increased in area moving down vertebral levels, with L5-S1 being the largest (133.59 ± 4.36 mm2). This trend followed a linear regression model when SAP was kept (p = 0.008) and removed (p = 0.003). There was also a considerable increase in the size of Kambin's triangle if the SAP was removed. CONCLUSIONS: Here, the authors have provided the first reported systematic review of the literature of Kambin's triangle, its measurements at each lumbar level, and key areas of debate related to the definition of the working safe zone. These findings indicate that CT is heavily utilized for imaging of the safe zone, the area of Kambin's triangle tends to increase caudally, and variation exists between patients. Future studies should focus on using advanced imaging techniques for preoperative planning and establishing guidelines for surgeons.

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Published In

Neurosurg Focus

DOI

EISSN

1092-0684

Publication Date

January 2023

Volume

54

Issue

1

Start / End Page

E6

Location

United States

Related Subject Headings

  • Surgeons
  • Radiculopathy
  • Neurology & Neurosurgery
  • Middle Aged
  • Male
  • Lumbar Vertebrae
  • Humans
  • Female
  • Cadaver
  • Aged
 

Citation

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Waguia Kouam, R., Tabarestani, T. Q., Sykes, D. A. W., Gupta, N., Futch, B. G., Kakmou, E., … Abd-El-Barr, M. M. (2023). How dimensions can guide surgical planning and training: a systematic review of Kambin's triangle. Neurosurg Focus, 54(1), E6. https://doi.org/10.3171/2022.10.FOCUS22606
Waguia Kouam, Romaric, Troy Q. Tabarestani, David A. W. Sykes, Nithin Gupta, Brittany G. Futch, Elisabeth Kakmou, C Rory Goodwin, et al. “How dimensions can guide surgical planning and training: a systematic review of Kambin's triangle.Neurosurg Focus 54, no. 1 (January 2023): E6. https://doi.org/10.3171/2022.10.FOCUS22606.
Waguia Kouam R, Tabarestani TQ, Sykes DAW, Gupta N, Futch BG, Kakmou E, et al. How dimensions can guide surgical planning and training: a systematic review of Kambin's triangle. Neurosurg Focus. 2023 Jan;54(1):E6.
Waguia Kouam, Romaric, et al. “How dimensions can guide surgical planning and training: a systematic review of Kambin's triangle.Neurosurg Focus, vol. 54, no. 1, Jan. 2023, p. E6. Pubmed, doi:10.3171/2022.10.FOCUS22606.
Waguia Kouam R, Tabarestani TQ, Sykes DAW, Gupta N, Futch BG, Kakmou E, Goodwin CR, Foster NA, Than KD, Wiggins WF, Abd-El-Barr MM. How dimensions can guide surgical planning and training: a systematic review of Kambin's triangle. Neurosurg Focus. 2023 Jan;54(1):E6.

Published In

Neurosurg Focus

DOI

EISSN

1092-0684

Publication Date

January 2023

Volume

54

Issue

1

Start / End Page

E6

Location

United States

Related Subject Headings

  • Surgeons
  • Radiculopathy
  • Neurology & Neurosurgery
  • Middle Aged
  • Male
  • Lumbar Vertebrae
  • Humans
  • Female
  • Cadaver
  • Aged