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Novel Merging of CT and MRI to Allow for Safe Navigation into Kambin's Triangle for Percutaneous Lumbar Interbody Fusion-Initial Case Series Investigating Safety and Efficacy.

Publication ,  Journal Article
Tabarestani, TQ; Sykes, DAW; Maquoit, G; Wang, TY; Ayoub, CM; Shaffrey, CI; Wiggins, WF; Abd-El-Barr, MM
Published in: Oper Neurosurg (Hagerstown)
March 1, 2023

BACKGROUND: For percutaneous lumbar fusion (percLIF), magnetic resonance imaging and computed tomography are critical to defining surgical corridors. Currently, these scans are performed separately, and surgeons then use fluoroscopy or neuromonitoring to guide instruments through Kambin's triangle. However, anatomic variations and intraoperative positional changes are possible, meaning that safely accessing Kambin's triangle remains a challenge because nerveroot visualization without endoscopes has not been thoroughly described. OBJECTIVE: To overcome the known challenges of percLIF and reduce the likelihood of iatrogenic injuries by showing real-time locations of neural and bony anatomy. METHODS: The authors demonstrate an intraoperative navigational platform that applies nerve root segmentation and image fusion to assist with percLIF. Five patients from a single institution were included. RESULTS: Of the 5 patients, the mean age was 71 ± 8 years and 3 patients (60%) were female. One patient had general anesthesia while the remaining 4 patients underwent awake surgery with spinal anesthesia. The mean area for the L4-L5 Kambin's triangle was 76.1 ± 14.5 mm 2 . A case example is shown where the side of approach was based on the fact that Kambin's triangle was larger on one side compared with the other. The mean operative time was 170 ± 17 minutes, the mean blood loss was 32 ± 16 mL, and the mean hospital length of stay was 19.6 ± 8.3 hours. No patients developed postoperative complications. CONCLUSION: This case series demonstrates the successful and safe application of nerve segmentation using magnetic resonance imaging/computed tomography fusion to perform percLIF and provide positive patient outcomes.

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Published In

Oper Neurosurg (Hagerstown)

DOI

EISSN

2332-4260

Publication Date

March 1, 2023

Volume

24

Issue

3

Start / End Page

331 / 340

Location

United States

Related Subject Headings

  • Wakefulness
  • Tomography, X-Ray Computed
  • Middle Aged
  • Male
  • Magnetic Resonance Imaging
  • Lumbar Vertebrae
  • Humans
  • Female
  • Brain Neoplasms
  • Aged
 

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Tabarestani, T. Q., Sykes, D. A. W., Maquoit, G., Wang, T. Y., Ayoub, C. M., Shaffrey, C. I., … Abd-El-Barr, M. M. (2023). Novel Merging of CT and MRI to Allow for Safe Navigation into Kambin's Triangle for Percutaneous Lumbar Interbody Fusion-Initial Case Series Investigating Safety and Efficacy. Oper Neurosurg (Hagerstown), 24(3), 331–340. https://doi.org/10.1227/ons.0000000000000531
Tabarestani, Troy Q., David A. W. Sykes, Gisselle Maquoit, Timothy Y. Wang, Chakib M. Ayoub, Christopher I. Shaffrey, Walter F. Wiggins, and Muhammad M. Abd-El-Barr. “Novel Merging of CT and MRI to Allow for Safe Navigation into Kambin's Triangle for Percutaneous Lumbar Interbody Fusion-Initial Case Series Investigating Safety and Efficacy.Oper Neurosurg (Hagerstown) 24, no. 3 (March 1, 2023): 331–40. https://doi.org/10.1227/ons.0000000000000531.
Tabarestani TQ, Sykes DAW, Maquoit G, Wang TY, Ayoub CM, Shaffrey CI, et al. Novel Merging of CT and MRI to Allow for Safe Navigation into Kambin's Triangle for Percutaneous Lumbar Interbody Fusion-Initial Case Series Investigating Safety and Efficacy. Oper Neurosurg (Hagerstown). 2023 Mar 1;24(3):331–40.
Tabarestani, Troy Q., et al. “Novel Merging of CT and MRI to Allow for Safe Navigation into Kambin's Triangle for Percutaneous Lumbar Interbody Fusion-Initial Case Series Investigating Safety and Efficacy.Oper Neurosurg (Hagerstown), vol. 24, no. 3, Mar. 2023, pp. 331–40. Pubmed, doi:10.1227/ons.0000000000000531.
Tabarestani TQ, Sykes DAW, Maquoit G, Wang TY, Ayoub CM, Shaffrey CI, Wiggins WF, Abd-El-Barr MM. Novel Merging of CT and MRI to Allow for Safe Navigation into Kambin's Triangle for Percutaneous Lumbar Interbody Fusion-Initial Case Series Investigating Safety and Efficacy. Oper Neurosurg (Hagerstown). 2023 Mar 1;24(3):331–340.
Journal cover image

Published In

Oper Neurosurg (Hagerstown)

DOI

EISSN

2332-4260

Publication Date

March 1, 2023

Volume

24

Issue

3

Start / End Page

331 / 340

Location

United States

Related Subject Headings

  • Wakefulness
  • Tomography, X-Ray Computed
  • Middle Aged
  • Male
  • Magnetic Resonance Imaging
  • Lumbar Vertebrae
  • Humans
  • Female
  • Brain Neoplasms
  • Aged