Kambins triangle vs ENR

This review discusses the anatomical orientation, area, and diameter of Kambin’s safety zone and limitations of the transforaminal approach.

1. DR. REZA AMINNEJAD Dr. Reza Aminnejad

2. DR. REZA AMINNEJAD

3. DR. REZA AMINNEJAD

4. This review discusses the anatomical orientation, area , and diameter of Kambin’s safety zone and limitations of the transforaminal approach. DR. REZA AMINNEJAD

5. Introduction DR. REZA AMINNEJAD

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7. DR. REZA AMINNEJAD

8. There are large variations in Kambin’s triangle . Furthermore, there is no space inside the triangle in approximately one-third of L2-L5 in cadaveric and surgical specimens. Some authors suggested using a partial superior facetectomy to avoid ENR injury. DR. REZA AMINNEJAD

9. Enr injury Using contrast material injection technique in the epidural space to determine the ENR anatomy during surgery, will not guarantee the prevent of nerve irritation. The shorter distance between the ENR and the lower facet can predict the occurrence of ENR injuries. Recently, the diffusion tensor imaging technique has been used for the structural and functional diagnosis of lumbar nerve damage before and after surgery. Attaching the guide needle to the lateral aspect of the superior facet for the insertion of dilators and cannula before accessing the annulus is recommended with the aim of preventing ENR injuries. The “walking technique ” may prevent POD (postoperative dysesthesia). In this technique the guide needle should touch a caudal pedicle before needling Kambin’s triangle. DR. REZA AMINNEJAD

10. Walking technique DR. REZA AMINNEJAD

11. discussion DR. REZA AMINNEJAD

12. DR. REZA AMINNEJAD

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16. Thanks for your attention DR. REZA AMINNEJAD