TPLIF microscopic safe operating area – based on CT imaging studies

TPLIF microscopic safe operating area – based on CT imaging studies | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article TPLIF microscopic safe operating area – based on CT imaging studies Wei Wang, Yukai Cui, Xilong Cui, Wen Yin, Wei Jiao This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4329318/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 9 You are reading this latest preprint version Abstract Background Endoscopic spine lumbar interbody fusion (Endo-LIF) is well-regarded within the academic community. However, it presents challenges such as intraoperative disorientation, high rates of nerve damage, a steep learning curve, and prolonged surgical times, often during the creation of the operative channel. Researchers have developed new techniques to enhance the efficiency of establishing the operative channel. However, these often lack robust anatomical data support. Furthermore, the undefined safe operational zones under endoscopy continue to pose risks to surgical safety. Objective This study analyzes the anatomical data of Kambin’s triangle via CT imaging to define the parameters of the safe operating area for Transforaminal Posterior Lumbar Interbody Fusion (TPLIF), providing crucial insights for clinical practice. Methods Identify the clearest coronal plane at the L4-L5 intervertebral space for examining the exiting and traversing nerve roots, and observe Kambin’s triangle along with the inscribed circle. Record the position of point “J” on the adjacent facet joint as the center “O” of the circle shifts by angle “β”. Measure the diameter of the inscribed circle “d” (mm), the abduction angle “β” (°), and the distances “L1” and “L2” (mm) from the trephine’s edge to the exiting and traversing nerve roots, respectively. Results In a dataset of 40 cases, the diameter of the inscribed circle 'd' measured 11.62 mm (11.35, 12.04), significantly exceeding the 8 mm diameter of the visible trephine (P < 0.001). The angle 'β' was 32.02° (± 0.90). The 'J' point, acting as the safe center, was consistently located in the outer upper quadrant of the demarcated facet joint (P < 0.001). Safe distances 'L1' and 'L2' measured 1.40 mm (1.34, 1.43) and 2.30 mm (2.14, 2.34), respectively, indicating that using an 8 mm diameter visible trephine would not damage the exiting or traversing nerve roots. Conclusions CT imaging studies conducted by the author's team have defined the safe operational area for TPLIF, offering effective clinical references. This is expected to reduce the learning curve, decrease surgery durations, and improve surgical safety. Endo-LIF TPLIF༛Kambin’s triangle༛visible trephine༛Three-dimensional reconstruction of lumbar spine CT Full Text Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 17 May, 2024 Reviewers agreed at journal 03 May, 2024 Reviewers agreed at journal 01 May, 2024 Reviews received at journal 01 May, 2024 Reviewers agreed at journal 01 May, 2024 Reviewers invited by journal 01 May, 2024 Editor assigned by journal 30 Apr, 2024 Submission checks completed at journal 29 Apr, 2024 First submitted to journal 26 Apr, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4329318","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":298252028,"identity":"8d57e5f4-2e83-49f4-a217-bf245bd33970","order_by":0,"name":"Wei Wang","email":"","orcid":"","institution":"Fuyang Hospital of Bengbu Medical University, Bengbu,China","correspondingAuthor":false,"prefix":"","firstName":"Wei","middleName":"","lastName":"Wang","suffix":""},{"id":298252029,"identity":"c03cf38f-1f07-4e4d-be77-3b323f3ae476","order_by":1,"name":"Yukai Cui","email":"","orcid":"","institution":"Fuyang Hospital of Anhui Medical University, Hefei,China","correspondingAuthor":false,"prefix":"","firstName":"Yukai","middleName":"","lastName":"Cui","suffix":""},{"id":298252030,"identity":"e2b92b07-bd3f-4c31-9bdd-c4e6eb0648c0","order_by":2,"name":"Xilong Cui","email":"","orcid":"","institution":"Department of Orthopaedics, Fuyang People’s Hospital,fuyang,China","correspondingAuthor":false,"prefix":"","firstName":"Xilong","middleName":"","lastName":"Cui","suffix":""},{"id":298252031,"identity":"1c343b98-a8fb-4b88-8e42-e932328b485d","order_by":3,"name":"Wen Yin","email":"","orcid":"","institution":"Department of Orthopaedics, Fuyang People’s Hospital,fuyang,China","correspondingAuthor":false,"prefix":"","firstName":"Wen","middleName":"","lastName":"Yin","suffix":""},{"id":298252032,"identity":"ba898724-b619-47d8-bee5-b370a433b0ea","order_by":4,"name":"Wei Jiao","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAvElEQVRIie3PMQrCMBTG8VcCcXmSNQ8ErxAQlELRq1QKTj1EoODmHi/SOaXgJO0B6lDxAu0FROsJnptg/svL8P2GAIRCP5hctvdeQ4JKWSZRGoXRcFiQ80xCDqUGqBNjUyYx3ak28bFFAz4axpxDbs2+p2OHG2EFnUsO8enKUNlhbL0UcyZZayobfD+YhFw+Ef8FUXjJDD0zJFcVvL/IWVE99HW7U6qohpFDpoT+nMgy99N24G9DoVDoH3sB0vY23RCFLpQAAAAASUVORK5CYII=","orcid":"","institution":"Department of Orthopaedics, Fuyang People’s Hospital,fuyang,China","correspondingAuthor":true,"prefix":"","firstName":"Wei","middleName":"","lastName":"Jiao","suffix":""}],"badges":[],"createdAt":"2024-04-26 11:44:10","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4329318/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4329318/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":55911708,"identity":"093435f0-45da-4c2b-84af-b0dfd1be956b","added_by":"auto","created_at":"2024-05-06 08:07:36","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":618583,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4329318/v1_covered_8c084f1e-7607-4d4a-b630-724799c91a04.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"TPLIF microscopic safe operating area – based on CT imaging studies","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":true,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"journal-of-orthopaedic-surgery-and-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"josr","sideBox":"Learn more about [Journal of Orthopaedic Surgery and Research](http://josr-online.biomedcentral.com)","snPcode":"13018","submissionUrl":"https://submission.nature.com/new-submission/13018/3","title":"Journal of Orthopaedic Surgery and Research","twitterHandle":"@MSKmedBMC","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Endo-LIF, TPLIF༛Kambin’s triangle༛visible trephine༛Three-dimensional reconstruction of lumbar spine CT","lastPublishedDoi":"10.21203/rs.3.rs-4329318/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4329318/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eEndoscopic spine lumbar interbody fusion (Endo-LIF) is well-regarded within the academic community. However, it presents challenges such as intraoperative disorientation, high rates of nerve damage, a steep learning curve, and prolonged surgical times, often during the creation of the operative channel. Researchers have developed new techniques to enhance the efficiency of establishing the operative channel. However, these often lack robust anatomical data support. Furthermore, the undefined safe operational zones under endoscopy continue to pose risks to surgical safety.\u003c/p\u003e\u003ch2\u003eObjective\u003c/h2\u003e \u003cp\u003eThis study analyzes the anatomical data of Kambin\u0026rsquo;s triangle via CT imaging to define the parameters of the safe operating area for Transforaminal Posterior Lumbar Interbody Fusion (TPLIF), providing crucial insights for clinical practice.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eIdentify the clearest coronal plane at the L4-L5 intervertebral space for examining the exiting and traversing nerve roots, and observe Kambin\u0026rsquo;s triangle along with the inscribed circle. Record the position of point \u0026ldquo;J\u0026rdquo; on the adjacent facet joint as the center \u0026ldquo;O\u0026rdquo; of the circle shifts by angle \u0026ldquo;β\u0026rdquo;. Measure the diameter of the inscribed circle \u0026ldquo;d\u0026rdquo; (mm), the abduction angle \u0026ldquo;β\u0026rdquo; (\u0026deg;), and the distances \u0026ldquo;L1\u0026rdquo; and \u0026ldquo;L2\u0026rdquo; (mm) from the trephine\u0026rsquo;s edge to the exiting and traversing nerve roots, respectively.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eIn a dataset of 40 cases, the diameter of the inscribed circle 'd' measured 11.62 mm (11.35, 12.04), significantly exceeding the 8 mm diameter of the visible trephine (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The angle 'β' was 32.02\u0026deg; (\u0026plusmn;\u0026thinsp;0.90). The 'J' point, acting as the safe center, was consistently located in the outer upper quadrant of the demarcated facet joint (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Safe distances 'L1' and 'L2' measured 1.40 mm (1.34, 1.43) and 2.30 mm (2.14, 2.34), respectively, indicating that using an 8 mm diameter visible trephine would not damage the exiting or traversing nerve roots.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eCT imaging studies conducted by the author's team have defined the safe operational area for TPLIF, offering effective clinical references. This is expected to reduce the learning curve, decrease surgery durations, and improve surgical safety.\u003c/p\u003e","manuscriptTitle":"TPLIF microscopic safe operating area – based on CT imaging studies","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-05-06 07:59:28","doi":"10.21203/rs.3.rs-4329318/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-05-17T23:51:02+00:00","index":"","fulltext":""},{"type":"reviewerAgreed","content":"42063041078932388771210559275796558337","date":"2024-05-03T06:56:06+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"191625284433147988238697929125115627945","date":"2024-05-01T18:52:19+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-05-01T06:29:19+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"138643170557152569583737726272098791375","date":"2024-05-01T06:11:40+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-05-01T06:08:43+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-05-01T03:02:07+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-04-30T00:06:34+00:00","index":"","fulltext":""},{"type":"submitted","content":"Journal of Orthopaedic Surgery and Research","date":"2024-04-26T11:23:30+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"journal-of-orthopaedic-surgery-and-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"josr","sideBox":"Learn more about [Journal of Orthopaedic Surgery and Research](http://josr-online.biomedcentral.com)","snPcode":"13018","submissionUrl":"https://submission.nature.com/new-submission/13018/3","title":"Journal of Orthopaedic Surgery and Research","twitterHandle":"@MSKmedBMC","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"f0a329fa-c14a-4b2b-b47e-20292732a1ce","owner":[],"postedDate":"May 6th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2024-05-31T13:51:37+00:00","versionOfRecord":[],"versionCreatedAt":"2024-05-06 07:59:28","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4329318","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4329318","identity":"rs-4329318","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}