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Using Novel Segmentation Technology to Define Safe Corridors for Minimally Invasive Posterior Lumbar Interbody

Troy Q Tabarestani¹, David S Salven¹, David A W Sykes¹

¹Department of Neurosurgery, Duke University School of Medicine, Durham , North Carolina , USA.

Operative Neurosurgery (Hagerstown, Md.)

|December 27, 2023

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Minimally invasive spine surgery uses novel segmentation to map safe corridors. The transfacet approach offers a larger surgical area than Kambin or safe triangles for lumbar interbody fusion.

Area of Science:

Neurosurgery
Spinal Surgery
Minimally Invasive Spine Techniques

Background:

Minimally invasive spine surgery offers advantages like reduced tissue damage and faster recovery.
Percutaneous lumbar interbody fusion and endoscopic transfacet approaches are common posterior access methods.
Risk of nerve root damage exists without precise preoperative visualization.

Purpose of the Study:

To analyze the anatomical borders and dimensions of safe triangle, Kambin, and transfacet corridors.
To utilize novel segmentation technology for enhanced surgical planning.
To determine safe cannula diameters for posterior lumbar interbody fusion approaches.

Main Methods:

Segmentation of nerve roots, theca, disk, and vertebrae on 3D T2-SPACE MRI.

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Measurement of safe triangle, Kambin, and transfacet corridor areas using specialized software.

Delineation of corridor borders to avoid nerve overlap.

Main Results:

The transfacet corridor demonstrated significantly larger mean area (124.1 mm²) and maximum cannula diameter (9.9 mm) compared to Kambin (83.0 mm², 6.8 mm) and safe triangles (49.5 mm², 6.05 mm).
Measurements were performed bilaterally at the operative level in 11 patients.
Statistical significance (P < .001) was found for the differences in corridor dimensions.

Conclusions:

The study defined the 3D borders of the transfacet corridor, including nerve roots and theca.
Preoperative segmentation of anatomical landmarks, particularly nerve roots, aids in selecting the optimal surgical approach.
This analysis supports improved decision-making for minimally invasive posterior lumbar procedures.