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Updated: Apr 24, 2026
Uniportal Full Endoscopic Posterolateral Transforaminal Lumbar Interbody Fusion
Published on: June 6, 2025
Exiting nerve root injury during full-endoscopic trans-Kambin's triangle lumbar interbody fusion (FE-KLIF) and how to
Kozaburo Mizutani1,2, Masatoshi Morimoto1,3, Seiji Yamaya4
1Department of Orthopedics, Tokushima University, Tokushima, Japan.
Abstract:
Full-endoscopic trans-Kambin's lumbar interbody fusion (FE-KLIF) is a type of minimally invasive fusion surgery that requires only a 14-mm skin incision for cage insertion. The only surgery-related complication of concern with FE-KLIF is exiting nerve root injury (ENRI). We investigated the incidence of ENRI in 131 cases that underwent FE-KLIF at 10 hospitals. After encountering 5 cases of ENRI, all of which occurred during insertion of an open cannula, we devised a novel type of open cannula, which we call a rescue cannula, to avoid ENRI. There were 5 cases of ENRI (5.7%) in the 88 patients who underwent FE-KLIF before use of the rescue cannula. We have put the rescue cannula in the FE-KLIF system, and one can use the rescue cannula when electromyography alarms. Under such strategy to avoid the ENRI for using the rescue cannula, none of these 43 cases developed ENRI. FE-KLIF is a minimally invasive fusion surgery in which ENRI is the only worrisome complication. Use of a rescue cannula could be the solution to avoiding ENRI. J. Med. Invest. 73 : 26-31, February, 2026.
Insights
Full-endoscopic trans-Kambin
Area of Science:
- Spinal Surgery
- Minimally Invasive Procedures
- Neurosurgery
Background:
- Full-endoscopic trans-Kambin's lumbar interbody fusion (FE-KLIF) is a minimally invasive spinal surgery.
- Exiting nerve root injury (ENRI) is the primary complication associated with FE-KLIF.
Purpose of the Study:
- To investigate the incidence of exiting nerve root injury (ENRI) during full-endoscopic trans-Kambin's lumbar interbody fusion (FE-KLIF).
- To evaluate the effectiveness of a novel "rescue cannula" in preventing ENRI during FE-KLIF.
Main Methods:
- A retrospective analysis of 131 FE-KLIF cases across 10 hospitals.
- Comparison of ENRI incidence before and after the introduction of a novel rescue cannula.
Main Results:
- The initial incidence of ENRI was 5.7% (5 cases) in 88 patients before rescue cannula use.
- Following the implementation of the rescue cannula strategy, no ENRI cases occurred in 43 patients.
Conclusions:
- Exiting nerve root injury is the main complication of FE-KLIF.
- The novel rescue cannula appears to be an effective solution for preventing ENRI during FE-KLIF procedures.
