Full-Endoscopic Trans-Kambin Triangle Lumbar Interbody Fusion : Surgical Technique

The goal of this protocol is to provide a reproducible method for performing full-endoscopic trans-Kambin triangle lumbar interbody fusion (KLIF). Lumbar interbody fusion (LIF) is a widely established surgical treatment for lumbar spinal instability and stenosis. While lateral access surgeries (e.g., Oblique Lateral Interbody Fusion (OLIF), Extreme Lateral Interbody Fusion (XLIF)) carry risks of injury to the psoas muscle and lumbar plexus, this article presents the protocol for KLIF, which offers an alternative lateral access route via Kambin's triangle. The procedure begins with percutaneous pedicle screw insertion, employing a specific screw locking sequence to facilitate vertebral reduction. The subsequent endoscopic phase strictly focuses on creating a safety aperture of at least 12 mm via controlled partial ventral facetectomy. This ensures sufficient space to accommodate the cannula and cage without injuring the exiting nerve root. The protocol emphasizes precise stepwise execution to ensure safe and reproducible outcomes. An expandable cage is then inserted to restore disc height. This technique is applicable for patients with degenerative lumbar conditions requiring minimally invasive lumbar interbody fusion with reduced soft tissue disruption. Anatomically, KLIF is distinct from conventional TLIF, which typically requires facetectomy and retraction of the dural sac. KLIF utilizes a "facet-preserving" approach that accesses the disc lateral to the superior articular process, thereby minimizing bleeding and dural tear risks. Consequently, the procedure generally allows for a drain-free postoperative course. KLIF provides a minimally invasive and safe strategy for lumbar fusion. This protocol provides a standardized framework for performing KLIF and may support its adoption in minimally invasive spine surgery.