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Sakane. Mini-invasive Surg 2017;1:99-102 Mini-invasive Surgery
DOI: 10.20517/2574-1225.2017.19
www.misjournal.net
Topic: Percutaneous endoscopic system for spinal diseases Open Access

Anatomical relationship between Kambin’s

triangle and exiting nerve root

Masataka Sakane

Department of Orthopaedic Surgery, Tsukuba Gakuen Hospital, Tsukuba 305-0854, Japan.
Correspondence to: Dr. Masataka Sakane, Department of Orthopaedic Surgery, Tsukuba Gakuen Hospital, 2573-1 Kamiyokoba, Tsukuba 305-0854,
Japan. E-mail: sakane-m@tsukuba-seikei.jp
How to cite this article: Sakane M. Anatomical relationship between Kambin’s triangle and exiting nerve root. Mini-invasive Surg 2017;1:99-102.

Article history: Received: 5 May 2017 Accepted: 10 May 2017 Published: 30 Sep 2017

Dr. Masataka Sakane is the Director of Department of Orthopedic Surgery and Rehabilitation, Tsukuba Gakuen
Hospital, Japan. He obtained his MD and PhD in the University of Tsukuba (Ibaraki, Japan). His research interest
focuses on endoscopic spinal surgery and sports medicine.

INTRODUCTION transforaminal approach.

Percutaneous endoscopic lumbar discectomy Kambin’s triangle is a three-dimensional anatomical
(PELD) was introduced by Kambin and Brager and right triangle located over the dorsolateral
[1]
Hijikata et al. prior to the 1980s and is a minimally intervertebral disc of the lumbar spine. This concept
[2]
invasive technique for lumbar disc herniation. is widely accepted for not only PELD but also
Many clinical reports have indicated that PELD is epidural injection and interbody fusion techniques. In
preferable to conventional open techniques. [3-5] an L4-L5 disc herniation, the L4 nerve root forms the
hypotenuse of the Kambin’s triangle, which maybe
There are three approaches for PELD: transforaminal, at potential risk for injury.
interlaminal, and posterolateral. Transforaminal and
interlaminar approaches are mainly used for intracanal ANATOMY OF KAMBIN’S TRIANGLE
disc herniation. The transforaminal approach is
also used for foraminal disc herniation, while the Kambin’s safety zone is the area surrounding the
posterolateral approach is used for extraforaminal superior endplate of the inferior vertebral body,
lesions. The transforaminal approach is typically used superior articulating facet, and exiting nerve root
to access intervertebral discs through the foramen (ENR) [Figure 1]. Based on specimens from cadavers,
without sacrificing the paravertebral muscles and this review discusses the anatomical orientation, area,
facet joint. In 1983, Kambin and Gellmann described and diameter of Kambin’s safety zone and limitations
[6]
a safety triangle called “Kambin’s triangle” for the of the transforaminal approach. [7]
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