Correspondence Address: Dr. E-mail: sakane-m tsukuba-seikei. His research interest focuses on endoscopic spinal surgery and sports medicine. Many clinical reports have indicated that PELD is preferable to conventional open techniques. Transforaminal and interlaminar approaches are mainly used for intracanal disc herniation. The transforaminal approach is also used for foraminal disc herniation, while the posterolateral approach is used for extraforaminal lesions.

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Corresponding author. Correspondence to: Yongbum Park. This article has been cited by other articles in PMC. Method Forty-two patients with radicular pain from lumbar spinal stenosis were enrolled.

Subjects were randomly assigned to one of two groups. All procedures were performed using C-arm KMC The frequency of complications during the procedure and the effect of TFESI at 2 and 4 weeks after the procedure between the two groups were compared.

Short-term outcomes were measured using a visual numeric scale VNS and a five-grade scale. Results VNS was improved 2 weeks after the injection and continued to improve until 4 weeks in both groups. There were no statistical differences in changes of VNS, effectiveness and contrast spread pattern between these two groups.

No correlation was found between the other variables tested and therapeutic effect. Suggested causes include inflammatory changes around nerve root, venous congestion and hematogenous disability. In this method, the injection needle is progressed towards the safe triangle under the inferior surface of the pedicle to locate the superolateral spinal nerve related to symptoms. The risk of damaging dura mater is decreased, as the injection needle goes through the border of the lateral upper intervertebral foramen.

According to Murthy et al. The sex ratio, duration of pain, body mass index BMI , nerve root as cause and period of prevalence are presented in Table 1. Patients showing no therapeutic effects at the 2-week follow-up after the first procedure patient satisfaction index 0 were excluded from the final analysis; those with partial effects i.

Table 1.


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Pain is partially caused by physical compression from degenerative changes and thickening of the ligamentum flavum, zygapophysial joint, and surrounding soft tissues; however, no unifying theory explains the exact etiology of the pain in lumbar spinal stenosis. Steroids interrupt the synthesis of prostaglandins, block conduction of nociceptive fibers, and decrease edema around the nerve root, thereby potentially decreasing pain. The transforaminal approach has shown excellent clinical efficacy, with improved pain scores, improved ability to complete activities of daily living, and decreased pain-related anxiety and depression. The transforaminal approach, although proven to have better clinical efficacy, has the potential for significant complications, including air emboli, cerebral thrombosis, epidural hematoma, nerve root injury, vascular transection, and vasospasm. However, the most devastating complications are cord ischemia or vascular injury from needle trauma or intravascular injection of particulate matter. Given the high risk of complications, selecting the safest technique for performing a transforaminal ESI is important.


Kambin’s Triangle Approach to Transforaminal Epidural Injections

Biography[ edit ] Kambin was born in Tehran , Iran on May 21, He received his doctorate degree in medicine from Tehran University Faculty of Medicine in He continued his post-graduate training as an intern at St. He was recognized by the College of Physicians of Philadelphia and his work in part has been exhibited in the Mutter Museum. Together with several colleagues, he assisted in the establishment of the International Society for Minimal Intervention in Spinal Surgery in and was elected the first president of the society in


Anatomical relationship between Kambin’s triangle and exiting nerve root


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