Exiting nerve root injury during full-endoscopic trans-Kambin’s triangle lumbar interbody fusion (FE-KLIF) and how to avoid it:a multicenter study

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