Total joint replacement of the lumbar spine: report of the first two cases with 16 years of follow-up.

Background: Total joint replacement (TJR) of the lumbar spine is a revolutionary procedure that couples the clinical benefits of neural decompression with preservation of natural motion and sagittal balance at the operative level. The TJR procedure involves reconstruction of the entire motion segment using a posterior bilateral transforaminal approach to access the disc space. The TJR implant (MOTUS, 3Spine, Chattanooga, TN, USA) replaces the function of the intervertebral disc and facet joints, performing biomechanically as a new articulation for the resected, degenerated disc and facets.

Technical Note on the Role of Kambin's Triangle in the Evolution of Total Joint Replacement of the Lumbar Spine.

We provide a historical and technical perspective on the evolution of Kambin's triangle as a safe working corridor for percutaneous access to the intervertebral disc to an anatomically expanded space to accommodate and facilitate open lumbar total joint replacement. The nearly 6-decade progression from intradiscal access in the intact lumbar spine to an enlarged working space following facetectomy to accommodate a transforaminal lumbar interbody fusion, and eventual further expansion via pedicle vertebral body osteotomy to support motion preservation with total joint replacement, represents a unique evolutionary pathway in surgical technique development. For each of these steps in evolution, we detail and provide the historical context of the corresponding surgical modifications required to expand the original anatomical boundaries of Kambin's triangle.