The following case would be the first case in Japan. Full-endoscopic debridement could subside the infection and several weeks later, chip bones were inserted through the Kambin triangle under full-endoscopic guidance in 2009. They called PED-fusion or endo-fusion at the time. They did not use a cage and percutaneous pedicle screws.

After 2013, percutaneous pedicle screws and cages started to use for the dull-endoscopic fusion. Since then, in the literature, so many reports have been published on the similar technique. The procedure is called as PETLIF, EndoLif, PELIF, FELIF, FETLIF and so one. All procedure is similar as the insertion of the cage through the Kambin triangle; thus, I proposed to use trans-Kambin fusion (KLIF) in 2019.

The following case is 57 y.o. female, high school teacher. The slippage in the neutral position is grade I; however, in flexed position it is grade II, almost 30%. Her symptom is just intermittent claudication, and there is no symptom at rest. Thus, FE-KLIF without direct decompression is conducted.

During the procedure, the slippage is reduced step by step. Finally, the slippage is reduced almost 0% being anatomically normal position. Afte surgery, her chief complaint is completely solved; then, she could return to the original activity.

Since FE-KLIF does not require facetectomy and laminectomy, there is no need for worrying about post-surgical hematoma. We do not use drainage after the surgery.

First, we inserted two PPSs from the right side using 20ml of 0.5% lidocaine. Next, trans-Kambin cage insertion was conducted from the left side using 20ml of 0.5% lidocaine. Finally, using the additional 20ml of 0.5% lidocaine, PPSs from the left side were inserted. For this elderly case with poor general anesthesia, FE-LIF was possible under local anesthesia with deep sedation by anesthesiologist.