Minimally invasive lumbar decompression—the surgical learning curve

Kim, Choll W.

doi:10.1016/j.spinee.2016.05.012

Cited by 44 publications

(3 citation statements)

References 2 publications

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“…Even with this training, we acknowledge that the use of endoscopic surgery in this context is new and its adoption should be done judiciously. However, the concept of gradually attaining proficiency is clearly demonstrated throughout the general surgical,24 neurosurgical25 26 and other surgical specialty literatures 27 28. As long as newly trained surgeons have received proper instruction and demonstrated competence in both technique and judgement, it is reasonable for them to proceed in appropriate clinical circumstances when they are comfortable.…”

Section: Discussionmentioning

confidence: 99%

The CURE Protocol: evaluation and external validation of a new public health strategy for treating paediatric hydrocephalus in low-resource settings

et al. 2020

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IntroductionManaging paediatric hydrocephalus with shunt placement is especially risky in resource-limited settings due to risks of infection and delayed life-threatening shunt obstruction. This study evaluated a new evidence-based treatment algorithm to reduce shunt-dependence in this context.MethodsA prospective cohort design was used. The CURE Protocol employs preoperative and intraoperative data to choose between endoscopic treatment and shunt placement. Data were prospectively collected for 730 children in Uganda (managed by local neurosurgeons highly experienced in the protocol) and, for external validation, 96 children in Nigeria (managed by a local neurosurgeon trained in the protocol).ResultsThe age distribution was similar between Uganda and Nigeria, but there were more cases of postinfectious hydrocephalus in Uganda (64.2% vs 26.0%, p<0.001). Initial treatment of hydrocephalus was similar at both centres and included either a shunt at first operation or endoscopic management without a shunt. The Nigerian cohort had a higher failure rate for endoscopic cases (adjusted HR 2.5 (95% CI 1.6 to 4.0), p<0.001), but not for shunt cases (adjusted HR 1.3 (0.5 to 3.0), p=0.6). Despite the difference in endoscopic failure rates, a similar proportion of the entire cohort was successfully treated without need for shunt at 6 months (55.2% in Nigeria vs 53.4% in Uganda, p=0.74).ConclusionUse of the CURE Protocol in two centres with different populations and surgeon experience yielded similar 6-month results, with over half of all children remaining shunt-free. Where feasible, this could represent a better public health strategy in low-resource settings than primary shunt placement.

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Section: Discussionmentioning

confidence: 99%

The CURE Protocol: evaluation and external validation of a new public health strategy for treating paediatric hydrocephalus in low-resource settings

et al. 2020

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“…[ 8 – 10 ] To date, only a few studies on the learning curve for ULBD have been reported, and to our best knowledge, there is no previous study reporting a learning curve of ULBD using a LC-CUSUM. [ 6 , 12 ]…”

Section: Introductionmentioning

confidence: 99%

“…[8][9][10] To date, only a few studies on the learning curve for ULBD have been reported, and to our best knowledge, there is no previous study reporting a learning curve of ULBD using a LC-CUSUM. [6,12] The purpose of this study was to determine the learning curve of ULBD for LSS using a LC-CUSUM analysis and to provide information on how many cases of ULBD were required to achieve competency for performing the procedure efficiently and safely.…”

Section: Introductionmentioning

confidence: 99%

Learning curve for microscopic unilateral laminectomy for bilateral decompression surgery using the cumulative summation test for learning curve

Park

et al. 2022

Medicine

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A retrospective observational study The purpose of this study was to characterize the learning curve for a single level unilateral laminectomy and bilateral decompression in lumbar spinal stenosis using a learning curve cumulative summation test. Unilateral laminectomy and bilateral decompression for lumbar spinal stenosis proposes a potential benefit with minimizing surgery-related instability compared to traditional bilateral laminectomy, by preserving posterior stabilizing structures and contralateral facet joint and neural arch. Due to a narrow surgical corridor, it is considered to exhibit a steep learning curve as other types of minimally invasive procedures. However, there are few reports available regarding learning curve of unilateral laminectomy and bilateral decompression. The learning curve of a single surgeon performing single level unilateral laminectomy and bilateral decompression was assessed using learning curve cumulative summation test analysis. The surgeon had minimal experience in open decompressive laminectomy but no previous experience in unilateral laminectomy and bilateral decompression. Procedure success was defined as an operation time less than 75 minutes. Surgery related complications were recorded. Total 194 consecutive patients, who underwent primary single level unilateral laminectomy and bilateral decompression by a single spine surgeon, were included. The mean operative time for unilateral laminectomy and bilateral decompression was 64.6 ± 23.6 minutes. The mean operative time in the early learning period (≤29 th case) was 80.6 ± 20.9 minutes, and that in the late learning period (after 29 th case) was 61.8 ± 22.7 minutes, respectively. The overall complication rate was 13.9%. Majority of complications occurred in the early learning period. The learning curve cumulative summation test signaled competency for unilateral laminectomy and bilateral decompression at the 29 th operation, indicating that the surgeon reached the competent level. In addition, based on the cumulative summation test, the surgeon seemed to maintain his competency for the procedure. This study showed that surgical experience reduced the operation time and surgery related complications. For inexperienced surgeon to achieve an acceptable outcome in unilateral laminectomy and bilateral decompression, minimum 30 cases of unilateral laminectomy and bilateral decompression are required to reach competent level of surgery.

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