Complications Associated With the Initial Learning Curve of Minimally Invasive Spine Surgery: A Systematic Review

Abstract

Background There is an inherently difficult learning curve associated with minimally invasive surgical (MIS) approaches to spinal decompression and fusion. The association between complication rate and the learning curve remains unclear. Questions/purposes We performed a systematic review for articles that evaluated the learning curves of MIS procedures for the spine, defined as the change in frequency of complications and length of surgical time as case number increased, for five types of MIS for the spine. Methods We conducted a systematic review in the PubMed database using the terms ''minimally invasive spine surgery AND complications AND learning curve'' followed by a manual citation review of included manuscripts. Clinical outcome and learning curve metrics were categorized for analysis by surgical procedure (MIS lumbar decompression procedures, MIS transforaminal lumbar interbody fusion, percutaneous pedicle screw insertion, laparoscopic anterior lumbar interbody fusion, and MIS cervical procedures). As the most consistent parameters used to evaluate the learning curve were procedure time and complication rate as a function of chronologic case number, our analysis focused on these. The search strategy identified 15 original studies that included 966 minimally invasive procedures. Learning curve parameters were correlated to chronologic procedure number in 14 of these studies. Results The most common learning curve complication for decompressive procedures was durotomy. For fusion procedures, the most common complications were implant malposition, neural injury, and nonunion. The overall postoperative complication rate was 11% (109 of 966 cases). The learning curve was overcome for operative time and complications as a function of case numbers in 20 to 30 consecutive cases for most techniques discussed within this review. Conclusions The quantitative assessment of the procedural learning curve for MIS techniques for the spine remains challenging because the MIS techniques have different learning curves and because they have not been assessed in a consistent manner across studies. Complication rates may be underestimated by the studies we identified because surgeons tend to select patients carefully during the early learning curve period. The field of MIS would benefit from a standardization of study design and collected parameters in future learning curve investigations.

What Is the Expected Learning Curve in Computer-assisted Navigation for Bone Tumor Resection?

“…The median registration error was 0.6 mm (range, 0.3-1.1 mm). This error is similar to that observed in previous publications [1,2,10,17,21,22]. In our study, the amount of registration error did not improve overtime (Fig.…”

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“…However, previous reports about navigation in trauma and arthroplasty have suggested that computer assistance techniques do not improve patient-reported outcomes and that these techniques add surgical time [6,8,13,20]. Intraoperative problems and increased surgical time might be expected with the adoption of new technology, and a learning curve may apply to surgeons who attempt new methods like navigation [1,12,17].…”

A comparison of the Wiltse versus midline approaches in degenerative conditions of the lumbar spine

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Minimally invasive techniques for lumbar decompressions and fusions

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