Learning curve and complications of minimally invasive transforaminal lumbar interbody fusion

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>Minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) has the potential advantage of minimizing soft-tissue damage and reducing recovery time compared to open procedures. A steep learning curve has been described for the technique. The aim of the present study was to define the learning curve that describes the progress of a single surgeon performing the MI-TLIF.</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>One hundred fifty consecutive patients with degenerative lumbar disease who underwent 1- or 2-level MI-TLIF were included in the study. Operative time, corrected operative time per level, and complications were analyzed. The learning curve was assessed using a negative exponential curve-fit regression analysis.</jats:p></jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>One hundred ten patients underwent 1-level and 18 patients underwent 2-level MI-TLIF; the remaining 22 underwent a single-level procedure plus an ancillary procedure (decompression at adjacent level, vertebral augmentation through fenestrated pedicle screws, interspinous device at adjacent level). Negative exponential curves appropriately described the relationship between operative time and experience for 1-level surgery and after correction of operative time per level (R<jats:sup>2</jats:sup> = 0.65 and 0.57). The median operative time was 140 minutes (interquartile range 120–173 minutes), and a 50% learning milestone was achieved at Case 12; a 90% learning milestone was achieved at Case 39. No patient required transfusion in the perioperative period. The overall complication rate was 12.67% and the most frequent complication was a dural tear (5.32%). Before the 50% and 90% learning milestones, the complication rates were 33% and 20.51%, respectively.</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>The MI-TLIF is a reliable and effective option for lumbar arthrodesis. According to the present study, 90% of the learning curve can be achieved at around the 40th case.</jats:p></jats:sec>

Accuracy of minimally invasive percutaneous thoracolumbar pedicle screws using 2D fluoroscopy: a retrospective review through 3D CT analysis

“…Percutaneous screw placement is such a technique with multiple authors confirming reduced error over time (24)(25)(26)(27). Our consecutive series showed that 20/25 screws were misplaced within the first 12 months of the series, with two screws misplaced in the last 6 months of the series.…”

“…Based on our data it is not possible to determine the exact numbers of screws that are required to reach an acceptable level of accuracy and reduced morbidity. Studies have estimated that approximately 30 cases are required in minimally invasive discectomy procedures (28) and perhaps one can extrapolate this to MIS percutaneous screw placement using fluoroscopy with initial studies showing a learning curve at between 40 to 50 cases (25,26). We have analysed our own data relating to fellowship training for the accuracy of pedicle screw placement and seen statistically significant differences once trainees place more than 45 screws.…”

Learning Curve in Single-Level Minimally Invasive Tlif: Experience of a Neurosurgeon

“…Economic savings, both direct and indirect, of up to 49% as compared to open procedures have been reported. 7,12 As previously mentioned, to date there is no ideal statistical method to assess learning in medicine and in surgical procedures in particular. For this reason, there are several calculations that have been adapted to this end.…”

“…11 Likewise, longer surgical times have been reported for MI, at least during the first cases, which could be a reflection of technical differences, but some authors associate this with a significant learning curve. [12][13][14][15][16][17][18] The objective of this study was to present and analyze the single level MI-TLIF learning curve for a single neurosurgeon (JASS). To this end, we evaluated various parameters, such as surgical time, amount of bleeding, and days of hospitalization.…”

Non-Surgical and Surgical Treatment of Lumbar Degenerative Disc Disease in the Course of Peripheral Neuropathy

“…Such an operation enables not only a hernia or a sequestrum removal but also a revision of intervertebral space. A wide surgical access enables a full decomposition of a nerve root on his relatively long course, an excision of sometimes present steophytes and also allows the execution of foraminotomy associated with a stenosis of the foramen (Silva et al 2013). …”