Learning curve for percutaneous endoscopic lumbar discectomy depending on the surgeon's training level of minimally invasive spine surgery

Wang, Hongwei; Huang, Bo; Li, Changqing; Zhang, Zhengfeng; Wang, Jian; Zheng, Wenjie; Zhou, Yue

doi:10.1016/j.clineuro.2013.06.008

Cited by 132 publications

(86 citation statements)

References 18 publications

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“…Surgeons are exposed to different landmarks, another direction of approach, and a laborious identification of anatomical structures during surgery. 3,15,28 Considering the long learning curve of PTED and potential bias, all surgeries were performed by a single neurosurgeon (B.S.H.) who already had extensive experience in performing the PTED technique.…”

Section: Discussionmentioning

confidence: 99%

Clinical outcomes after percutaneous transforaminal endoscopic discectomy for lumbar disc herniation: a prospective case series

Gadjradj

Tulder²,

Dirven

et al. 2016

FOC

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OBJECTIVE Throughout the last decades, full-endoscopic techniques to treat lumbar disc herniation (LDH) have gained popularity in clinical practice. To date, however, no Class I evidence on the efficacy of percutaneous transforaminal endoscopic discectomy (PTED) has been published, and studies describing its safety and short- and long-term efficacy are scarce. In this study the authors aimed to evaluate the clinical outcomes and safety in patients undergoing PTED for LDH. METHODS Patients who underwent PTED for LDH between January 2009 and December 2012 were prospectively followed. The primary outcomes were the visual analog scale (VAS) score for leg pain and the score on the Quebec Back Pain Disability Scale (QBPDS). Secondary outcomes were the perceived experience with the local anesthesia used and satisfaction with the results after 1 year using Likert-type scales. The pretreatment means were compared with the means obtained 6 and 52 weeks after surgery using paired t-tests. RESULTS A total of 166 patients underwent surgery for a total of 167 LDHs. The mean duration of surgery (± SD) was 51.0 ± 9.0 minutes. The 1-year follow-up rate was 95.2%. The mean reported scores on the VAS and QBPDS were 82.5 ± 17.3 mm and 60.0 ± 18.4 at baseline, respectively. Six weeks after surgery, the scores on the VAS and QBPDS were significantly reduced to 28.8 ± 24.5 mm and 26.7 ± 20.6, respectively (p < 0.001). After 52 weeks of follow-up, the scores were further reduced compared with baseline scores (p < 0.001) to 19.6 ± 23.5 mm on the VAS and 20.2 ± 18.1 on the QBPDS. A total of 4 complications were observed, namely 1 dural tear, 1 deficit of ankle dorsiflexion, and 2 cases of transient paresis in the foot due to the use of local anesthetics. CONCLUSIONS PTED appears to be a safe and effective intervention for LDH and has similar clinical outcomes compared to conventional open microdiscectomy. High-quality randomized controlled trials are required to study the efficacy and cost-effectiveness of PTED.

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Section: Discussionmentioning

confidence: 99%

Clinical outcomes after percutaneous transforaminal endoscopic discectomy for lumbar disc herniation: a prospective case series

Gadjradj

Tulder²,

Dirven

et al. 2016

FOC

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“…They demonstrated that the learning curve of the transforaminal approach was steep while that of the interlaminar approach was flat, which indicated that the transforaminal approach was easier to learn than the interlaminar approach. In addition, Wang et al (2013) found that the training level of minimally invasive spine surgery played a role in increasing the rate of learning. In our study, the learning curve of transforaminal PELD at the L5/S1 level was shallower than that at the L4/5 level (Fig.…”

Section: Discussionmentioning

confidence: 99%

“…Fortunately, the learning curve of the PELD technique can be managed by standard training and eligible subject selection (Kafadar et al, 2006). Many studies have discussed different aspects of the learning curve of PELD (Lee and Lee, 2008;Wang B. et al, 2011;Chaichankul et al, 2012;Hsu et al, 2013;Wang H. et al, 2013). However, no papers have compared the learning curve of PELD in a transforaminal approach at the L4/5 and L5/S1 levels.…”

Section: Introductionmentioning

confidence: 99%

Learning curves of percutaneous endoscopic lumbar discectomy in transforaminal approach at the L4/5 and L5/S1 levels: a comparative study

Fan

et al. 2016

J. Zhejiang Univ. Sci. B

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Abstract:Objectives: This study aimed to compare the learning curves of percutaneous endoscopic lumbar discectomy (PELD) in a transforaminal approach at the L4/5 and L5/S1 levels. Methods: We retrospectively reviewed the first 60 cases at the L4/5 level (Group I) and the first 60 cases at the L5/S1 level (Group II) of PELD performed by one spine surgeon. The patients were divided into subgroups A, B, and C (Group I: A cases 1-20, B cases 21-40, C cases 41-60; Group II: A cases 1-20, B cases 21-40, C cases 41-60). Operation time was thoroughly analyzed. Results: Compared with the L4/5 level, the learning curve of transforaminal PELD at the L5/S1 level was flatter. The mean operation times of Groups IA, IB, and IC were (88.75±17.02), (67.75±6.16), and (64.85±7.82) min, respectively. There was a significant difference between Groups A and B (P<0.05), but no significant difference between Groups B and C (P=0.20). The mean operation times of Groups IIA, IIB, and IIC were (117.25±13.62), (109.50±11.20), and (92.15±11.94) min, respectively. There was no significant difference between Groups A and B (P=0.06), but there was a significant difference between Groups B and C (P<0.05). There were 6 cases of postoperative dysesthesia (POD) in Group I and 2 cases in Group IIA (P=0.27). There were 2 cases of residual disc in Group I, and 4 cases in Group II (P=0.67). There were 3 cases of recurrence in Group I, and 2 cases in Group II (P>0.05). Conclusions: Compared with the L5/S1 level, the learning curve of PELD in a transforaminal approach at the L4/5 level was steeper, suggesting that the L4/5 level might be easier to master after short-term professional training.

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“…1 Authors of other studies have discussed the surgeon's learning curve in endoscopic spine surgery and its impact on patient outcomes; less experience implementing the endoscopic surgical technique will probably result in longer fluoroscopy times, another factor that may affect radiation exposure to the patient and surgeon. 23 The data presented here are intended to provide for the first time information on patient radiation exposure during endoscopic lumbar discectomy procedures. The measured radiation doses presented are actually calculated doses determined by pooling patient dosimeter readings and then dividing the mean radiation dose by the fluoroscopy time (mSv/sec).…”

Section: Discussionmentioning

confidence: 99%

Patient radiation exposure during transforaminal lumbar endoscopic spine surgery: a prospective study

Iprenburg¹,

Wagner

Godschalx³

et al. 2016

FOC

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OBJECTIVE The aim of this study was to describe patient radiation exposure during single-level transforaminal endoscopic lumbar discectomy procedures at levels L2–5 and L5–S1. METHODS Radiation exposure was monitored in 151 consecutive patients undergoing single-level transforaminal endoscopic lumbar discectomy procedures. Two groups were studied: patients undergoing procedures at the L4–5 level or above and those undergoing an L5–S1 procedure. RESULTS For the discectomy procedures at L4–5 and above, the average duration of fluoroscopy was 38.4 seconds and the mean calculated patient radiation exposure dose was 1.5 mSv. For the L5–S1 procedures, average fluoroscopy time was 54.6 seconds and the mean calculated radiation exposure dose was 2.1 mSv. The average patient radiation exposure dose among these cases represents a 3.5-fold decrease compared with the senior surgeon's first 100 cases. CONCLUSIONS Transforaminal lumbar endoscopic discectomy can be used as a minimally invasive technique for the treatment of lumbar radiculopathy in the setting of a herniated lumbar disc without the significant concern of exposing the patient to harmful doses of radiation. One caveat is that both the surgeon and the patient are likely to be exposed to higher doses of radiation during a surgeon's early experience in minimally invasive endoscopic spine surgery.

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Learning curve for percutaneous endoscopic lumbar discectomy depending on the surgeon's training level of minimally invasive spine surgery

Cited by 132 publications

References 18 publications

Clinical outcomes after percutaneous transforaminal endoscopic discectomy for lumbar disc herniation: a prospective case series

Clinical outcomes after percutaneous transforaminal endoscopic discectomy for lumbar disc herniation: a prospective case series

Learning curves of percutaneous endoscopic lumbar discectomy in transforaminal approach at the L4/5 and L5/S1 levels: a comparative study

Patient radiation exposure during transforaminal lumbar endoscopic spine surgery: a prospective study

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