Learning curve of trans-sacral epiduroscopic laser decompression in herniated lumbar disc disease

Abstract

Background: Trans-sacral epiduroscopic laser decompression (SELD) using slender epiduroscope and a holmium YAG laser is one of the minimally invasive surgical options for lumbar disc herniation. However, the learning curve of SELD and the effect of surgical proficiency on clinical outcome have not yet been established. We investigated patients with lumbar disc herniation undergoing SELD to report the clinical outcome and learning curve. Methods: Retrospective analysis of clinical outcome and learning curve were performed at a single center from clinical data collected from November 2015 to November 2018. A total of 82 patients who underwent single-level SELD for lumbar disc herniation with a minimum follow-up of 6.0 months were enrolled. Based on the findings that the cut-off of familiarity was 20 cases according to the cumulative study of operation time, patients were allocated to two groups: early group (n = 20) and late group (n = 62). The surgical, clinical, and radiological outcomes were retrospectively evaluated between the two groups to analyze the learning curve of SELD.Results: According to linear and log regression analyses, the operation time was obtained by the formula: operation time = 58.825 - (0.181 × [case number]) (p < 0.001). The mean operation time was significantly different between the two groups (mean 56.95 minutes; 95% confidence interval [CI], 49.12–64.78 in the early group versus mean 45.34 minutes; 95% CI, 42.45–48.22 in the late group; p = 0.008, non-parametric Mann-Whitney U test).Baseline characteristics, including demographic data, clinical factors, and findings of preoperative magnetic resonance imaging, did not differ between the two groups. Also, there was no significant difference in terms of surgical outcomes, including complication and failure rates, as well as clinical and radiological outcomes between the two groups.Conclusion: The learning curve of SELD was not as steep as that of other minimally invasive spinal surgery techniques, and the experience of surgery was not an influencing factor for outcome variation.

Feasibility of intrathecal therapeutic injections in spinal muscular atrophy patients via a percutaneous transsacral hiatus route: An initial neuroimaging morphometric study

“…We then identified a cohort of 19 consecutive SMAps (Table 1) who had lumbosacral spine CT imaging, including There are several case reports of transsacral hiatus approaches for contrast medium myelography, 17 subarachnoid anesthesia, 18 and epiduroscopic laser decompression. 19 When taken together with the radiological evidence presented by Trinh et al for HCs, our findings show the presence of significantly straighter sacra in SMAps.…”

Sacral Epidural Laser Discectomy Efficacy in Non-Operated Lumbar Disc Herniation-A Single Center Experience

“…Although SELD is an easier procedure than other endoscopic surgical procedures, it requires access through the sacral hiatus, safe entry into the ventral epidural space, reaching the target area with a flexible endoscope, and the ability to use a very narrow and enlarged endoscopic view. In a study evaluating the effectiveness of SELD learning curve and surgical adequacy on clinical response, depending on the operation time and results, the learning curve of SELD is not as difficult as other minimally invasive spinal surgeries and the procedure time gets shorter as the number of operations increases found to have no effect (22).Many factors such as demographic and ethnic characteristics of the patients, the level of the disc, the degree of degeneration and the morphology of the pathology affect the clinical response variability of the patients (23).Although no significant difference was found in terms of efficacy in a study comparing SELD at the L5-S1 level with the microscopic open interlaminar approach, SELD seems to be more advantageous because it provides healing without scar tissue and a quick return to daily life (26).At the L5-S1 level, the location of the epiduroscope is more advantageous than other anatomical levels, it is closer to the sacral hiatus and has a wider disc space. At other anatomical levels (L1-L5), the epiduroscope has to pass through multiple intervertebral structures (26).…”