Minimally invasive separation surgery for the treatment of spinal metastases with small incision and freehand pedicle screw fixation: the surgical learning curve

Abstract

Background Minimally invasive separation surgery (MISS) is a safe and effective surgical technique, the current optimal treatment for spinal metastases. However, the learning curve for this technique has not been analyzed. This study aimed to define and analyze the surgical learning curve of MISS for the treatment of spinal metastases with small incision and freehand pedicle screw fixation. Methods A continuous series of 62 patients with spinal metastases who underwent MISS were included. Each patient's operative data were accurately counted. The improvement of the patients' neurological function was followed up after surgery to evaluate the surgical treatment effect. Logarithmic curve-fit regression was used to analyze the surgical learning curve of MISS. The number of cases needed to achieve proficiency was analyzed. Based on this cut-off point, this series of cases was divided into the early phase and later phase groups. The influence of the time sequence of MISS on surgical data and surgical efficacy was analyzed. Results The operative time decreased gradually with the number of surgical cases increasing and stabilized after the 20th patient. There was no statistical difference in demographic characteristics and preoperative characteristics between the two groups. The mean operative time in the later phase group was about 39 min shorter than that in the early phase group (mean 227.95 vs. 189.02 min, P = 0.027). However, it did not affect other operative data or the surgical treatment effect. Conclusion The learning curve of MISS for spinal metastases is not steep. With the increase of surgeons' experience, the operative time drops rapidly and stabilizes within a certain range. MISS can be safely and effectively performed at the beginning of a surgeon's caree.

Mini-open compared with the trans-tubular approach in patients with spinal metastases underwent decompression surgery---a retrospective cohort study

“…Lin J et al analyzed 62 patients with spinal metastases who underwent mini-open surgery. The operative time decreased gradually with the number of surgical cases increasing and stabilized after the 20th patient [ 13 ]. The complication rate will improve with the growth of this trans-tubular learning curve in the future.…”

“…An experienced spinal tumor surgeon under general anesthesia performed all surgeries. Pedicle screws were percutaneously placed under fluoroscopy or freehand pedicle screw fixation [ 13 ]. Circum-spinal decompression was achieved through the trans-tubular approach and the Mini-open approach.…”

Ten-step minimally invasive slalom unilateral laminotomy for bilateral decompression (sULBD) with navigation

“…Navigation can aid in speeding up this process through adding a layer of safety to the surgeon as navigation can confirm and control the extent of decompression. It has been suggested that after twenty to thirty procedures performed by a single surgeon, the operative time and results reach a more consistent stage on the learning curve [ 29 ]. Despite a higher complication rate at the beginning of the learning curve, clinical and radiographic long-term outcomes are not affected by the learning curve [ 30 ].…”

Ten-Step Minimally Invasive Slalom Unilateral Laminotomy for Bilateral Decompression (sULBD) with Navigation

“…Strategies to accelerate the learning curve include the understanding of three-dimensional anatomy, surgical aptitude along with manual dexterity, and guidance by a pro cient surgeon along the way [27,28]. It has been suggested that after twenty to thirty procedures performed by a single surgeon, the operative time and results reach a more consistent stage on the learning curve [29]. Despite a higher complication rate at the beginning of the learning curve, clinical and radiographic long-term outcomes are not affected by the learning curve [30].…”