Learning Curve of Percutaneous Endoscopic Lumbar Discectomy Based on the Period of Surgery: A Retrospective Comparative study
Article Sidebar
Main Article Content
Abstract
BACKGROUND: The learning curve of percutaneous endoscopic lumbar discectomy (PELD) was steep.
OBJECTIVE: To evaluate the learning curve, clinical outcomes and the complications based on the period of surgery in patients with lumbar disc herniation who underwent PELD by a single surgeon.
METHODS: Sixty patients with lumbar disc herniation who underwent PELD were included and assigned to six groups that contained 10 participants each (Groups A to F), which was categorized by the consecutive period of operation. The operative time, length of stay (LOS), resting VAS, activity VAS, ODI score, and complications were recorded during the preoperative period and on day one, at two months, and six months after the surgery. Statistical analysis was used by one-way ANOVA, the Kruskal Wallis test, Friedman’s test, and Chi-square test.
RESULTS: The resting VAS and activity VAS were decreased and statistically significant (p < 0.001). The ODI score was increased significantly (p < 0.001). The clinical results showed no difference between the groups, and the operative time and re-surgery rate showed significant difference between the groups (p < 0.001 and p = 0.02, respectively).
CONCLUSIONS: The learning curve was steep, and the amount of surgical experience had an influence on the learning curve for PELD. However, pathology and surgical techniques should also be considered.
Article Details
References
Walker BF. The prevalence of low back pain: a systematic review of the literature from 1966 to 1998. J Spinal Disord 2000;13:205-17.
Krismer M, van Tulder M. Strategies for prevention and management of musculoskeletal conditions. Low back pain (non-specific). Best Pract Res Clin Rheumatol 2007;21 :77-91.
Saal JA, Saal JS. Nonoperative treatment of herniated lumbar intervertebral disc with radiculopathy. An outcome study. Spine (Phila Pa 1976) 1989 ;14:431-7.
Chen P, Hu Y, Li Z. Percutaneous endoscopic transforaminal discectomy precedes interlaminar discectomy in the efficacy and safety for lumbar disc herniation. Biosci Rep [Internet]. 2019 [cited 2020 May 15];39(2): BSR20181866.
Kuonsongtum V, Paiboonsirijit S, Kesornsak W, Chaiyosboorana V, Rukskul P, Chumnanvej S, et al. Result of full endoscopic uniportal lumbar discectomy: preliminary report. J Med Assoc Thai 2009;92:776-80.
Bamrungthin N, Chaiyabut S, Pornprapai A, Kuonsongtum V. Clinical results of percutaneous endoscopic lumbar discectomy in patients with lumbar disc herniation: a consecutive prospective study. J Med Assoc Thai 2018; 101(3 Suppl 3) : 41.
Ruetten S, Komp M, Merk H, Godolias G. Use of newly developed instruments and endoscopes: full-endoscopic resection of lumbar disc herniations via the interlaminar and lateral transforaminal approach. J Neurosurg Spine 2007;6:521-30.
Ruetten S, Komp M, Merk H, Godolias G. Full-endoscopic interlaminar and transforaminal lumbar discectomy versus conventional microsurgical technique: a prospective, randomized, controlled study. Spine (Phila Pa 1976) 2008;33:931-9.
Hsu HT, Chang SJ, Yang SS, Chai CL. Learning curve of full-endoscopic lumbar discectomy. Eur Spine J 2013 ;22:727-33.
Sclafani JA, Kim CW. Complications associated with the initial learning curve of minimally invasive spine surgery: a systematic review. Clin Orthop Relat Res.2014 ;472:1711-7.
Chaichankul C, Poopitaya S, Tassanawipas W. The effect of learning curve on the results of percutaneous transforaminal endoscopic lumbar discectomy. J Med Assoc Thai 2012 ; 95:( Suppl 10):S206-12
Ahn SS, Kim SH, Kim DW. Learning curve of percutaneous endoscopic lumbar discectomy based on the period (early vs. late) and technique (in-and-out vs. in-and-out-and-in): a retrospective comparative study. J Korean Neurosurg Soc 2015 ;58:539-46.
Low JB, Du J, Zhang K, Yue JJ. ProDisc-L learning curve: 24-month clinical and radiographic outcomes in 44 consecutive cases. Int J Spine Surg 2012;6:184-9.
Wu XB, Fan GX, Gu X, Shen TG, Guan XF, Hu AN, et al. Learning curves of percutaneous endoscopic lumbar discectomy in transforaminal approach at the L4/5 and L5/S1 levels: a comparative study. J Zhejiang Univ Sci B 2016 ;17:553-60.
Choi DJ, Choi CM, Jung JT, Lee SJ, Kim YS. Learning curve associated with complications in biportal endoscopic spinal surgery: challenges and strategies. Asian Spine J 2016;10: 624-9.