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The Learning Curve of Minimally-Invasive Lumbar Microdiscectomy

Published online by Cambridge University Press:  02 December 2014

Gregory S. McLoughlin  and
Daryl R. Fourney
Gregory S. McLoughlin
Affiliation:
Division of Neurosurgery, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
Daryl R. Fourney
Affiliation:
Division of Neurosurgery, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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Abstract

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Object:

The safe integration into practice of a new surgical technique requires an appreciation of the learning curve. The object of this study was to assess the learning curve for minimally invasive microdiscectomy (MIM) utilizing a tubular retractor system.

Methods:

A prospective evaluation of a single surgeon's first 52 consecutive MIM cases for radiculopathy secondary to single-level posterolateral lumbar disc herniation was performed. The learning curve was assessed using operative time, conversion to open rate, complications, and length of hospitalization.

Results:

The duration of operative time decreased over the course of the study (range, 49-151 min). By case 15, operative time was typically 60 min or less. There was only one conversion to an open procedure (Case 2). Complications occurred in three cases. All but nine patients were discharged home on the day of surgery.

Conclusion:

The learning curve for MIM was demonstrated. Further assessment of this curve for a large group of surgeons is necessary before a randomized controlled trial comparing standard microdiscectomy to MIM can be conducted.

Résumé:

RÉSUMÉ: <span class='italic'> <span class='bold'>Objectif</span></span>:

L'intégration sû'une nouvelle technique chirurgicale dans la pratique courante repose sur une bonne estimation de la courbe d'apprentissage. Le but de cette étude était d'évaluer la courbe d'apprentissage de la microdiscectomie endoscopique (MCE) à l'aide d'un système tubulaire de rétraction.

<span class='italic'> <span class='bold'>Méthodes</span></span>:

Il s'agit d'une évaluation prospective de 52 cas consécutifs de MCE exécutées par le même chirurgien pour radiculopathie secondaire à une hernie discale postérolatérale à un seul niveau. La courbe d'apprentissage a été évaluée en considérant le temps opératoire, le taux de recours à la chirurgie conventionnelle, les complications et la durée d'hospitalisation.

<span class='italic'> <span class='bold'>Résultats</span></span>:

La durée du temps opératoire a diminué au cours de l'étude (plage de 49 à 151 minutes). Àpartir du 15e cas, le temps opératoire était habituellement de 60 minutes ou moins. On n'a eu recours à la chirurgie conventionnelle que chez un seul patient (le deuxième). Trois patients ont présenté des complications. Tous les patients sauf neuf sont retournés à domicile le jour même.

<span class='italic'> <span class='bold'>Conclusion</span></span>:

Nous avons décrit la courbe d'apprentissage de la MCE. Il faut évaluer cette courbe chez un échantillon de grande taille avant de procéder à une étude contrôlée randomisée comparant la microdiscectomie standard à la MCE.

Type
Original Articles
Information
Canadian Journal of Neurological Sciences , Volume 35 , Issue 1 , March 2008 , pp. 75 - 78
Copyright
Copyright © The Canadian Journal of Neurological 2008

References

1. Foley, K, Smith, M. Microendoscopic discectomy. Tech Neurosurg. 1997; 3: 301–7.Google Scholar
2. Huang, TJ, Hsu, RW, Li, YY, Cheng, CC. Less systemic cytokine response in patients following microendoscopic versus open lumbar discectomy. J Orthop Res. 2005; 23(2):406–11.CrossRefGoogle ScholarPubMed
3. Javedan, S, Sonntag, V. Lumbar disc herniation: microsurgical approach. Neurosurgery. 2003; 52(1):160–3.Google ScholarPubMed
4. Nowitzke, AM. Assessment of the learning curve for lumbar microendoscopic discectomy. Neurosurgery. 2005; 56(4):755–62.CrossRefGoogle ScholarPubMed
5. Perez-Cruet, MJ, Foley, KT, Isaacs, RE, Rice-Wyllie, L, Wellington, R, Smith, MM, et al. Microendoscopic lumbar discectomy: technical note. Neurosurgery. 2002; 51(5 Suppl):129–36.CrossRefGoogle ScholarPubMed
6. Kraemer, R, Wild, A, Haak, H, Herdmann, J, Krauspe, R, Kraemer, J. Classification and management of early complications in open lumbar microdiscectomy. Eur Spine J. 2003; 12: 239–46.CrossRefGoogle ScholarPubMed
7. Perez-Cruet, M, Fessler, R, Perin, N. Review: complications of minimally invasive spine surgery. Neurosurgery. 2002; 51(5 Suppl):26–36.CrossRefGoogle Scholar
8. Nakagawa, H, Kamimura, M, Uchiyama, S, Takahara, K, Itsubo, T, Miyasaka, T. Microendoscopic discectomy (MED) for lumbar disc prolapse. J Clin Neurosci. 2003; 10(2):231–5.CrossRefGoogle ScholarPubMed
9. Wu, X, Zhuang, S, Mao, Z, Chen, H. Microendoscopic discectomy for lumbar disc herniation: surgical technique and outcome in 873 cases. Spine. 2006; 31(23):2689–94.CrossRefGoogle ScholarPubMed