집도의의 최소침습 척추수술의 술기수준에 따른 PELD의 학습곡선 Learning curve for percutaneous endoscopic lumbar discectomy depending on the surgeon's training level of minimally invasive spine surgery

Brief review

*Title: Learning curve for percutaneous endoscopic lumbar discectomy depending on the surgeon's training level of minimally invasive spine surgery
집도의의 최소침습 척추수술의 술기수준에 따른 PELD의 학습곡선

*Authors: Wang H, Huang B, Li C, Zhang Z, Wang J, Zheng W, Zhou Y

*Bibliography: Clin Neurol Neurosurg. 2013 Oct;115(10):1987-91.

PURPOSE

To evaluate the differences of learning curve for PELD depending on the surgeon' s training level of minimally invasive spine surgery.

METHODS

▶Reviewed the medical records: 120 patients with sciatica and L4-5 disk herniation who underwent PELD

▶Divide the group as surgeons’s training level

-Group A: surgeon with little professional training of PELD

-Group B: surgeon with 2 years of demonstration teaching of PELD

▶Patients can be divided into 3 stages: 1–20(earlier stage) / 21–40(middle stage) /41–60(latest stage)

RESULTS

▶Age, Sex, symptom duration, herniated disc location, rates of smokers/ patients with accompanying disease/ history of injury: No statistically significant differences

▶Op time: Significant differences (p=0.000)

-significant differences were observed between the 1-20 patients group and 41-60 patients group in Group B (p=0.041), but there were no significant differences among the 1-20 patients group, 21-40 patients group and 41-60 patients group in Group A

▶Hospital stay: Significant differences (p=0.026)

-Significant differences in the 1-20 patients group between Group A and Group B (p=0.011)

▶Reoperation rate: Significant differences (p=0.050)

-Significant difference was observed between the 1-20 patients group and 41-60 patients group in Group A (p=0.028) but there were no significant differences among the 1-20 patients group, 21-40 patients group and 41-60 patients group in Group B.

▶Clinical outcomes: Significant differences between pre/post VAS back, leg, JOA score. 

-Higher improvement in the VAS leg score was observed in Group B than Group A (p=0.031).

CONCLUSIONS

-The surgeons' training level of minimally invasive spine surgery was an important factor for the success of PELD

-Especially the demonstration teaching of PELD for the new minimally invasive spine surgeons.