내시경을 이용한 경피적 요추 절제술에서의 학습곡선 Learning curve for percutaneous endoscopic lumbar discectomy

Brief review

이 논문은 PELD에서의 learning curve에 대한 논문 입니다.

요새 계속 PELD learning curve에 대한 논문을 보고 있는데, 각 논문별로 언급된 항목에 조금씩 차이가 있네요. 여기서는 수술시간, 1년 후의 임상적 결과, 수술 성공률, 수술 실패율, 합병증 발생률, 재발률 등의 항목을 조사하였습니다. 

이 논문이 2008년에 출판되었는데, 최근에 출판된 PELD learning curve관련 논문들과 큰 차이는 없어보입니다.

Clinical success를 아래의 기준으로 판단했습니다.

1. 통증지수(VAS)의 향상률이 2점 이상

2. 장애지수(ODI)의 향상률이 25% 이상

3. 환자의 주관적인 회복률이 50% 이상

4. 주요한 합병증이 없음

그런데 주관적인 회복률을 어떻게 평가했는지 안나와있네요.. clinical outcome 평가 시 처럼 환자에게 전화하여 환자가 느끼는 회복률을 적용한 것 일까요

그리고 특이한점은 일반적으로 의학통계에 널리 사용되는 SPSS가 아니라 SAS라는 프로그램을 사용하여 분석을 했습니다.

아래의 링크 따라가셔서 전체 내용 확인하세요^^

*Title: Learning curve for percutaneous endoscopic lumbar discectomy

내시경을 이용한 경피적 요추 절제술에서의 학습곡선

*Authors: Lee DY, Lee SH

*Bibliography: Neurol Med Chir (Tokyo). 2008Sep;48(9):383-8; discussion 388-9.

Background of data

Percutaneous endoscopic lumbar discectomy (PELD) is one of the surgical options for soft lumbar disk herniation, but the learning curve is perceived to be steep.

Methods

▶Subjects: 51 PELD cases performed for single-level intracanalicular lumbar disk herniation causing radiculopathy.

▶Divided into 3 groups: each 17 patients

▶Evaluating parameters: operating time, failure rate, complication rate, and 1-year reherniation rate.

▶1 year clinical success rate was assessed by telephone interviews

Results

▶4 patients required subsequent open discectomy due to PELD failure.

▶2 minor complications.

▶1 year clinical success: achieved in 42 of the 47 patients

▶Reherniation developed in 5 patients

-A significant reduction in operating time was observed after 17 patients had been treated (p = 0.0004).

▶Failure rate, complication rate: no significant differences between the 3 groups

▶1year clinical success rate, reherniation rate: no significant differences

Conclusion

The PELD learning curve seems to be stable and acceptable with proper pre-PELD training.

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.

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.

*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

We retrospectively reviewed the medical records of 120 patients (surgeon A with his first 60 patients, surgeon B with his first 60 patients) with sciatica and single-level L4/5 disk herniation who underwent PELD by the two surgeons with different training level of minimally invasive spine surgery (Group A: surgeon with little professional training of PELD; Group B: surgeon with 2 years of demonstration teaching of PELD).

RESULTS

Significant differences were observed in the operation time (p=0.000), postoperative hospital stay (p=0.026) and reoperation rate (p=0.050) between the two groups.

In the operation time, 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. In the postoperative hospital stay, the significant differences were observed in the 1-20 patients group between Group A and Group B (p=0.011). Significant differences were observed between preoperative and postoperative VAS back score, VAS leg score and JOA score. Higher improvement in the VAS leg score was observed in Group B than Group A (p=0.031). In the rate of reoperation, the 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.

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.