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.