- Department of Neuroscience, Winthrop Neuroscience, Winthrop University Hospital, Mineola, New York, USA
Correspondence Address:
Nancy E. Epstein
Department of Neuroscience, Winthrop Neuroscience, Winthrop University Hospital, Mineola, New York, USA
DOI:10.4103/sni.sni_39_17
Copyright: © 2017 Surgical Neurology International This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.How to cite this article: Nancy E. Epstein. Learning curves for minimally invasive spine surgeries: Are they worth it?. 26-Apr-2017;8:61
How to cite this URL: Nancy E. Epstein. Learning curves for minimally invasive spine surgeries: Are they worth it?. 26-Apr-2017;8:61. Available from: http://surgicalneurologyint.com/surgicalint-articles/learning-curves-for-minimally-invasive-spine-surgeries-are-they-worth-it/
Abstract
Background:Minimally invasive surgery (MIS) spine procedures were developed to limit operative time, the extent of dissection, and reduce perioperative morbidity. Here, we asked what are the “learning curves” for these MIS spine procedures?
Methods:We reviewed studies in the literature that discussed the “learning curves” attributed to performing different MIS spine surgical procedures. Of interest, the majority were single-surgeon series.
Results:Very few articles assessed the learning curves for different MIS spine procedures. One study reported no learning curve for open vs. MIS discectomy/laminotomy. Another study indicated that 20–30 cases were required for a surgeon to become proficient in performing a variety of MIS spine fusions [e.g., cervical MIS fusions, MIS anterior lumbar interbody fusions (ALIF), MIS transforaminal lumbar interbody fusions (TLIF), and MIS pedicle/screw placement in the thoracic/lumbar spine]. Several other studies specifically cited that, to become proficient in the performance of TLIF, surgeons had to have performed between 10, to 32, to 40, to 44 such cases.
Conclusions:There is a very limited literature available that focuses on the “learning curves” associated with the performance of different types of MIS spine procedures. The number of cases required to satisfy the “learning curves” for different operations varied from 0 for MIS vs. open discectomy/laminotomy, to 20-30 for a variety of cervical-thoracic-lumbar procedures, and up to 44 cases for TLIF. Shouldn’t we ask whether better oversight measures and/or mentoring programs could limit the morbidity/AE occurring during these “learning curves” in the future?
Keywords: Adverse events, learning curve, minimally invasive spine surgery, minimizing, morbidity, mortality, under-reporting
INTRODUCTION
Minimally invasive spine surgery (MIS) theoretically limits operative time/dissection, and reduces perioperative morbidity and mortality. Here, we focused on the “learning curves,” defined as the number of cases required to become proficient (e.g., reduce operative time, estimated blood loss, morbidity/adverse events) for performing various MIS spinal procedures. As some studies documented comparable long-term outcomes for open vs. MIS spinal operations, how do we determine wheter (not if) the “learning curve’ is “worth it”?
MIS SPINE SURGERY ASSOCIATED WITH SIGNIFICANT ADVERSE EVENTS
The adverse events (AE) attributed to MIS spine surgery need to be better recognized [
MINIMAL TO STEEP LEARNING CURVES FOR MIS SPINE SURGERY
Several studies, most of which were single-surgeon series, identified “steep” learning curves for MIS spinal surgery [
In 2013, Silva et al., in another single-surgeon series, noted MIS-TLIF correlated with “a steep learning curve.”[
Subsequently, in 2014, Nandyala et al., again in a single-surgeon study, evaluated the learning curve for the first 32 cases of MIS TLIF vs. the latter 33 MIS TLIF performed for disc disease/lumbar spinal stenosis with grade I or II spondylolisthesis.[
Lee et al. in 2014 assessed the learning curve for 90 one-level MIS TLIF performed by one surgeon.[
In 2015, Jin-Tao et al. summarized the findings of 14 studies (12-month follow-up) involving MIS TLIF vs. open PLIF/TLIF.[
Sclafani and Kim in 2014 also discussed the learning curves found in 14 studies involving 966 MIS procedures that included MIS TLIF, percutaneous pedicle screw insertion (thoracic/lumbar), MIS anterior lumbar interbody fusion, and MIS cervical fusions.[
NO LEARNING CURVE FOR MIS LUMBAR DISKECTOMY OR MIS TLIF
Two studies claimed no significant learning curves were associated with performing MIS vs. open lumbar discectomy, and MIS vs. open TLIF [
CONCLUSION
The spine literature documents different learning curves (e.g., complications/AE) for performing various types of MIS spinal surgical procedures.[
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