Learning Curve of Percutaneous Endoscopic Lumbar Discectomy Based on the Period (Early vs. Late) and Technique (in-and-out vs. in-and-out-and-in): A Retrospective Comparative Study.
10.3340/jkns.2015.58.6.539
- Author:
Sang Soak AHN
1
;
Sang Hyeon KIM
;
Dong Won KIM
Author Information
1. Department of Neurosurgery, Spine and Spinal Cord Institute, Gangnam Severance Spine Hospital, Yonsei University College of Medicine, Seoul, Korea. ahnsangsoak@hanmail.net
- Publication Type:Comparative Study ; Original Article
- Keywords:
Percutaneous endoscopic lumbar discectomy;
Learning curve;
Intervertebral disc herniation
- MeSH:
Diskectomy*;
Humans;
Learning Curve*;
Learning*;
Leg;
Magnetic Resonance Imaging;
Operative Time;
Retrospective Studies*
- From:Journal of Korean Neurosurgical Society
2015;58(6):539-546
- CountryRepublic of Korea
- Language:English
-
Abstract:
OBJECTIVE: To report the learning curve of percutaneous endoscopic lumbar discectomy (PELD) for a surgeon who had not been previously exposed to this procedure based on the period and detailed technique with a retrospective matched comparative design. METHODS: Of 213 patients with lumbar disc herniation encountered during the reference period, 35 patients who were followed up for 1 year after PELD were enrolled in this study. The patients were categorized by the period and technique of operation : group A, the first 15 cases, who underwent by the 'in-and-out' technique; group B, the next 20 cases, who underwent by the 'in-and-out-and-in' technique. The operation time, failure rate, blood loss, complication rate, re-herniation rate, the Visual Analogue Scale (VAS) for back and leg were checked. The alteration of dural sac cross-sectional area (DSCSA) between the preoperative and the postoperative MRI was checked. RESULTS: Operative time was rapidly reduced in the early phase, and then tapered to a steady state for the 35 cases receiving the PELD. After surgery, VAS scores for the back and leg were decreased significantly in both groups. Complications occurred in 2 patients in group A and 2 patients in group B. Between the two groups, there were significant differences in operative time, improvement of leg VAS, and expansion of DSCSA. CONCLUSION: PELD learning curve seems to be acceptable with sufficient preparation. However, because of their high tendency to delayed operation time, operation failure, and re-herniation, caution should be exercised at the early phase of the procedure.
