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Percutaneous endoscopic transforaminal discectomy and unilateral biportal endoscopic discectomy for lumbar disc herniation: a comparative analysis of learning curves

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Abstract

Objective

The purpose of this study was to investigate the learning curve of percutaneous endoscopic transforaminal discectomy (PETD) and interlaminar unilateral biportal endoscopic discectomy (UBED) in the treatment of lumbar disc herniation (LDH).

Methods

Between 2018 and 2023, 120 consecutive patients with lumbar disc herniation (LDH) treated by endoscopic lumbar discectomy were retrospectively included. The PETD group comprised 87 cases, and the UBED group comprised 33 cases. Cumulative sum analysis was used to evaluate the learning curve, with the occurrence of complications or unresolved symptoms defined as surgical failure, and variables of different phases of the learning curve being compared.

Results

The learning curve analysis identified the cutoff point at 40 cases in the PETD group and 15 cases in the UBED group. In the mastery phase, both PETD and UBED demonstrated a significant reduction in operation times (approximately 38 min for PTED and 49 min for UBED). In both PETD and UBED groups, the surgical failure rates during the learning and mastery phases showed no statistically significant differences. The visual analogue scale at the last follow-up was significantly lower than before surgery in both the PETD and UBED groups.

Conclusion

PETD and UBED surgery are effective in the treatment of LDH with a low incidence of complications. However, achieving mastery in PETD necessitates a learning curve of 40 cases, while UBED requires a minimum of 15 cases to reach proficiency.

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Funding

This work was supported by the Clinical Research Incubation Program, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China (CYFH202316) and Beijing Municipal Science and Technology Commission Capital Clinical Diagnostic and Treatment Technology Research and Demonstration Application (Z211100002921027).

Author information

Author notes

  1. Zhangfu Li and Honghao Yang contributed equally to this study as co-first authors.

Authors and Affiliations

  1. Department of Orthopedic Surgery, Beijing Chaoyang Hospital, Capital Medical University of China, 8 Gong Ti Nan Road, Chaoyang District, Beijing, 100020, China

    Zhangfu Li, Honghao Yang, Yaoshen Zhang, Chaofan Han, Yuzeng Liu, Li Guan, Jincai Yang, Yong Hai & Aixing Pan

  2. Joint Laboratory for Research and Treatment of Spinal Cord Injury in Spinal Deformity, Capital Medical University of China, Beijing, China

    Zhangfu Li, Honghao Yang, Yaoshen Zhang, Chaofan Han, Yuzeng Liu, Li Guan, Jincai Yang, Yong Hai & Aixing Pan

  3. Laboratory for Clinical Medicine, Capital Medical University of China, Beijing, China

    Zhangfu Li, Honghao Yang, Yaoshen Zhang, Chaofan Han, Yuzeng Liu, Li Guan, Jincai Yang, Yong Hai & Aixing Pan

  4. Center for Spinal Deformity, Capital Medical University, Beijing, China

    Zhangfu Li, Honghao Yang, Yaoshen Zhang, Chaofan Han, Yuzeng Liu, Li Guan, Jincai Yang, Yong Hai & Aixing Pan

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  1. Zhangfu Li
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Correspondence to Yong Hai or Aixing Pan.

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Li, Z., Yang, H., Zhang, Y. et al. Percutaneous endoscopic transforaminal discectomy and unilateral biportal endoscopic discectomy for lumbar disc herniation: a comparative analysis of learning curves. Eur Spine J (2024). https://doi.org/10.1007/s00586-024-08293-8

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  • DOI: https://doi.org/10.1007/s00586-024-08293-8

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