European Spine Journal

, Volume 24, Supplement 3, pp 361–368 | Cite as

The learning curve of lateral access lumbar interbody fusion in an Asian population: a prospective study

  • Chong Leslie Lich NgEmail author
  • Boon Chuan Pang
  • Paul Julius A. Medina
  • Kimberly-Anne Tan
  • Selvaraj Dahshaini
  • Li-Zhen Liu
Original Article



Lateral access lumbar interbody fusion (LLIF) is a minimally invasive technique that has an increasing popularity. It offers unique advantages and circumvents risk of certain serious complications encountered in other conventional spinal approaches. This study provides a statistical analysis defining the lateral access learning curve in the Asian population.


This prospective study included 32 consecutive patients who underwent LLIF from April 2012 to August 2014. The surgeries were performed by two senior spine surgeons and follow-up was conducted at 6 weeks, 3, 6, 9 months and 1 year post-operation.


The breakpoint in operating time occurred at the 22nd level operated, from a mean of 71 min in the early phase group to a mean of 42 min in the steady state group. LLIF at L4/5 level is technically more demanding but technically feasible as competency is achieved.


During the learning process, there was no compromise of perioperative or clinical outcomes. It should be feasibly incorporated into a spine surgeon’s repertoire of procedures for the lumbar spine.


Lateral access lumbar surgery Minimally invasive surgery Lumbar spine Learning curve 



We would like to acknowledge Richard Tjahjono, medical illustrator, for his drawings used in this article.

Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  • Chong Leslie Lich Ng
    • 1
    Email author
  • Boon Chuan Pang
    • 2
  • Paul Julius A. Medina
    • 3
  • Kimberly-Anne Tan
    • 4
  • Selvaraj Dahshaini
    • 1
  • Li-Zhen Liu
    • 5
  1. 1.Spine Surgery, Deptartment of OrthopedicsTan Tock Seng HospitalSingaporeSingapore
  2. 2.National Neuroscience InstituteSingaporeSingapore
  3. 3.Department of OrthopedicsTan Tock Seng HospitalSingaporeSingapore
  4. 4.Faculty of Medicine, UNSW MedicineUniversity of New South Wales, UNSWSydneyAustralia
  5. 5.Tan Tock Seng HospitalSingaporeSingapore

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