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Is selective nerve root block necessary for learning percutaneous endoscopic lumbar discectomy: a comparative study using a cumulative summation test for learning curve

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Abstract

Purpose

The aim of this study was to investigate the effect of lumbar spine selective nerve root block (SNRB) experience on the learning efficiency of percutaneous endoscopic lumbar discectomy (PELD) for junior trainees.

Methods

A total of 480 patients undergoing single-level PELD performed by eight junior trainees were included. The trainees were divided into two groups based on whether they had previous SNRB experience (group A, yes; group B, no). Surgical proficiency was defined as total operation time less than 65 minutes and cumulative radiation exposure time no more than 40 seconds. The learning curve was analyzed by cumulative summation (CUSUM) test. Clinical evaluations included Macnab classification, visual analog scale (VAS)-low back score, VAS-leg score, and Oswestry Disability Index (ODI). Follow-up information at 12 months was also obtained.

Results

Integral number of cases before achieving an acceptable surgical level in group A (47.75 ± 2.50 cases) was significantly smaller than that in group B (56.50 ± 1.29 cases, p < 0.05), along with less accumulated failure (18.75 ± 0.96 cases vs. 25.50 ± 1.75 cases, p < 0.05). The two groups were comparable in clinical outcomes. Forty-seven cases of complications were observed, with 17 in group A and 30 in group B (p < 0.05).

Conclusion

Previous experience of SNRB improved the performance of PELD with shorter operation time and less radiation exposure. SNRB practice may reduce the complication rate without a significant effect on the recurrence of symptoms and reoperation.

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Funding

This work was supported by the National Natural Science Foundation of China, China (81802120, 81772376) and the Shanghai Municipal Natural Science Foundation (19ZR1456700).

Author information

Author notes

  1. Bin Sun, Huiqiao Wu, Zeng Xu, Xin Gu and Changgui Shi contributed equally to this work.

Authors and Affiliations

  1. Department of Orthopaedics, Changzheng Hospital, Second Military Medical University, 415 Fengyang Road, Shanghai, 200003, People’s Republic of China

    Bin Sun, Huiqiao Wu, Zeng Xu, Jiajia Lu, Yunhao Wang, Ke Zhang, Xiaolong Shen, Xiao-Dong Wu, Ying Zhang, Xin Gu, Changgui Shi & Wen Yuan

  2. Department of Orthopaedics, The 455th Hospital of Chinese People’s Liberation Army, Shanghai, China

    Xiaoxiang Gao

Authors
  1. Bin Sun
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  2. Huiqiao Wu
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  11. Xin Gu
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Corresponding authors

Correspondence to Xin Gu or Changgui Shi.

Ethics declarations

This study was approved by the institutional review board of a public university in Southern China. Informed consent was obtained from the participants.

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Headings

1. Junior trainees with previous SNRB experience were more competent in PELD with fewer cases needed for practice and lower failure rates.

2. Experience with SNRB significantly reduced operative time, radical exposure during the learning process of PELD, and postoperative complications.

3. Junior trainees are recommended to receive SNRB training necessary for PELD.

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Bin Sun, Huiqiao Wu, and Zeng Xu are co-first authors.

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Sun, B., Wu, H., Xu, Z. et al. Is selective nerve root block necessary for learning percutaneous endoscopic lumbar discectomy: a comparative study using a cumulative summation test for learning curve. International Orthopaedics (SICOT) 44, 1367–1374 (2020). https://doi.org/10.1007/s00264-020-04558-1

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  • DOI: https://doi.org/10.1007/s00264-020-04558-1

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