Abstract
Although minimally invasive full-endoscopic (FE) spine surgery through the interlaminar approach has proved safe and effective for surgical treatment of lumbar disk herniation, the learning curve of the procedure has not been sufficiently established. The purpose of this study is to determine the learning curve for the FE surgery through interlaminar approach for treating the L5/S1 disk herniation. Thirty-six patients with lumbar disk herniation (L5/S1 segment) who underwent FE lumbar discectomy through the interlaminar approach between March 2011 and March 2012 were equally divided into Group A, B, and C by the study time of the surgeons. Clinical evaluation data included perioperative parameters (operative duration, intraoperative blood loss, and the amount of intraoperative bone and ligament excision), clinical curative effect index [visual analog scale (VAS) score for leg and back pain], complications, and the rate of conversion to open surgery. The operation duration, intraoperative bleeding, and the amount of bone and ligament excision were gradually and significantly reduced in the Groups A, B, and C (P < 0.01) and reflected in steep curves of proficiency suggesting that the rate of learning was fast. The VAS scores of leg and back pain were significantly improved (P < 0.01) and no symptomatic recurrence was noticed during the follow-up period (1–1.5 years). The outcomes the three groups were not significantly different. The clinical outcomes of the minimally invasive surgery for the treatment of L5/S1 segment disk herniation through the interlaminar approach were excellent suggesting of a satisfactory curative effect. The steep learning curves of perioperative parameters plotted against the number of surgeries conducted suggest that proficiency can be reached reasonably fast.
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Blumenthal, S. L., Ohnmeiss, D. D., & NASS. (2003). Intervertebral cages for degenerative spinal diseases. Spine Journal, 3(4), 301–309.
Bono, C. M., & Vaccaro, A. R. (2007). Interspinous process devices in the lumbar spine. Journal of Spinal Disorders & Techniques, 20(3), 255–261.
Gibson, J. N., Cowie, J. G., & Iprenburg, M. (2012). Transforaminal endoscopic spinal surgery: the future ‘gold standard’ for discectomy? A review. Surgeon, 10(5), 290–296.
Ruetten, S., Komp, M., Merk, H., et al. (2007). Use of newly developed instruments and endoscopes: Full-endoscopic resection of lumbar disc herniations via the interlaminar and lateral transforaminal approach. Journal of Neurosurgery: Spine, 6(6), 521–530.
Wang, B., Lü, G., Patel, A. A., Ren, P., et al. (2011). An evaluation of the learning curve for a complex surgical technique: The full endoscopic interlaminar approach for lumbar disc herniations. Spine Journal, 11(2), 122–130.
Benzel, E. C., & Orr, R. D. (2011). A steep learning curve is a good thing! Spine Journal, 11(2), 131–132.
Nellensteijn, J., Ostelo, R., Bartels, R., et al. (2010). Transforaminal endoscopic surgery for lumbar stenosis: A systematic review. European Spine Journal, 19(6), 879–886.
Ruetten, S., Komp, M., Merk, H., et al. (2009). Full-endoscopic anterior decompression versus conventional anterior decompression and fusion in cervical disc herniations. International Orthopaedics, 33(6), 1677–1682.
Ruetten, S., Komp, M., Merk, H., et al. (2007). A new full-endoscopic technique for cervical posterior foraminotomy in the treatment of lateral disc herniations using 6.9-mm endoscopes: Prospective 2-year results of 87 patients. Minimally Invasive Neurosurgery, 50(4), 219–226.
Tsou, P. M., & Yeung, A. T. (2002). Transforaminal endoscopic decompression for radiculopathy secondary to intracanal noncontained lumbar disc herniations: Outcome and technique. Spine Journal, 2(1), 41–48.
Yeung, A. T., & Tsou, P. M. (2002). Posterolateral endoscopic excision for lumbar disc herniation: Surgical technique, outcome, and complications in 307 consecutive cases. Spine (Phila Pa 1976), 27(7), 722–731.
Florensa, R., Muñoz, J., Cardiel, I., et al. (2011). Posterior spinal instrumentation image guided and assisted by neuronavigation. Experience in 120 cases. Neurocirugia (Astur), 22(3), 224–234.
Nellensteijn, J., Ostelo, R., Bartels, R., et al. (2010). Transforaminal endoscopic surgery for symptomatic lumbar disc herniations: A systematic review of the literature. European Spine Journal, 19(2), 181–204.
Ruetten, S., Komp, M., Merk, H., et al. (2008). Full-endoscopic interlaminar and transforaminal lumbar discectomy versus conventional microsurgical technique: a prospective, randomized, controlled study. Spine (Phila Pa 1976), 33(9), 931–939.
Ruetten, S., Komp, M., & Godolias, G. (2006). Lumbar discectomy with the full-endoscopic interlaminar approach using newly-developed optical system and instruments. WJS, 1(3), 148–156.
Kuonsongtum, V., Paiboonsirijit, S., Kesornask, W., et al. (2009). Result of full endoscopic uniportal lumbar discectomy: Preliminary reported. Journal of the Medical Association of Thailand, 2(6), 776–780.
Li, T., Han, D., Liu, B., et al. (2012). Clinical assessment of reformed lumbar microdiscectomy. The European Journal of Orthopaedic Surgery & Traumatology,. doi:10.1007/s00590-012-1123-8.
Hartmann, F., Janssen, C., Böhm, S., et al. (2012). Biomechanical effect of graded minimal-invasive decompression procedures on lumbar spinal stability. Archives of Orthopaedic and Trauma Surgery, 132(9), 1233–1239.
Wang, B., Lü, G., Liu, W., et al. (2012). Full-endoscopic interlaminar approach for the surgical treatment of lumbar disc herniation: The causes and prophylaxis of conversion to open. Archives of Orthopaedic and Trauma Surgery, 132(11), 1531–1538.
Ruetten, S., Komp, M., Merk, H., et al. (2009). Recurrent lumbar disc herniation after conventional discectomy: A prospective, randomized study comparing full-endoscopic interlaminar and transforaminal versus microsurgical revision. Journal of Spinal Disorders & Techniques, 22(2), 122–129.
Cahill, K. S., Dunn, I., Gunnarsson, T., et al. (2010). Lumbar microdiscectomy in pediatric patients: A large single-institution series. Journal of Neurosurgery: Spine, 12(2), 165–170.
Teli, M., Lovi, A., Brayda-Bruno, M., et al. (2010). Higher risk of dural tears and recurrent herniation with lumbar micro-endoscopic discectomy. European Spine Journal, 19(3), 443–450.
O’Toole, J. E., Eichholz, K. M., & Fessler, R. G. (2007). Minimally invasive far lateral microendoscopic discectomy for extraforaminal disc herniation at the lumbosacral junction: cadaveric dissection and technical case report. Spine Journal, 7(4), 414–421.
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Haidong Xu and Xiaozhou Liu contribute equally to this study.
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Xu, H., Liu, X., Liu, G. et al. Learning Curve of Full-Endoscopic Technique Through Interlaminar Approach for L5/S1 Disk Herniations. Cell Biochem Biophys 70, 1069–1074 (2014). https://doi.org/10.1007/s12013-014-0024-3
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DOI: https://doi.org/10.1007/s12013-014-0024-3