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Percutaneous Transforaminal Endoscopic Discectomy Learning Curve

医学 透视 学习曲线 经皮 Oswestry残疾指数 外科 可视模拟标度 腰椎 椎间盘切除术 回顾性队列研究 正式舞会 腰痛 替代医学 管理 经济 病理 产科
作者
Omri Maayan,Anthony Pajak,Pratyush Shahi,Tomoyuki Asada,Tejas Subramanian,Kasra Araghi,Nishtha Singh,Maximillian K. Korsun,Sumedha Singh,Olivia Tuma,Evan Sheha,James Dowdell,Sheeraz A. Qureshi,Sravisht Iyer
出处
期刊:Spine [Lippincott Williams & Wilkins]
卷期号:48 (21): 1508-1516 被引量:20
标识
DOI:10.1097/brs.0000000000004730
摘要

Retrospective review of prospectively collected data.To describe the learning curve for percutaneous transforaminal endoscopic discectomy (PTED) and demonstrate its efficacy in treating lumbar disc herniation.The learning curve for PTED has not yet been standardized in the literature.Consecutive patients who underwent lumbar PTED by a single surgeon between December 2020 and 2022 were included. Cumulative sum analysis was applied to operative and fluoroscopy time to assess the learning curve. Inflection points were used to divide cases into early and late phases. The 2 phases were analyzed for differences in operative and fluoroscopy time, length of stay, complications, and patient-reported outcome measures (PROMs). Patient characteristics and operative levels were also compared. PROMs entailed the Oswestry Disability Index, Patient-Reported Outcomes Measurement Information System, Visual Analog Scale Back/Leg, and 12-item Short Form Survey at preoperative, early postoperative (<6 mo), and late postoperative (≥6 mo) time points. PROMs between PTED cases and a comparable cohort of tubular microdiscectomy cases, performed by the same surgeon, were compared.Fifty-five patients were included. Cumulative sum analysis indicated that both operative and fluoroscopy time diminished rapidly after case 31, suggesting a learning curve of 31 cases (early phase: n = 31; late phase: n = 24). Late-phase cases exhibited significantly lower operative times (85.7 vs . 62.2 min, P = 0.001) and fluoroscopy times (131.0 vs . 97.2 s, P = 0.001) compared with the early-phase cases. Both early and late-phase cases showed significant improvement in all PROMs. There were no differences in PROMs between the patients who underwent PTED and tubular microdiscectomy.The PTED learning curve was found to be 31 cases and did not impact PROMs or complication rates. Although this learning curve reflects the experiences of a single surgeon and may not be broadly applicable, PTED can serve as an effective modality for the treatment of lumbar disc herniation.
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