What is the learning curve for endoscopic spine surgery? A comprehensive systematic review

IF 4.7 1区医学 Q1 CLINICAL NEUROLOGY Spine Journal Pub Date : 2025-01-27 DOI:10.1016/j.spinee.2025.01.004

Justin P. Chan MD , Thomas Olson MD , Beshoy Gabriel BS , Sohaib Hashmi MD , Hao-Hua Wu MD , Hansen Bow MD , Yu-Po Lee MD , Nitin Bhatia MD , Michael Oh MD , Don Y Park MD

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Abstract

BACKGROUND CONTEXT

Endoscopic spine surgery (ESS) is rapidly emerging as a viable minimally invasive technique to successfully treat symptomatic degenerative spinal conditions. Widespread adoption has been limited in part due to the learning curve.

PURPOSE

To systematically review the learning curve for uniportal and biportal ESS and compare the 2 techniques.

STUDY DESIGN/SETTING

A systematic review based on PRISMA guidelines.

PATIENT SAMPLE

About 29 studies were included with 18 studies investigating uniportal learning curves and 11 biportal studies. There were 1,493 patients across all uniportal studies. There was a total of 1,005 patients across all biportal studies.

OUTCOME MEASURES

Number of patients, technique type, patient reported outcomes, complications, operative time before the learning curve threshold, operative time after learning curve threshold, number of cases required to meet threshold, number of surgeons in the study, and cases per surgeon were collected and analyzed.

METHODS

A comprehensive literature search was conducted using PubMed, Medline, and Embase from 2000 to present date. Data was extracted by 3 independent reviewers.

RESULTS

The learning curve studies were reviewed and summarized. The overall median number of cases to reach the learning curve threshold was significantly less in uniportal vs biportal studies (20 vs 37.5, p=.0463). When stratifying by various procedures, there was no significant difference between the techniques with number of cases required or improvement of operative time. Operative time for biportal discectomies decreased by a significantly greater amount vs uniportal (44.5% vs 21.4%, p=.0332).

CONCLUSIONS

The learning curve literature for ESS was systematically reviewed and ways to overcome the learning curve were discussed. The overall median number of cases for the learning curve was significantly fewer in uniportal vs biportal but the improvement in operative time was significantly greater with biportal discectomies, typically the entry level procedure by novice surgeons. Overcoming the learning curve for ESS is a critical factor to widespread adoption and understanding it may aid surgeons in progressing to proficiency while mitigating the risk of complications.

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内窥镜脊柱手术的学习曲线是什么？全面的系统评价。

背景背景：内窥镜脊柱手术（ESS）正迅速成为一种可行的微创技术，可以成功治疗有症状的脊柱退行性疾病。广泛采用受到限制，部分原因在于学习曲线。目的：系统回顾单门和双门ESS的学习曲线，并对两种技术进行比较。研究设计/设置：基于PRISMA指南的系统评价。患者样本：纳入29项研究，其中18项研究调查单门学习曲线，11项研究调查双门学习曲线。在所有的单门户研究中有1493名患者。所有双门静脉研究共纳入1005例患者。结果测量：收集并分析患者人数、技术类型、患者报告的结果、并发症、学习曲线阈值前的手术时间、学习曲线阈值后的手术时间、满足阈值所需的病例数、参与研究的外科医生数量、每位外科医生的病例数。方法：检索2000年至今的PubMed、Medline和Embase文献。数据由三位独立审稿人提取。结果：对学习曲线研究进行了回顾和总结。达到学习曲线阈值的总病例中位数在单门静脉研究中明显少于双门静脉研究（20 vs 37.5, p=0.0463）。在不同手术方式进行分层时，不同手术方式对手术所需病例数和手术时间的改善无显著差异。双门静脉椎间盘切除术的手术时间比单门静脉椎间盘切除术明显减少。（44.5% vs . 21.4%, p=0.0332）。结论：系统地回顾了ESS的学习曲线文献，并讨论了克服学习曲线的方法。学习曲线的总中位数单门静脉比双门静脉明显更少，但双门静脉椎间盘切除术的手术时间改善明显更大，通常是新手外科医生的入门级手术。克服ESS的学习曲线是广泛采用和理解的关键因素，它可以帮助外科医生在降低并发症风险的同时提高熟练程度。

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来源期刊

Spine Journal 医学-临床神经学

CiteScore

8.20

自引率

6.70%

发文量

680

审稿时长

13.1 weeks

期刊介绍： The Spine Journal, the official journal of the North American Spine Society, is an international and multidisciplinary journal that publishes original, peer-reviewed articles on research and treatment related to the spine and spine care, including basic science and clinical investigations. It is a condition of publication that manuscripts submitted to The Spine Journal have not been published, and will not be simultaneously submitted or published elsewhere. The Spine Journal also publishes major reviews of specific topics by acknowledged authorities, technical notes, teaching editorials, and other special features, Letters to the Editor-in-Chief are encouraged.

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