Learning Curve and Clinical Outcomes of Ultrasonic Osteotome‐based En Bloc Laminectomy for Thoracic Ossification of the Ligamentum Flavum
Objective Despite rapid advances in minimally invasive surgery, en bloc laminectomy remains the most common surgical approach for treating thoracic ossification of the ligamentum flavum (TOLF). However, the learning curve of this risky operation is rarely reported. Therefore, we aimed to describe an...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2023-09-01
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| Series: | Orthopaedic Surgery |
| Subjects: | |
| Online Access: | https://doi.org/10.1111/os.13804 |
| _version_ | 1797693901495074816 |
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| author | Yuanyu Hu Yanlei Dong Junbo Qi Zhongqiang Chen Weishi Li Yun Tian Chuiguo Sun |
| author_facet | Yuanyu Hu Yanlei Dong Junbo Qi Zhongqiang Chen Weishi Li Yun Tian Chuiguo Sun |
| author_sort | Yuanyu Hu |
| collection | DOAJ |
| description | Objective Despite rapid advances in minimally invasive surgery, en bloc laminectomy remains the most common surgical approach for treating thoracic ossification of the ligamentum flavum (TOLF). However, the learning curve of this risky operation is rarely reported. Therefore, we aimed to describe and analyze the learning curve of ultrasonic osteotome‐based en bloc laminectomy for TOLF. Methods Among 151 consecutive patients with TOLF who underwent en bloc laminectomy performed by one surgeon between January 2012 and December 2017, we retrospectively analyzed their demographic data, surgical parameters, and neurological function. Neurological outcome was evaluated with the modified Japanese Orthopaedic Association (mJOA) scale, and the Hirabayashi method was used to calculate the neurological recovery rate. The learning curve was assessed with logarithmic curve‐fitting regression analysis. Univariate analysis methods were used for statistical analysis, including t‐test, rank sum test, and chi‐square test. Results A total of 50% of learning milestones could be reached in approximately 14 cases, and the asymptote in 76 cases. Therefore, 76 of the 151 enrolled patients were defined as the “early group,” and the remaining 75 were delimitated as the “late group” for comparison. There was a significant intergroup difference in the corrected operative time (94.80 ± 27.77 vs 65.93 ± 15.67 min, P < 0.001) and the estimated blood loss (median 240 vs 400 mL, P < 0.001). The overall follow‐up was 83.1 ± 18.5 months. The mJOA significantly increased from a median of 5 (IQR: 4–5) before the surgery to 10 (IQR: 9–10) at the last follow‐up (P < 0.001). The overall complication rate was 37.1%, and no significant intergroup difference was found, except for the incidence of dural tears (31.6% vs 17.3%, p = 0.042). Conclusion Initially, mastering the en bloc laminectomy technique using ultrasonic osteotome for TOLF treatment can be challenging, but the surgeon's experience improves as the operative time and blood loss decrease. Improved surgical experience reduced the risk of dural tears but was not associated with the overall complication rate or long‐term neurological function. Despite the relatively long learning curve, en bloc laminectomy is a secure and valid technique for TOLF treatment. |
| first_indexed | 2024-03-12T02:50:21Z |
| format | Article |
| id | doaj.art-76b0a36d23ba4489a35df46c0097122a |
| institution | Directory Open Access Journal |
| issn | 1757-7853 1757-7861 |
| language | English |
| last_indexed | 2024-03-12T02:50:21Z |
| publishDate | 2023-09-01 |
| publisher | Wiley |
| record_format | Article |
| series | Orthopaedic Surgery |
| spelling | doaj.art-76b0a36d23ba4489a35df46c0097122a2023-09-04T04:41:45ZengWileyOrthopaedic Surgery1757-78531757-78612023-09-011592318232710.1111/os.13804Learning Curve and Clinical Outcomes of Ultrasonic Osteotome‐based En Bloc Laminectomy for Thoracic Ossification of the Ligamentum FlavumYuanyu Hu0Yanlei Dong1Junbo Qi2Zhongqiang Chen3Weishi Li4Yun Tian5Chuiguo Sun6Department of Orthopaedics Peking University Third Hospital Beijing ChinaDepartment of Orthopaedics Peking University Third Hospital Beijing ChinaDepartment of Orthopaedics Peking University Third Hospital Beijing ChinaDepartment of Orthopaedics Peking University Third Hospital Beijing ChinaDepartment of Orthopaedics Peking University Third Hospital Beijing ChinaDepartment of Orthopaedics Peking University Third Hospital Beijing ChinaDepartment of Orthopaedics Peking University Third Hospital Beijing ChinaObjective Despite rapid advances in minimally invasive surgery, en bloc laminectomy remains the most common surgical approach for treating thoracic ossification of the ligamentum flavum (TOLF). However, the learning curve of this risky operation is rarely reported. Therefore, we aimed to describe and analyze the learning curve of ultrasonic osteotome‐based en bloc laminectomy for TOLF. Methods Among 151 consecutive patients with TOLF who underwent en bloc laminectomy performed by one surgeon between January 2012 and December 2017, we retrospectively analyzed their demographic data, surgical parameters, and neurological function. Neurological outcome was evaluated with the modified Japanese Orthopaedic Association (mJOA) scale, and the Hirabayashi method was used to calculate the neurological recovery rate. The learning curve was assessed with logarithmic curve‐fitting regression analysis. Univariate analysis methods were used for statistical analysis, including t‐test, rank sum test, and chi‐square test. Results A total of 50% of learning milestones could be reached in approximately 14 cases, and the asymptote in 76 cases. Therefore, 76 of the 151 enrolled patients were defined as the “early group,” and the remaining 75 were delimitated as the “late group” for comparison. There was a significant intergroup difference in the corrected operative time (94.80 ± 27.77 vs 65.93 ± 15.67 min, P < 0.001) and the estimated blood loss (median 240 vs 400 mL, P < 0.001). The overall follow‐up was 83.1 ± 18.5 months. The mJOA significantly increased from a median of 5 (IQR: 4–5) before the surgery to 10 (IQR: 9–10) at the last follow‐up (P < 0.001). The overall complication rate was 37.1%, and no significant intergroup difference was found, except for the incidence of dural tears (31.6% vs 17.3%, p = 0.042). Conclusion Initially, mastering the en bloc laminectomy technique using ultrasonic osteotome for TOLF treatment can be challenging, but the surgeon's experience improves as the operative time and blood loss decrease. Improved surgical experience reduced the risk of dural tears but was not associated with the overall complication rate or long‐term neurological function. Despite the relatively long learning curve, en bloc laminectomy is a secure and valid technique for TOLF treatment.https://doi.org/10.1111/os.13804En Bloc LaminectomyLearning CurveThoracic Ossification of the Ligamentum FlavumUltrasonic Osteotome |
| spellingShingle | Yuanyu Hu Yanlei Dong Junbo Qi Zhongqiang Chen Weishi Li Yun Tian Chuiguo Sun Learning Curve and Clinical Outcomes of Ultrasonic Osteotome‐based En Bloc Laminectomy for Thoracic Ossification of the Ligamentum Flavum Orthopaedic Surgery En Bloc Laminectomy Learning Curve Thoracic Ossification of the Ligamentum Flavum Ultrasonic Osteotome |
| title | Learning Curve and Clinical Outcomes of Ultrasonic Osteotome‐based En Bloc Laminectomy for Thoracic Ossification of the Ligamentum Flavum |
| title_full | Learning Curve and Clinical Outcomes of Ultrasonic Osteotome‐based En Bloc Laminectomy for Thoracic Ossification of the Ligamentum Flavum |
| title_fullStr | Learning Curve and Clinical Outcomes of Ultrasonic Osteotome‐based En Bloc Laminectomy for Thoracic Ossification of the Ligamentum Flavum |
| title_full_unstemmed | Learning Curve and Clinical Outcomes of Ultrasonic Osteotome‐based En Bloc Laminectomy for Thoracic Ossification of the Ligamentum Flavum |
| title_short | Learning Curve and Clinical Outcomes of Ultrasonic Osteotome‐based En Bloc Laminectomy for Thoracic Ossification of the Ligamentum Flavum |
| title_sort | learning curve and clinical outcomes of ultrasonic osteotome based en bloc laminectomy for thoracic ossification of the ligamentum flavum |
| topic | En Bloc Laminectomy Learning Curve Thoracic Ossification of the Ligamentum Flavum Ultrasonic Osteotome |
| url | https://doi.org/10.1111/os.13804 |
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