Surgeons Learning Curve of Transforaminal Endoscopic Discectomy for Sciatica
Objective Full-endoscopic spine surgery is gaining interest as a less-invasive alternative to treat sciatica caused by a lumbar disc herniation. Concerns, however, exist with the learning curve as percutaneous transforaminal endoscopic discectomy (PTED) appears to be more difficult to be performed c...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Korean Spinal Neurosurgery Society
2022-09-01
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| Series: | Neurospine |
| Subjects: | |
| Online Access: | http://e-neurospine.org/upload/pdf/ns-2244342-171.pdf |
| _version_ | 1797334772736851968 |
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| author | Pravesh S. Gadjradj Arnold Vreeling Paul R. Depauw Pieter J. Schutte Biswadjiet S. Harhangi |
| author_facet | Pravesh S. Gadjradj Arnold Vreeling Paul R. Depauw Pieter J. Schutte Biswadjiet S. Harhangi |
| author_sort | Pravesh S. Gadjradj |
| collection | DOAJ |
| description | Objective Full-endoscopic spine surgery is gaining interest as a less-invasive alternative to treat sciatica caused by a lumbar disc herniation. Concerns, however, exist with the learning curve as percutaneous transforaminal endoscopic discectomy (PTED) appears to be more difficult to be performed compared to other techniques. In this study, the clinical outcomes during and after the learning curve are presented of 3 surgeons naïve to PTED. Methods In the first phase of a randomized controlled, noninferiority trial comparing PTED with microdiscectomy, 3 surgeons were trained in the PTED-procedure by a senior surgeon. After performing up to 20 cases under supervision, they started performing PTED on their own. Results of the early cases were compared to the later cases (>20). Furthermore, complications and reoperations were compared. Finally, differences in clinical outcomes between surgeons were compared. Results At 12 months of follow-up, 87% of the patients had follow-up data available. In general, there were no significant differences in patient-reported outcomes between the early and later PTED cases. Furthermore, outcomes of the early PTED cases were comparable to the outcomes of microdiscectomy, while the later PTED cases had small, but more favorable outcomes compared to microdiscectomy. Two learning curve surgeons had substantially higher rates of reoperations within 1 year, compared to the senior surgeon or the microdiscectomy group. Duration of surgery was also longer for all learning curve surgeons. Finally, when comparing clinical outcomes of patients undergoing PTED versus microdiscectomy, there appears to be some statistically significant differences in outcomes compared between the senior and 3 learning curve surgeons. Conclusion PTED appears to be safe to be adopted by surgeons naïve to the procedure when they are initially supervised by an experienced senior surgeon. Duration of surgery and risk of repeated surgery are increased during the learning curve, but patient-reported outcomes of the early PTED cases are similar to the outcomes of later PTED cases, and similar to the outcomes of microdiscectomy cases. This study underlines the need for an experienced mentor for surgeons to safely adopt PTED. |
| first_indexed | 2024-03-08T08:26:02Z |
| format | Article |
| id | doaj.art-fe571d7e5cb84f28b981bc00f59350b5 |
| institution | Directory Open Access Journal |
| issn | 2586-6583 2586-6591 |
| language | English |
| last_indexed | 2024-03-08T08:26:02Z |
| publishDate | 2022-09-01 |
| publisher | Korean Spinal Neurosurgery Society |
| record_format | Article |
| series | Neurospine |
| spelling | doaj.art-fe571d7e5cb84f28b981bc00f59350b52024-02-02T04:45:26ZengKorean Spinal Neurosurgery SocietyNeurospine2586-65832586-65912022-09-0119359460210.14245/ns.2244342.1711296Surgeons Learning Curve of Transforaminal Endoscopic Discectomy for SciaticaPravesh S. Gadjradj0Arnold Vreeling1Paul R. Depauw2Pieter J. Schutte3Biswadjiet S. Harhangi4 Department of Neurological Surgery, Weill Cornell Brain and Spine Center, New York, NY, USA Department of Orthopedic Surgery, Rijnstate Ziekenhuis, Arnhem, The Netherlands Department of Neurosurgery, Elisabeth-TweeSteden Ziekenhuis, Tilburg, The Netherlands Department of Neurosurgery, Alrijne Ziekenhuis, Leiderdorp, The Netherlands Department of Neurosurgery, Park Medical Center, Rotterdam, The NetherlandsObjective Full-endoscopic spine surgery is gaining interest as a less-invasive alternative to treat sciatica caused by a lumbar disc herniation. Concerns, however, exist with the learning curve as percutaneous transforaminal endoscopic discectomy (PTED) appears to be more difficult to be performed compared to other techniques. In this study, the clinical outcomes during and after the learning curve are presented of 3 surgeons naïve to PTED. Methods In the first phase of a randomized controlled, noninferiority trial comparing PTED with microdiscectomy, 3 surgeons were trained in the PTED-procedure by a senior surgeon. After performing up to 20 cases under supervision, they started performing PTED on their own. Results of the early cases were compared to the later cases (>20). Furthermore, complications and reoperations were compared. Finally, differences in clinical outcomes between surgeons were compared. Results At 12 months of follow-up, 87% of the patients had follow-up data available. In general, there were no significant differences in patient-reported outcomes between the early and later PTED cases. Furthermore, outcomes of the early PTED cases were comparable to the outcomes of microdiscectomy, while the later PTED cases had small, but more favorable outcomes compared to microdiscectomy. Two learning curve surgeons had substantially higher rates of reoperations within 1 year, compared to the senior surgeon or the microdiscectomy group. Duration of surgery was also longer for all learning curve surgeons. Finally, when comparing clinical outcomes of patients undergoing PTED versus microdiscectomy, there appears to be some statistically significant differences in outcomes compared between the senior and 3 learning curve surgeons. Conclusion PTED appears to be safe to be adopted by surgeons naïve to the procedure when they are initially supervised by an experienced senior surgeon. Duration of surgery and risk of repeated surgery are increased during the learning curve, but patient-reported outcomes of the early PTED cases are similar to the outcomes of later PTED cases, and similar to the outcomes of microdiscectomy cases. This study underlines the need for an experienced mentor for surgeons to safely adopt PTED.http://e-neurospine.org/upload/pdf/ns-2244342-171.pdflumbar disc herniationendoscopic discectomysciaticarandomized controlled trial |
| spellingShingle | Pravesh S. Gadjradj Arnold Vreeling Paul R. Depauw Pieter J. Schutte Biswadjiet S. Harhangi Surgeons Learning Curve of Transforaminal Endoscopic Discectomy for Sciatica Neurospine lumbar disc herniation endoscopic discectomy sciatica randomized controlled trial |
| title | Surgeons Learning Curve of Transforaminal Endoscopic Discectomy for Sciatica |
| title_full | Surgeons Learning Curve of Transforaminal Endoscopic Discectomy for Sciatica |
| title_fullStr | Surgeons Learning Curve of Transforaminal Endoscopic Discectomy for Sciatica |
| title_full_unstemmed | Surgeons Learning Curve of Transforaminal Endoscopic Discectomy for Sciatica |
| title_short | Surgeons Learning Curve of Transforaminal Endoscopic Discectomy for Sciatica |
| title_sort | surgeons learning curve of transforaminal endoscopic discectomy for sciatica |
| topic | lumbar disc herniation endoscopic discectomy sciatica randomized controlled trial |
| url | http://e-neurospine.org/upload/pdf/ns-2244342-171.pdf |
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