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Learning Curve and Early Results of Interlaminar and Transforaminal Full-Endoscopic Resection of Lumbar Disc Herniations

Background Full-endoscopic spinal surgery is an evolving technique. A laborious learning phase is inevitable due to the complexity of the orientation and instrumentation. The goal of the present study is to evaluate a single surgeon’s learning curve and early outcomes in full-endoscopic resection of...

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Autores principales: Zelenkov, Petr, Nazarov, Vyacheslav V, Kisaryev, Sergey, Pimenova, Leysan, Zakirov, Bahrom A, Goldberg, Maria, Konovalov, Nikolay A, Feniksov, Viktor, Kondrashov, Aleksei, Popov, Ilya, Zagirov, Ruslan I
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Cureus 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7053674/
https://www.ncbi.nlm.nih.gov/pubmed/32190523
http://dx.doi.org/10.7759/cureus.7157
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author Zelenkov, Petr
Nazarov, Vyacheslav V
Kisaryev, Sergey
Pimenova, Leysan
Zakirov, Bahrom A
Goldberg, Maria
Konovalov, Nikolay A
Feniksov, Viktor
Kondrashov, Aleksei
Popov, Ilya
Zagirov, Ruslan I
author_facet Zelenkov, Petr
Nazarov, Vyacheslav V
Kisaryev, Sergey
Pimenova, Leysan
Zakirov, Bahrom A
Goldberg, Maria
Konovalov, Nikolay A
Feniksov, Viktor
Kondrashov, Aleksei
Popov, Ilya
Zagirov, Ruslan I
author_sort Zelenkov, Petr
collection PubMed
description Background Full-endoscopic spinal surgery is an evolving technique. A laborious learning phase is inevitable due to the complexity of the orientation and instrumentation. The goal of the present study is to evaluate a single surgeon’s learning curve and early outcomes in full-endoscopic resection of lumbar disc herniations. Methods This was a prospective non-controlled single-surgeon cohort study. In 54 patients with 57 herniations, 41 interlaminar and 16 transforaminal resections were performed. Surgery time, severity of adhesive process in the spinal canal, complication rates and clinical outcomes (VAS, ODI, custom questionnaire, recurrence and re-operation rate) were assessed. Results In the interlaminar group, operative time has decreased from 60 ± 20 min in the first 20 operations to 45 ± 14 min in the following 17 (p=0.023). In the transforaminal group, operative time has decreased from 60 ± 16 min in the first 7 operations to 41 ± 12 min in following 9 (p=0.023). Severe adhesive process in spinal canal was associated with duration of symptoms greater than 2 years, longer surgery and higher risk of surgical complications. Four recurrent disc herniations were re-operated using full-endoscopic technique. VAS, ODI and pain medications significantly decreased in both groups and in re-operated patients. Conclusion The plateau of the learning curve and good short-term clinical results of full-endoscopic interlaminar and transforaminal surgery may be achieved after twenty operations, given extensive previous experience in microsurgery. Risk of complications at the learning phase may be decreased by excluding the patients with symptoms lasting over two years.
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spelling pubmed-70536742020-03-18 Learning Curve and Early Results of Interlaminar and Transforaminal Full-Endoscopic Resection of Lumbar Disc Herniations Zelenkov, Petr Nazarov, Vyacheslav V Kisaryev, Sergey Pimenova, Leysan Zakirov, Bahrom A Goldberg, Maria Konovalov, Nikolay A Feniksov, Viktor Kondrashov, Aleksei Popov, Ilya Zagirov, Ruslan I Cureus Neurosurgery Background Full-endoscopic spinal surgery is an evolving technique. A laborious learning phase is inevitable due to the complexity of the orientation and instrumentation. The goal of the present study is to evaluate a single surgeon’s learning curve and early outcomes in full-endoscopic resection of lumbar disc herniations. Methods This was a prospective non-controlled single-surgeon cohort study. In 54 patients with 57 herniations, 41 interlaminar and 16 transforaminal resections were performed. Surgery time, severity of adhesive process in the spinal canal, complication rates and clinical outcomes (VAS, ODI, custom questionnaire, recurrence and re-operation rate) were assessed. Results In the interlaminar group, operative time has decreased from 60 ± 20 min in the first 20 operations to 45 ± 14 min in the following 17 (p=0.023). In the transforaminal group, operative time has decreased from 60 ± 16 min in the first 7 operations to 41 ± 12 min in following 9 (p=0.023). Severe adhesive process in spinal canal was associated with duration of symptoms greater than 2 years, longer surgery and higher risk of surgical complications. Four recurrent disc herniations were re-operated using full-endoscopic technique. VAS, ODI and pain medications significantly decreased in both groups and in re-operated patients. Conclusion The plateau of the learning curve and good short-term clinical results of full-endoscopic interlaminar and transforaminal surgery may be achieved after twenty operations, given extensive previous experience in microsurgery. Risk of complications at the learning phase may be decreased by excluding the patients with symptoms lasting over two years. Cureus 2020-03-02 /pmc/articles/PMC7053674/ /pubmed/32190523 http://dx.doi.org/10.7759/cureus.7157 Text en Copyright © 2020, Zelenkov et al. http://creativecommons.org/licenses/by/3.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Neurosurgery
Zelenkov, Petr
Nazarov, Vyacheslav V
Kisaryev, Sergey
Pimenova, Leysan
Zakirov, Bahrom A
Goldberg, Maria
Konovalov, Nikolay A
Feniksov, Viktor
Kondrashov, Aleksei
Popov, Ilya
Zagirov, Ruslan I
Learning Curve and Early Results of Interlaminar and Transforaminal Full-Endoscopic Resection of Lumbar Disc Herniations
title Learning Curve and Early Results of Interlaminar and Transforaminal Full-Endoscopic Resection of Lumbar Disc Herniations
title_full Learning Curve and Early Results of Interlaminar and Transforaminal Full-Endoscopic Resection of Lumbar Disc Herniations
title_fullStr Learning Curve and Early Results of Interlaminar and Transforaminal Full-Endoscopic Resection of Lumbar Disc Herniations
title_full_unstemmed Learning Curve and Early Results of Interlaminar and Transforaminal Full-Endoscopic Resection of Lumbar Disc Herniations
title_short Learning Curve and Early Results of Interlaminar and Transforaminal Full-Endoscopic Resection of Lumbar Disc Herniations
title_sort learning curve and early results of interlaminar and transforaminal full-endoscopic resection of lumbar disc herniations
topic Neurosurgery
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7053674/
https://www.ncbi.nlm.nih.gov/pubmed/32190523
http://dx.doi.org/10.7759/cureus.7157
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