Difficulties, Challenges, and the Learning Curve of Avoiding Complications in Lumbar Endoscopic Spine Surgery

Abstract

Spinal endoscopy has the stigma of being reserved for only a few surgeons who can figure out how to master the steep learning curve and develop clinical practice settings where endoscopic spine surgery can thrive. In essence, endoscopic treatment of herniated discs specifically and nerve root compression in the lumbar spine in general amounts to replacing traditional open spine surgery protocols with spinal endoscopic surgery techniques. In doing so, the endoscopic spine surgeon must be confident that the degenerative spine's common painful problems can be handled with endoscopic spinal surgery techniques with at least comparable clinical results and complication rates. In this review article, the authors illustrate the difficulties and challenges of the endoscopic lumbar decompression procedure. In addition, they shed light on how to master the learning curve by systematically looking at all sides of the problem, ranging from the ergonomic aspects of the endoscopic platform and its instruments, surgical access planning, challenging clinical scenarios, complications, and sequelae, as well as the training gaps after postgraduate residency and fellowship programs.

Endoscopic Techniques for Spinal Oncology: A Systematic Literature Review

“…It has been well acknowledged that the learning curve is one of the primary barriers to the broader adoption of endoscopic spine surgery. 22,24 The problem is compounded by the relative rarity of spinal oncologic cases compared with degenerative ones and the presumed lack of familiarity with these techniques by surgeons and physicians on multidisciplinary tumor boards. Patient selection is paramount with this approach, since achieving the surgical aims may require spinal column destabilization requiring fixation.…”

“…One case was of a 67-year-old man who presented with a meningioma at the level of L1. 22 Under general anesthesia, the tumor was resected via an endoscopic approach. The surgeons were able to achieve a gross total resection without complication.…”

Clinical Consequences of Incidental Durotomy during Full-Endoscopic Lumbar Decompression Surgery in Relation to Intraoperative Epidural Pressure Measurements

“…Stenotic lesions in the central and lateral spinal canal and foraminal stenosis can be effectively treated in the lumbar [ 10 , 11 , 12 , 13 ], thoracic [ 14 , 15 ], and cervical [ 16 , 17 , 18 ] spine with various endoscopic surgeries carried out through the transforaminal or interlaminar approach or variations thereof. Many surgeons have learned how to effectively use power drills, burrs, and specialized rongeurs to perform wide bony and soft tissue decompression, which plays a central role in interlaminar and in some uniportal/biportal (UBE) techniques [ 19 ]. As a result, previously difficult-to-reach extraforaminal disc herniations and other pain generators within the intervertebral disc and the facet joint complex can be directly visualized and treated during endoscopic decompression surgery [ 20 , 21 ].…”

Education for Being A Spine Endoscopic Surgeon: What Matters?

“…However, every time when it comes to the obstacle to the state-of-the-art technique, learning curve would be mentioned primarily which has been long considered as a stumbling block keeping away from many young surgeons to master it well [8][9]. Several literature contributed some great work to clarify its steep learning curve and point out that it was likely much sharper than any other minimally invasive spine surgery [10][11][12].…”