Minimally Invasive Spine Surgery: The Learning Curve of a Single Surgeon

Kimchi, Gil; Orlev, Alon; Hadanny, Amir; Knoller, Nachshon; Harel, Ran

doi:10.1177/2192568219880872

Cited by 21 publications

(22 citation statements)

References 17 publications

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“…Previous studies have focused on the learning curve of specific operations, such as ACDF, [ 5 , 11 ] lateral lumbar interbody fusion, [ 12 ] and TLIF. [ 13 , 14 ] There have also been similar studies on specific techniques, such as MIS, [ 3 , 15 ] pedicle screw insertion, [ 16 ] osteotomies, [ 17 ] and endoscopic interlaminar lumbar decompressions. [ 18 ] Most of these studies examine a senior spine surgeon's experience with a new technique or operation, where an accelerated learning curve would be expected when compared to a novice surgeon.…”

Section: Discussionmentioning

confidence: 99%

Describing the spine surgery learning curve during the first two years of independent practice

et al. 2021

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Retrospective cohort studyTo characterize the learning curve of a spine surgeon during the first 2 years of independent practice by comparing to an experienced colleague. To stratify learning curves based on procedure to evaluate the effect of experience on surgical complexity.The learning curve for spine surgery is difficult to quantify, but is useful information for hospital administrators/surgical programs/ new graduates, so appropriate expectations and accommodations are considered.Data from a retrospective cohort (2014-2016) were analyzed at a quaternary academic institution servicing a geographicallyisolated, mostly rural area. Procedures included anterior cervical discectomy and fusion, posterior cervical decompression and stabilization, single and 2-level posterior lumbar interbody fusion, lumbar discectomy, and laminectomy. Data related to patient demographics, after-hours surgery, and revision surgery were collected. Operative time was the primary outcome measure, with secondary measures including cerebrospinal fluid leak and early re-operation. Time periods were stratified into 6 month quarters (quarter [Q] 1-Q4), with STATA software used for statistical analysis.There were 626 patients meeting inclusion criteria. The senior surgeon had similar operative times throughout the study. The new surgeon demonstrated a decrease in operative time from Q1 to Q4 (158 minutes-119 minutes, P < .05); however, the mean operative time was shorter for the senior surgeon at 2 years (91 minutes, P < .05). The senior surgeon performed more revision surgeries (odds ratio [OR] 2.5 [95% confidence interval [CI] 1.7-3.6]; P < .001). Posterior interbody fusion times remained longer for the new surgeon, while laminectomy surgery was similar to the senior surgeon by 2 years. There were no differences in rates of cerebrospinal fluid leak (OR 1.2 [95% CI 0.6-2.5]; P > .05), nor reoperation (OR 1.16 [95% CI 0.7-1.9]; P > .05) between surgeons.A significant learning curve exists starting spine practice and likely extends beyond the first 2 years for elective operations.

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Section: Discussionmentioning

confidence: 99%

Describing the spine surgery learning curve during the first two years of independent practice

et al. 2021

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“…The surgical interventions have been performed by a team of six spine surgeons with extensive experience in both open and minimally invasive approaches, excluding those interventions performed before completing at least a 5-year learning curve [15][16][17]. We classified the groups according to two techniques: traditional open with midline incision and posterolateral or circumferential arthrodesis through transforaminal lumbar interbody fusion (TLIF) or minimally invasive with Wiltse and TLIF approach.…”

Section: Surgical Techniquementioning

confidence: 99%

Medium-Term Results of Minimally Invasive Surgery Vs. Open Surgery for the Treatment of Lumbar Degenerative Discopathy

2023

J Surg

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Background: Currently, lumbar pathology has the option of being surgically treated in an open way (OPEN) or a minimally invasive way (MIS), a treatment that is presented as an alternative that promises the same results but with less soft tissue injury and a speedy recovery. The objective of this study is to analyse the perioperative and postoperative results of patients undergoing open posterolateral or circumferential arthrodesis in comparison with minimally invasive surgery in lumbar degenerative pathology. Material and methods:A retrospective comparative study was carried out on 83 patients operated on using the OPEN technique and 36 patients using the MIS technique. Both diagnosed with lumbar degenerative disc disease, without previous interventions, with no central canal stenosis and symptoms of low back pain and radiculopathy. To assess the results, we carried out a preoperative and postoperative clinical follow-up at 3, 6 and 12 months. Among other items, the lumbar and radicular VAS, the patient's functional and occupational status, as well as the appearance of complications during follow-up and the need for reoperation were compared.Results: Lumbar and radicular VAS improved in both groups during follow-up. However, this improvement was noticeably better in the open surgery group during the first year. Regarding functional recovery, it was shown that at 3 months more than 62.2% of the open group had totally or partially recovered their activity compared to 51.4% of the MIS group and at 6 months more than 95.2% of the open group had partially or fully recovered vs. 69.7% of the MIS group. A statistically significant difference was found in both cases (p<0.05). Only after a year do the results become equal. Regarding the appearance of complications, a rate of 41.7% of complications of some kind was found during the first year in the MIS group, especially in the first 3 months after surgery, compared to 18.1% in those operated openly. This being a statistically significant difference. The reoperation rate was 11% vs 2.4%, respectively, throughout the follow-up.Conclusions: Open and percutaneous surgery are two very different techniques that aim to achieve the same results. However, in light of our study we have been able to see that functional recovery and pain improvement, although after one year it is equal in both groups, it is plausibly better in those operated on openly. In summary, we can conclude that minimally invasive surgery is currently unable to improve the results of open surgery in patients suffering from degenerative disc disease, which could open a debate on its current indications.

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“…To reduce the impact of learning curve effects, we excluded surgeons who had been in practice for less than 4 years and/or performed less than 40 cases of any fusion technique that represented 20% or more of their volume. [11][12][13][14]…”

Section: Casesmentioning

confidence: 99%

Drivers of Cost in Primary Single-Level Lumbar Fusion Surgery

Hwang

Golenbock

Kim

2021

Global Spine Journal

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Study Design: Retrospective cohort. Objectives: Allocating cost is challenging with traditional hospital accounting. Time-driven activity-based costing (TDABC) is an efficient method to accurately assign cost. We sought to characterize the variation in direct total hospital cost (THC) among both lumbar fusion approaches and surgeons. Methods: Patients were treated with single-level anterior interbody (ALIF), lateral interbody (LLIF), transforaminal interbody (TLIF), instrumented posterolateral (PLF) or in-situ fusion (ISF) for degenerative disease. Process maps were developed for preoperative, intraoperative and postoperative care. THC was composed of implant, medication, other supply, and personnel costs. Linear regression and descriptive statistics were used to analyze THC variation. Results: A total of 696 patients underwent surgery by 8 surgeons. Approximately 50% of THC variation was associated with procedure choice while patient characteristics explained 10%. Implants (including biologics) accounted for 45% of cost. With reference to PLF, THC ranged from 0.6x (ISF) to 1.7x (LLIF). Implant cost ranged from 2.5x reference (LLIF) to 0.1x (ISF). There was a 1.7x difference between the highest THC surgeon and the lowest. The fusion type with the highest THC variation was TLIF. The surgeon with the highest TLIF THC was 1.5x more expensive than the surgeon with the lowest. Conclusions: Surgeon-based choices have the greatest effect on THC variation and represent the largest opportunities for cost savings. Primary single-level lumbar fusion THC is driven primarily by fusion type. Implants, including biologics, account for nearly half this cost. Future work should incorporate outcomes data to characterize the differential value conferred by higher THC fusions.

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Minimally Invasive Spine Surgery: The Learning Curve of a Single Surgeon

Cited by 21 publications

References 17 publications

Describing the spine surgery learning curve during the first two years of independent practice

Describing the spine surgery learning curve during the first two years of independent practice

Medium-Term Results of Minimally Invasive Surgery Vs. Open Surgery for the Treatment of Lumbar Degenerative Discopathy

Drivers of Cost in Primary Single-Level Lumbar Fusion Surgery

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