Learning curve of tubular micro-endoscopic decompression in patients with degenerative lumbar canal stenosis over 200 cases

• Published in: Indian Spine Journal 2020-07, Vol.3 (2), p.238-242
• Main Authors: Jain, Sanyam, Kundnani, Vishal, Kire, Neilakou, Merchant, Zahir, Patel, Jwalant
• Format: Article
• Language: English
• Subjects: lumbar canal stenosis; micro-endoscopic decompression; operative time
• ISSN: 2589-5079; 2589-5087
• DOI: 10.4103/isj.isj_24_19

Introduction: Tubular micro-endoscopic decompression is a technically demanding surgical technique involving familiarity of microscope handling with surgical and radiographic anatomical planning. Understanding the learning curve is necessary to delineate the problems faced during initial cases to reduce the complication rates and set guidelines for safe spine surgery through educational and training programs on bone-saw models and organizing workshops to enhance the standard of health care with improvement in surgical skills. Aims and Objectives: The aim of this study was to evaluate the learning curve of tubular micro-endoscopic decompression in patients with degenerative lumbar canal stenosis based on surgical and clinical parameters and delineate the challenges faced in early cases in long series of patients. Materials and Methods: Study design. Retrospective analysis of prospectively collected data. Study cohort. Data of first 220 consecutive patients with single-level degenerative lumbar canal stenosis managed with tubular micro-endoscopic decompression surgery from 2010 to 2016 with a minimum two-year follow-up were retrieved. Methodology. First 200 patients available at the final follow-up were divided into quartiles (50 each) as per the date of surgery with each consecutive group serving control for prior. Preoperatively and postoperatively clinical parameters (pain scores: visual analog scale [VAS]; functional disability: oswestry disability index [ODI] score), perioperative (operative time, blood loss, and hospital stay), technical issues (guide wire migration, tube docking-related problems, and dural tear), and postoperative complications (postoperative leg pain, neural injury, infection, and recurrence) were evaluated. Statistical analysis. The logarithmic curve-fit regression analysis and analysis of variance test were used to find the asymptote. Results: The mean age of patients was 61.81 years (ranging from 39 to 85) with male-to-female ratio of 121:79 with no significant difference among the quartiles. Statistically significant differences (P < 0.005) were noted in mean operative time (q1 = 109 min, q2 = 69.4 min) and mean blood loss (q1 = 110.6 mL, q2 = 69.6 mL) between the first and second quartiles with no further significant reduction in the third and fourth quartiles.Statistically significant differences (P < 0.005) in clinical parameters (VAS preoperative/postoperative 6.7/1.43; ODI preoperative/postoperative 39.08/12.63) were noted b