Attitudes regarding barriers to entry and the learning curve associated with endoscopic decompression-only surgery: an international survey

• Published in: The spine journal 2024-11
• Main Authors: Alostaz, Murad, Derman, Peter, Lipson, Patricia, Du, Jerry, Gardocki, Raymond, Hofstetter, Christoph, Wang, Michael, Qureshi, Sheeraz, Louie, Philip K.
• Format: Article
• Language: English
• Subjects: Cervical vertebrae; Diffusion of innovation; Endoscopic surgical procedures; Learning curve; Lumbar vertebrae; Spinal decompression; Thoracic vertebrae
• ISSN: 1529-9430; 1878-1632; 1878-1632
• DOI: 10.1016/j.spinee.2024.11.009

•This international study captured responses from 171 fellowship-trained spine surgeons from six unique regions across the world.•Barriers to adopting endoscopy included the steep learning curve associated with training and the prohibitive costs of associated equipment.•Reasons for wanting to adopt endoscopic techniques include minimizing tissue trauma, improved access to foraminal pathology, and minimizing recovery. Challenges included concerns for incomplete decompression and the duration of surgery, with significant variation in perceived difficulty during the learning curve. Endoscopic spine decompression surgery (ESDS) offers numerous benefits, including reduced tissue damage, smaller incisions, shorter recovery times, and a lower risk of complications. However, its adoption among spine surgeons in the United States has been slow. The reluctance to adopt ESDS can be attributed to factors such as the learning curve, cost of equipment and training, and limited access to necessary resources. The primary objective of this study is to assess attitudes toward barriers to and reasons for not adopting ESDS. A secondary objective is to further identify the learning curves, challenges, and common concerns of surgeons considering ESDS adoption. An international survey of fellowship-trained spine surgeons from the Society for Minimally Invasive Spine Surgery (SMISS). A total of 171 fellowship-trained spine surgeons from the Society for Minimally Invasive Spine Surgery voluntarily and anonymously responded to our survey via the RedCap platform. Surgeons were located across the globe, representing six regions. Data on current region of practice, specialty training, time in practice, practice type, and surgical volume was obtained for each surgeon who responded to the survey. Additionally, we obtained data on perceived benefits, barriers to entry, and the learning curve of endoscopic techniques. A survey was distributed to fellowship-trained spine surgeons from the Society for Minimally Invasive Spine Surgery, with questions focusing on perceived benefits, barriers to adoption, and the learning curve of endoscopic techniques. A total of 171 surgeons responded to the survey, representing six regions: North America (48.0%), Asia Pacific (28.7%), and Europe (11.7%). Respondents were trained in Orthopaedic Surgery (59.1%) and Neurological Surgery (35.7%). Experience varied, with 35.9% having over 20 years in practice. Most respondents were in Private Practice (59.6%) or