Artikel
Learning curve of a navigation assisted mini-open approach in lumbar pedicle screw fixation and interbody fusion
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Autoren
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Alexander Younsi
- Department of Neurosurgery, University of Heidelberg, Germany
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Basem Ishak
- Department of Neurosurgery, University of Heidelberg, Germany
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Karl Kiening
- Department of Neurosurgery, University of Heidelberg, Germany
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Berk Orakcioglu
- Department of Neurosurgery, University of Heidelberg, Germany
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Andreas Unterberg
- Department of Neurosurgery, University of Heidelberg, Germany
| Veröffentlicht: | 8. Juni 2016 |
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Gliederung
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Objective: Minimally invasive operative techniques for spinal fusion procedures are currently on the rise. They are however often difficult to master. This study sought to assess the learning curve of a mini-open approach for navigated lumbar pedicle screw fixation and interbody fusion when performed by a junior neurosurgeon.
Method: We retrospectively reviewed all consecutive cases of lumbar fusion for degenerative and isthmic spondylosis performed by a junior neurosurgeon. To asses the surgeons’ learning curve, a negative exponential curve-fit regression analysis for corrected operation times was performed and the 50% learning milestone was calculated. Complications, clinical, radiological outcome and patient satisfaction were compared before and after the milestone.
Results: 147 patients were included, 1-level fusion was performed in 66% of cases. After correction of the operation times, the surgeons’ learning curve was diagrammed (y = 207.2e(-0.009x)+133.3) and the 50% operative milestone was computed (case no. 77). Patient satisfaction after the milestone was significantly lower (p=0.007) despite shorter operative time (p<0.0001) and reduced blood loss (p=0.0012). Specific screw complication rate (0%) as well as overall complication rate (12.2%) were generally low and did not significantly change over time.
Conclusions: The mini-open approach for navigated lumbar fusion surgery has a low complication rate with high patient satisfaction (91.1%) even when performed by a junior neurosurgeon. In contrast to steep learning curves of other minimally invasive techniques, operation time shows a gradual but continuous improvement. After reaching the 50% milestone, invasiveness decreases significantly while patient satisfaction does not automatically increase with the surgeons’ experience.
