Gutiérrez-Partida CF, Quillo-Olvera J, Soriano-Solis S, Zuñiga-Rivera Julio-Cesar, Padilla-Sanchez A, Rodríguez-García M, Soriano-Sánchez José-Antonio

Language: Spanish
References: 20
Page: 54-64
PDF size: 179.30 Kb.

ABSTRACT

Introduction: Several studies have reported the learning curve in minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) technique based on surgical time, estimated blood loss, and high rate of perioperative complications associated with the initial experience in performing the technique. A different approach to the learning curve of this technique is proposed in this study.
Objective: To assess the learning curve in MITLIF by a single surgeon during his minimally invasive spine surgery fellowship training.
Methods: Retrospective review of surg ical records. Piecewise regression and cumulative sum (CUSUM) analysis were applied to assess the learning curve of a single surgeon for MI-TLIF technique from February 2012 to March 2015.
Results: Surgical records of 54 patients who underwent MI-TLIF procedure were reviewed. Technique-related skills obtained during the minimally invasive spine surgery fellowship were evaluated. Piecewise regression analysis and CUSUM operative time chart evidenced an inflection at the 16th patient. The mean operative time was 182.4±63.6 min, mean intraoperative blood loss was 43.8±34.1 mL and median hospital length stay was 3 days. There were significant differences in clinical and functional outcomes at six months and at final follow-up. No perioperative complications occurred. The objective structured assessment of technical skills evaluations were ≥ 25 in every procedure. CUSUM chart demonstrated an extended period of surgical proficiency after the 16th patient.
Conclusions: MI-TLIF learning curve requires knowledge and skills acquired through anatomical, biomechanical and cadaveric training sessions, as well as simulation and learning strategies in operating room for a long time. Finally, surgical proficiency represents a personal gift that cannot be easily measured and the surgeon must perform in order to obtain particular surgical goals.

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