The learning curve associated with thoracoscopic spinal instrumentation

Area of Science:

• Spine Surgery
• Minimally Invasive Techniques
• Adolescent Idiopathic Scoliosis

Background:

• Thoracoscopic spinal instrumentation offers an alternative to traditional open surgery for thoracic adolescent idiopathic scoliosis.
• This minimally invasive technique is technically demanding and has been perceived to have a steep learning curve.
• Evaluating surgical outcomes and operative data is crucial for understanding the learning curve associated with new procedures.

Purpose of the Study:

• To define the learning curve for thoracoscopic spinal instrumentation.
• To evaluate operative data and early outcomes for a single surgeon's cases.
• To assess the feasibility and safety of this technique in treating thoracic adolescent idiopathic scoliosis.

Main Methods:

• Prospective radiographic and medical record review of consecutive cases.
• Evaluation of operative data including operating time, estimated blood loss, levels fused, and complication rates.
• Comparison of outcomes between early (first 28) and later (next 29) cases to identify learning curve effects.

Main Results:

• Operating time significantly decreased after 28 cases (6.2 vs. 5.3 hours, P=0.011).
• Percent curve correction significantly improved after 28 cases (54.4% vs. 65.7%, P=0.005).
• No significant differences were observed in blood loss, levels fused, transfusion rates, or complication rates between early and later cases.

Conclusions:

• The learning curve for thoracoscopic spinal instrumentation is acceptable.
• Surgical proficiency, indicated by reduced operating time and improved curve correction, is achieved after approximately 28 cases.
• The complication rate remained stable, suggesting the procedure can be performed safely throughout a surgeon's experience.