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Learning Curve for Interlaminar Endoscopic Lumbar Discectomy: A Systematic Review
Yong Ahn1, Sol Lee2, Seong Son1
1Department of Neurosurgery, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea.
World Neurosurgery
|April 4, 2021
Summary
The learning curve for interlaminar endoscopic lumbar discectomy (IELD) is not well-defined, with proficiency potentially reached around 22 cases. Current data suggests this cutoff primarily impacts operative time, not patient outcomes.
Area of Science:
- Minimally Invasive Spine Surgery
- Surgical Education
- Neurosurgery
Background:
- Interlaminar endoscopic lumbar discectomy (IELD) is an effective treatment for lumbar disc herniation.
- The procedure has a steep learning curve that lacks standardization.
- Understanding this learning curve is crucial for optimizing surgical training.
Purpose of the Study:
- To review and analyze the characteristics of the learning curve for IELD.
- To identify the cutoff point for achieving technical proficiency in IELD.
- To discuss effective training methodologies for IELD.
Main Methods:
- Systematic literature search of PubMed, Embase, and Cochrane Library for studies on IELD learning curves.
- Quantitative data analysis of operative time and patient outcomes.
- Quality assessment using the Newcastle-Ottawa scale.
Main Results:
- Six studies involving 302 IELD cases were analyzed.
- The average learning curve cutoff point was approximately 22 cases (range: 10-43).
- Shorter operative times were observed post-cutoff, but patient outcomes (pain, function, complications) showed no significant difference.
Conclusions:
- Current evidence on the IELD learning curve is limited.
- Reported cutoff points may reflect efficiency gains rather than true proficiency.
- Future research should focus on patient outcomes to define learning curve plateaus.
