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Surgeons Learning Curve of Transforaminal Endoscopic Discectomy for Sciatica.
Pravesh S Gadjradj1,2, Arnold Vreeling3, Paul R Depauw4
1Department of Neurological Surgery, Weill Cornell Brain and Spine Center, New York, NY, USA.
Neurospine
|October 7, 2022
Summary
Percutaneous transforaminal endoscopic discectomy (PTED) is safe for new surgeons with mentorship. While initial surgery duration and reoperation risks are higher, patient outcomes are comparable to microdiscectomy.
Area of Science:
- Minimally Invasive Spine Surgery
- Neurosurgery
- Orthopedic Surgery
Background:
- Full-endoscopic spine surgery is an emerging, less-invasive option for sciatica due to lumbar disc herniation.
- Concerns exist regarding the learning curve for percutaneous transforaminal endoscopic discectomy (PTED) compared to other techniques.
Purpose of the Study:
- To evaluate the clinical outcomes of surgeons new to PTED during and after their learning curve.
- To compare PTED outcomes with microdiscectomy.
Main Methods:
- A randomized controlled, noninferiority trial comparing PTED with microdiscectomy.
- Three surgeons trained in PTED by a senior surgeon, performing up to 20 supervised cases before independent practice.
- Comparison of early (<20 cases) versus later (>20 cases) PTED outcomes, including complications, reoperations, and clinical results.
Main Results:
- No significant difference in patient-reported outcomes between early and later PTED cases at 12 months.
- Early PTED outcomes were comparable to microdiscectomy; later PTED outcomes were slightly more favorable.
- Higher reoperation rates and longer surgery durations were observed in learning curve surgeons compared to the senior surgeon or microdiscectomy group.
Conclusions:
- PTED can be safely adopted by surgeons new to the procedure with initial senior surgeon supervision.
- Increased surgery duration and reoperation risk during the learning curve are noted, but patient outcomes remain consistent and comparable to microdiscectomy.
- An experienced mentor is crucial for the safe adoption of PTED by surgeons.
