Percutaneous Transforaminal Endoscopic Discectomy Learning Curve: A CuSum Analysis

Area of Science:

• Neurosurgery
• Minimally Invasive Spine Surgery

Background:

• The learning curve for percutaneous transforaminal endoscopic discectomy (PTED) is not well-established in existing literature.
• Standardizing PTED procedures is crucial for consistent surgical outcomes.

Purpose of the Study:

• To define the learning curve for PTED in treating lumbar disc herniation.
• To assess the efficacy and safety of PTED through learning curve analysis.

Main Methods:

• Retrospective review of prospectively collected data from 55 patients undergoing PTED by a single surgeon.
• Cumulative sum analysis of operative and fluoroscopy times to identify learning curve inflection points (31 cases).
• Comparison of patient-reported outcome measures (PROMs) and complication rates between early (n=31) and late (n=24) phases, and with tubular microdiscectomy.

Main Results:

• The learning curve for PTED was determined to be 31 cases, with significant reductions in operative and fluoroscopy times in the late phase.
• All PROMs demonstrated significant improvement in both early and late phases of the learning curve.
• No significant differences in PROMs or complication rates were observed between PTED and tubular microdiscectomy cohorts.

Conclusions:

• A learning curve of 31 cases was identified for PTED, after which operative efficiency improved without compromising patient outcomes or safety.
• PTED is an effective treatment for lumbar disc herniation, comparable to traditional microdiscectomy in terms of patient-reported outcomes.
• While this single-surgeon experience provides valuable insights, further multi-center studies may be needed to broadly validate the PTED learning curve.