Is there a learning curve preforming balloon kyphoplasty?

Retrospective Cohort Study.

Balloon Kyphoplasty (BKP) is a minimally invasive surgical option for vertebral fractures. The learning curve associated with BKP remains underexplored. This study aims to delineate the learning curve of BKP, focusing on operative time, radiation exposure, and PMMA leakage, hypothesizing that proficiency stabilizes after 10-20 cases.

We retrospectively reviewed 194 patients who underwent BKP at a single center (2008-2020). Data collected were demographics, operative time, radiation exposure, and PMMA leakage. Statistical analysis employed t-tests, Chi-square, and multivariate logistic regression to correlate outcomes with surgeon experience.

Our Cohort's age was 77.3±9.2, with female predominance (73.2%). The average surgery length for single-level BKP was 37.3±18.4 minutes, with radiation exposure at 14.3±12.1 mGy. The learning curve, best modelled by a second-order polynomial equation (single-level BKP): y=0.0404X²-0.21194X+63.36, revealed initial rapid gains in efficiency, followed by a plateau. Radiation exposure displayed a less steep learning curve, stabilizing after approximately 100 cases.

The learning curve of BKP plateaus relatively early in a surgeon's experience, suggesting that the procedure's technical proficiency can be acquired rapidly. However, optimizing radiation exposure requires continued attention beyond the initial learning phase. This study is novel in describing a spine surgeon's learning curve performing BKP with an added value to every surgery performed well beyond the first 10-20 cases. PMMA leakage incidence did not change over surgical experience, suggesting a trade-off between vertebral PMMA filling versus the occurrence of an insignificant anterolateral or intradiscal PMMA leak.

Balloon kyphoplasty (BKP); Polymethylmethacrylate (PMMA.