Achieving Efficiency in Full Endoscopic Interlaminar Lumbar Decompression: A Prospective Learning-Curve Cumulative...

Area of Science:

• Neurosurgery
• Minimally Invasive Spine Surgery
• Spinal Decompression Techniques

Background:

• Full endoscopic interlaminar lumbar decompression is gaining traction for lumbar spinal stenosis.
• The learning curve and its clinical impact for this technique are not well-established.
• Prospective evaluation is needed to understand surgeon proficiency development.

Purpose of the Study:

• To prospectively assess a single surgeon's learning curve for full endoscopic interlaminar lumbar decompression.
• To identify the point of competency based on operative efficiency.
• To evaluate patient outcomes and safety throughout the learning process.

Main Methods:

• A prospective, single-surgeon cohort study of 77 adult patients undergoing single-level decompression for lumbar spinal stenosis (2018-2023).
• Operative efficiency defined as operative time ≤90 minutes; learning-curve cumulative summation (LC-CUSUM) used to determine competency.
• Patient-reported outcomes (Oswestry Disability Index, Visual Analog Scale) and safety endpoints (complications, reoperations) were tracked.

Main Results:

• Competency in operative efficiency was achieved by the 44th case, as indicated by LC-CUSUM analysis.
• Mean operative time decreased significantly from the early phase (111.2 min) to the late phase (81.7 min).
• Both early and late phases showed comparable significant improvements in Oswestry Disability Index and Visual Analog Scale scores, with similar complication and reoperation rates.

Conclusions:

• Surgeons can achieve technical efficiency in full endoscopic interlaminar lumbar decompression within a defined learning curve.
• The development of surgical efficiency did not compromise patient-reported outcomes or safety.
• This technique can be safely adopted with a structured approach to learning and competency assessment.