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KMID : 0388720060130040311
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Journal of Korean Society of Spine Surgery
2006 Volume.13 No. 4 p.311 ~ p.318
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Factors Affecting Learning Curve in Endoscopic Lumbar Discectomy using Interlaminar Approach
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Kim Eung-Ha
Shin Dong-Hoon
Cha Joo-Seok
Kim Yong-Bum
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Abstract
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Study Design:A retrospective study
Objectives: To try and find the best surgical technique by analyzing the real-time video taken during a percutaneous endoscopic interlaminar lumbar discectomy.
Summary of the Literature Review:A percutaneous endoscopic lumbar discectomy, using an interlaminar approach, has superior aspects, such as anatomical similarity with that of open spinal surgery, and applicability regardless of the herniated level. However, the technical difficulty can be an obstacle to shortening of the learning-curve.
Materials and Methods:
Results:The mean operation time was 65 minutes (28 minutes~127 minutes). The mean operation times in patients either requiring or not requiring partial removal of the lamina were 84 minutes (45 minutes~127 minutes) and 45 minutes (28 minutes~91 minutes), respectively, and also showed a statistically significant correlation (p=0.023). The mean operation times for the first and last 10 cases were 107 and 48 minutes, respectively. 3 cases needed revision open surgery due to failed symptom resolution. The procedures affecting a prolonged operation time were partial removal the lamina and ligament flavum resection. The time required for ligament flavum resection plateaued after 20 cases, and that for partial removal of the lamina reached plateau after 19 cases.
Conclusions:By overcoming such technical problems, shortening of the learning-curve for a percutaneous endoscopic interlaminar lumbar discectomy was possible.
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KEYWORD
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Interlaminar approach, Percutaneous endoscopic lumbar discectomy, Learning-curve
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