Learning curves of percutaneous endoscopic lumbar discectomy in transforaminal approach at the L4/5 and L5/S1 levels: a comparative study

Abstract

This study aimed to compare the learning curves of percutaneous endoscopic lumbar discectomy (PELD) in a transforaminal approach at the L4/5 and L5/S1 levels. We retrospectively reviewed the first 60 cases at the L4/5 level (Group I) and the first 60 cases at the L5/S1 level (Group II) of PELD performed by one spine surgeon. The patients were divided into subgroups A, B, and C (Group I: A cases 1–20, B cases 21–40, C cases 41–60; Group II: A cases 1–20, B cases 21–40, C cases 41–60). Operation time was thoroughly analyzed. Compared with the L4/5 level, the learning curve of transforaminal PELD at the L5/S1 level was flatter. The mean operation times of Groups IA, IB, and IC were (88.75±17.02), (67.75±6.16), and (64.85±7.82) min, respectively. There was a significant difference between Groups A and B (P<0.05), but no significant difference between Groups B and C (P=0.20). The mean operation times of Groups IIA, IIB, and IIC were (117.25±13.62), (109.50±11.20), and (92.15±11.94) min, respectively. There was no significant difference between Groups A and B (P=0.06), but there was a significant difference between Groups B and C (P<0.05). There were 6 cases of postoperative dysesthesia (POD) in Group I and 2 cases in Group IIA (P=0.27). There were 2 cases of residual disc in Group I, and 4 cases in Group II (P=0.67). There were 3 cases of recurrence in Group I, and 2 cases in Group II (P>0.05). Compared with the L5/S1 level, the learning curve of PELD in a transforaminal approach at the L4/5 level was steeper, suggesting that the L4/5 level might be easier to master after short-term professional training. 探讨经皮椎间孔镜技术治疗腰4/5 和腰5 骶1 椎间盘突出症学习曲线之间的差异。 本文第一次比较了经皮椎间孔镜治疗腰4/5 和腰5/骶1 椎间盘突出症的学习曲线,得出经皮椎间孔镜治疗腰4/5 椎间盘突出症的学习曲线更加陡峭,经过专业化培训更加容易掌握,为初学者提供了指导方向。 回顾性分析2011 年6 月至2013 年8 月于上海市第十人民医院行经皮椎间孔镜治疗的120 例腰4/5 和腰5 骶1椎间盘突出症患者的临床资料。120例患者由同一术者实行手术操作,根据突出节段不同分为两组:腰4/5 组(组I)60 例和腰5 骶1组(组II)60 例。每组又分成三个亚组:组IA 1∼20、IB 21∼40、IC 41∼60;组IIA 1∼20、IIB 21∼40、IIC 41∼60。分别记录每位患者的手术时间。 实验结果显示:组IA、IB、IC 平均手术时间分别为(88.75±17.02) 、(67.75±6.16) 和(64.85±7.82) min,组IA 与组IB 之间的差异有统计学意义,组IB 与组IC 之间的差异无统计学意义;组IIA、IIB、IIC 平均手术时间分别为(117.25±13.62)、(109.50±11.20)和(92.15±11.94) min,组IIA 与组IIB之间的差异无统计学意义,组IIB 与组IIC 之间的差异有统计学意义。术后8 例患者出现术后感觉减退(POD),其中组I 有6 例,组II 有2 例。术后磁共振成像(MRI)检查有6 例患者有椎间盘残留,其中组I 有2 例,组II 有4 例。术后随访5 例患者复发,其中组I 有3 例,组II 有2 例,但差异无统计学意义。与腰5 骶1 学习曲线相比,经皮椎间孔镜治疗腰4/5 椎间盘突出的学习曲线更加陡峭,经过专业化培训更加容易掌握。

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