Biportal Endoscopic Spine Surgery for Lumbar Laminectomy and Diskectomy: Postoperative Outcomes and Surgical Learning Curve, a Single US Surgeon's Experience.
Journal
Journal of the American Academy of Orthopaedic Surgeons. Global research & reviews
ISSN: 2474-7661
Titre abrégé: J Am Acad Orthop Surg Glob Res Rev
Pays: United States
ID NLM: 101724868
Informations de publication
Date de publication:
01 Aug 2024
01 Aug 2024
Historique:
received:
21
08
2023
accepted:
17
05
2024
medline:
20
8
2024
pubmed:
20
8
2024
entrez:
20
8
2024
Statut:
epublish
Résumé
Biportal endoscopic spine surgery (BESS) has gained traction for lumbar laminectomy and diskectomy. To justify the transition to BESS, outcomes and the surgical learning curve should be known. This study evaluates rates of complications with BESS and how these rates change with increased surgeon experience. A single surgeon's consecutive patients who underwent BESS were evaluated. Patients older than 18 years who underwent BESS for lumbar laminectomy and diskectomy were included. Patients with previous spine surgery, multiple levels, or BESS for fusion were excluded. Demographics, length of surgery, intraoperative complications, postoperative complications, and revision surgery were recorded. The learning phase group and mastery phase group were based on a cumulative summation analysis based on surgical time. A total of 63 patients, with 31 and 32 patients in the learning and mastery group, respectively, were included. Surgical time decreased from 87 to 52 minutes in the mastery phase. Conversion to open decreased from 3 to 0 cases (P = 0.1803), intraoperative complications decreased from 3 to 0 (P = 0.1803), postoperative complications decreased from 7 to 2 (P = 0.017), and rates of revision surgery decreased from 4 to 1 (P = 0.4233). This study suggests a learning curve of 31 cases for adequate performance of BESS for lumbar laminectomy and diskectomy.
Identifiants
pubmed: 39162736
doi: 10.5435/JAAOSGlobal-D-23-00161
pii: 01979360-202408000-00013
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
Copyright © 2024 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Orthopaedic Surgeons.
Références
Binder DK, Schmidt MH, Weinstein PR: Lumbar spinal stenosis. Semin Neurol 2002;22:157-166.
Lewandrowski KU, Soriano-Sánchez JA, Zhang X, et al.: Regional variations in acceptance, and utilization of minimally invasive spinal surgery techniques among spine surgeons: Results of a global survey. J Spine Surg 2020;6(suppl 1):S260-S274.
Jang JW, Lee DG, Park CK: Rationale and advantages of endoscopic spine surgery. Int J Spine Surg 2021;15:S11-S20.
Choi CM: Biportal endoscopic spine surgery (BESS): Considering merits and pitfalls. J Spine Surg 2020;6:457-465.
Xu J, Wang D, Liu J, et al.: Learning curve and complications of unilateral biportal endoscopy: Cumulative sum and risk-adjusted cumulative sum analysis. Neurospine 2022;19:792-804.
Park SM, Kim HJ, Kim GU, et al.: Learning curve for lumbar decompressive laminectomy in biportal endoscopic spinal surgery using the cumulative summation test for learning curve. World Neurosurg 2019;122:e1007-e1013.
Ju CI, Lee SM: Complications and management of endoscopic spinal surgery. Neurospine 2023;20:56-77.
Park DY, Upfill-Brown A, Curtin N, et al.: Clinical outcomes and complications after biportal endoscopic spine surgery: A comprehensive systematic review and meta-analysis of 3673 cases. Eur Spine J 2023;32:2637-2646.
Guerin P, El Fegoun AB, Obeid I, et al.: Incidental durotomy during spine surgery: Incidence, management and complications. A retrospective review. Injury 2012;43:397-401.
Strömqvist F, Sigmundsson FG, Strömqvist B, Jönsson B, Karlsson MK: Incidental durotomy in degenerative lumbar spine surgery - a register study of 64,431 operations. Spine J 2019;19:624-630.
Djurasovic M, Campion C, Dimar JR II, Glassman SD, Gum JL: Postoperative epidural hematoma. Orthop Clin North Am 2022;53:113-121.
Aono H, Ohwada T, Hosono N, et al.: Incidence of postoperative symptomatic epidural hematoma in spinal decompression surgery. J Neurosurg Spine 2011;15:202-205.
Kim JE, Choi DJ, Kim MC, Park EJ: Risk factors of postoperative spinal epidural hematoma after biportal endoscopic spinal surgery. World Neurosurg 2019;129:e324-e329.
Zakko P, Lipphardt M, Park DK: Endoscopic spine surgery: Advertisement or game changer? Instr Course Lect 2023;72:675-687.
Hasan S, Härtl R, Hofstetter CP: The benefit zone of full-endoscopic spine surgery. J Spine Surg 2019;5(suppl 1):S41-S56.
Lee MJ, Konodi MA, Cizik AM, Bransford RJ, Bellabarba C, Chapman JR: Risk factors for medical complication after spine surgery: A multivariate analysis of 1,591 patients. Spine J 2012;12:197-206.
Harris AB, Zhang B, Marrache M, et al.: Chronic opioid use following lumbar discectomy: Prevalence, risk factors, and current trends in the United States. Neurospine 2020;17:879-887.
Schoenfeld AJ, Nwosu K, Jiang W, et al.: Risk factors for prolonged opioid use following spine surgery, and the association with surgical intensity, among opioid-naive patients. J Bone Joint Surg Am 2017;99:1247-1252.
Kowalski C, Ridenour R, McNutt S, et al.: Risk factors for prolonged opioid use after spine surgery. Glob Spine J 2023;13:683-688.