Department of Neurosurgery, Austin Hospital, Melbourne, Australia.
Spine (Phila Pa 1976). 2009 Oct 1;34(21):E761-5. doi: 10.1097/BRS.0b013e3181b2f928.
A retrospective study.
Assess the learning curve of pedicle screw (PS) placement of a Spinal Surgery Fellow (SSF) with no previous experience with the technique.
Recent studies have attempted to identify the learning curve for different surgical procedures to define training requirements. Several authors have described a learning curve for PS placement. However, no one has defined the number of PS necessary to be competent in this skill.
All patients who had PS inserted by the SSF under the supervision of an Attending Spinal Consultant (ASC) and had adequate postoperative radiographs and computed tomography scans available, were included in this study. PS position was assessed by 2 blinded independent observers using a grading scale. PS placement by the SSF was evaluated by examining the assessed position in chronological groups of 40 screws. RESULTS.: Ninety-four patients underwent internal fixation of the spine with 582 PS. Eight cases (40 screws) were excluded because of lack of imaging studies. Of the 542 screws under evaluation, 320 (59%) were performed by the SSF, 187 (34.5%) by the ASC, and 35 (6.5%) by advanced orthopedic or neurosurgical trainees.The rate of misplaced PS performed by the SSF for the first 80 PS was 12.5% and dropped to 3.4% for the remaining 240 screws, which is a statistically significant difference (P < 0.01). Evaluation of computed tomography of vertebrae with PS placed by the SSF on one side and by the ASC on the other showed that the ASC achieved better placement during the first 80 PS (P < 0.01). However, this difference disappeared in the last 240 (P = 1.00).
The findings demonstrate a learning curve for PS placement. In this series, the asymptote for this technique for an inexperienced SSF, started after about 80 screws (approximately 25 cases).
回顾性研究。
评估没有脊柱手术经验的脊柱外科住院医师（SSF）进行椎弓根螺钉（PS）置入的学习曲线。
最近的研究试图确定不同手术程序的学习曲线，以确定培训要求。几位作者描述了 PS 放置的学习曲线。但是，没有人定义在这项技能中需要多少 PS 才能胜任。
所有由 SSF 在主治脊柱顾问（ASC）的监督下插入 PS 并具有足够的术后 X 线和计算机断层扫描的患者均包括在本研究中。通过 2 位盲法独立观察者使用分级量表评估 PS 位置。通过按 40 个螺钉的时间顺序组检查评估的位置来评估 SSF 的 PS 放置。结果：94 例患者接受脊柱内固定，共置入 582 枚 PS。由于缺乏影像学研究，排除了 8 例（40 个螺钉）。在评估的 542 个螺钉中，320 个（59%）由 SSF 完成，187 个（34.5%）由 ASC 完成，35 个（6.5%）由高级骨科或神经外科受训人员完成。SSF 在前 80 个 PS 中出现错位 PS 的发生率为 12.5%，而在剩余的 240 个螺钉中降至 3.4%，这具有统计学意义（P < 0.01）。对一侧由 SSF 放置 PS、另一侧由 ASC 放置 PS 的椎骨进行 CT 评估显示，在最初的 80 个 PS 中，ASC 实现了更好的位置（P < 0.01）。但是，在最后 240 个螺钉中，这种差异消失了（P = 1.00）。
研究结果表明 PS 放置存在学习曲线。在本系列中，对于没有经验的 SSF，该技术的渐近线开始于大约 80 个螺钉（约 25 例）之后。
