Epstein Nancy E
Department of Neuroscience, Winthrop Neuroscience, Winthrop University Hospital, Mineola, New York, USA.
Surg Neurol Int. 2017 Apr 26;8:61. doi: 10.4103/sni.sni_39_17. eCollection 2017.
Minimally invasive surgery (MIS) spine procedures were developed to limit operative time, the extent of dissection, and reduce perioperative morbidity. Here, we asked what are the "learning curves" for these MIS spine procedures?
We reviewed studies in the literature that discussed the "learning curves" attributed to performing different MIS spine surgical procedures. Of interest, the majority were single-surgeon series.
Very few articles assessed the learning curves for different MIS spine procedures. One study reported no learning curve for open vs. MIS discectomy/laminotomy. Another study indicated that 20-30 cases were required for a surgeon to become proficient in performing a variety of MIS spine fusions [e.g., cervical MIS fusions, MIS anterior lumbar interbody fusions (ALIF), MIS transforaminal lumbar interbody fusions (TLIF), and MIS pedicle/screw placement in the thoracic/lumbar spine]. Several other studies specifically cited that, to become proficient in the performance of TLIF, surgeons had to have performed between 10, to 32, to 40, to 44 such cases.
There is a very limited literature available that focuses on the "learning curves" associated with the performance of different types of MIS spine procedures. The number of cases required to satisfy the "learning curves" for different operations varied from 0 for MIS vs. open discectomy/laminotomy, to 20-30 for a variety of cervical-thoracic-lumbar procedures, and up to 44 cases for TLIF. Shouldn't we ask whether better oversight measures and/or mentoring programs could limit the morbidity/AE occurring during these "learning curves" in the future?
微创脊柱手术（MIS）的发展旨在缩短手术时间、减少解剖范围并降低围手术期发病率。在此，我们探讨这些MIS脊柱手术的“学习曲线”是怎样的？
我们回顾了文献中讨论不同MIS脊柱手术“学习曲线”的研究。有趣的是，大多数是单术者系列研究。
极少有文章评估不同MIS脊柱手术的学习曲线。一项研究报告称开放与MIS椎间盘切除术/椎板切开术不存在学习曲线。另一项研究表明，外科医生要熟练进行各种MIS脊柱融合术[如颈椎MIS融合术、MIS前路腰椎椎间融合术（ALIF）、MIS经椎间孔腰椎椎间融合术（TLIF）以及MIS胸椎/腰椎椎弓根/螺钉置入术]需要完成20至30例手术。其他几项研究特别指出，为熟练进行TLIF手术，外科医生必须完成10至32至40至44例此类手术。
关注不同类型MIS脊柱手术“学习曲线”的文献非常有限。不同手术达到“学习曲线”所需的病例数各不相同，从MIS与开放椎间盘切除术/椎板切开术的0例，到各种颈椎 - 胸椎 - 腰椎手术的20至30例，再到TLIF的44例。我们难道不应该思考未来更好的监督措施和/或指导计划是否可以减少这些“学习曲线”期间发生的发病率/不良事件吗？
