Staartjes Victor E, de Wispelaere Marlies P, Miedema Johan, Schröder Marc L
Department of Neurosurgery, Bergman Clinics, Amsterdam, The Netherlands; Faculty of Medicine, University of Zurich, Zurich, Switzerland.
Department of Neurosurgery, Bergman Clinics, Amsterdam, The Netherlands.
World Neurosurg. 2017 Nov;107:28-34. doi: 10.1016/j.wneu.2017.07.121. Epub 2017 Jul 29.
Tubular microdiscectomy has become a staple technique among spine surgeons. Yet the associated learning curve, especially its later stages, has not been extensively studied. With studies reporting a higher rate of recurrent herniation using tubular microdiscectomy, surgeons' level of experience becomes of primary importance for the interpretation of such findings. We aimed to analyze possible improvements in the later stages of the learning curve and to identify factors independently associated with recurrent herniation.
A retrospective study was conducted using prospectively collected data from a consecutive cohort of all 1241 patients operated for single-level lumbar disc herniation with tubular microdiscectomy by a single surgeon who already had extensive experience with this technique. We collected demographic and perioperative data and consequently tracked all complications, recurrent herniations, and other reoperations. In addition, 495 patients (40%) provided complete outcome scores on a numeric rating scale for back and leg pain and the Oswestry Disability Index at baseline, 6 weeks, and 12 months postoperatively.
A decrease in surgical time (P < 0.001) and recurrent herniations was observed (P = 0.012) over time. Increased leg pain at 6 weeks was independently associated with recurrent herniation (P = 0.01). Fifty-six patients (4.5%) experienced ipsilateral recurrent herniation.
Relevant improvements in clinical results were seen even after the surgeon had already accumulated extensive experience. Any future studies should unambiguously report the level of experience of the participating surgeons, possibly including the number of cases previously treated using a particular technique.
管状显微椎间盘切除术已成为脊柱外科医生常用的技术。然而，与之相关的学习曲线，尤其是后期阶段，尚未得到广泛研究。有研究报告称，使用管状显微椎间盘切除术复发性疝的发生率较高，因此外科医生的经验水平对于解读这些结果至关重要。我们旨在分析学习曲线后期可能的改善情况，并确定与复发性疝独立相关的因素。
采用回顾性研究，数据来自前瞻性收集的连续队列，该队列包含由一位对该技术已有丰富经验的外科医生采用管状显微椎间盘切除术治疗单节段腰椎间盘突出症的所有1241例患者。我们收集了人口统计学和围手术期数据，并追踪了所有并发症、复发性疝和其他再次手术情况。此外，495例患者（40%）在基线、术后6周和12个月时提供了关于腰腿痛和Oswestry功能障碍指数的完整数字评分量表结果评分。
随着时间推移，手术时间减少（P < 0.001），复发性疝发生率降低（P = 0.012）。术后6周腿痛加重与复发性疝独立相关（P = 0.01）。56例患者（4.5%）发生同侧复发性疝。
即使在外科医生已经积累了丰富经验之后，临床结果仍有相关改善。未来的任何研究都应明确报告参与研究的外科医生的经验水平，可能包括先前使用特定技术治疗的病例数量。
