Hospital for Special Surgery.
Weill Cornell Medical College, New York, NY.
Clin Spine Surg. 2022 Feb 1;35(1):E111-E120. doi: 10.1097/BSD.0000000000001167.
Retrospective review.
The aim was to evaluate the learning curve of skin-anchored intraoperative navigation (ION) for minimally invasive lumbar surgery.
ION is increasingly being utilized to provide better visualization, improve accuracy, and enable less invasive procedures. The use of noninvasive skin-anchored trackers for navigation is a novel technique, with the few reports on this technique demonstrating safety, feasibility, and significant reductions in radiation exposure compared with conventional fluoroscopy. However, a commonly cited deterrent to wider adoption is the learning curve.
Retrospective review of patients undergoing 1-level minimally invasive lumbar surgery was performed. Outcomes were: (1) time for ION set-up and image-acquisition; (2) operative time; (3) fluoroscopy time; (4) radiation dose; (5) operative complications; (6) need for repeat spin; (7) incorrect localization.Chronologic case number was plotted against each outcome. Derivative of the nonlinear curve fit to the dataset for each outcome was solved to find plateau in learning.
A total of 270 patients [114 microdiscectomy; 79 laminectomy; 77 minimally invasive transforaminal lumbar interbody fusion (MI-TLIF)] were included. (1) ION set-up and image-acquisition: no learning curve for microdiscectomy. Proficiency at 23 and 31 cases for laminectomy and MI-TLIF, respectively. (2) Operative time: no learning curve for microdiscectomy. Proficiency at 36 and 31 cases for laminectomy and MI-TLIF, respectively. (3) Fluoroscopy time: no learning curve. (4) Radiation dose: proficiency at 42 and 33 cases for microdiscectomy and laminectomy, respectively. No learning curve for MI-TLIF. (5) Operative complications: unable to evaluate for microdiscectomy and MI-TLIF. Proficiency at 29 cases for laminectomy. (6) Repeat spin: unable to evaluate for microdiscectomy and laminectomy. For MI-TLIF, chronology was not associated with repeat spins. (7) Incorrect localization: none.
Skin-anchored ION did not result in any wrong level surgeries. Learning curve for other parameters varied by surgery type, but was achieved at 25-35 cases for a majority of outcomes.
Level III.
回顾性研究。
评估皮肤锚定术中导航（ION）在微创腰椎手术中的学习曲线。
ION 越来越多地被用于提供更好的可视化效果，提高准确性，并实现更微创的手术。使用非侵入性的皮肤锚定跟踪器进行导航是一种新的技术，少数关于该技术的报告表明，与传统的透视技术相比，它具有安全性、可行性，并且显著降低了辐射暴露。然而，一个普遍被引用的阻碍广泛采用的因素是学习曲线。
对接受 1 节段微创腰椎手术的患者进行回顾性研究。结果包括：（1）ION 设置和图像采集时间；（2）手术时间；（3）透视时间；（4）辐射剂量；（5）手术并发症；（6）需要重复旋转；（7）定位错误。每个结果的时间点以时间顺序表示。对数据集的非线性曲线拟合的导数进行求解，以找到学习的平台。
共纳入 270 例患者[114 例微创椎间盘切除术；79 例椎板切除术；77 例微创经椎间孔腰椎椎间融合术（MI-TLIF）]。（1）ION 设置和图像采集：微创椎间盘切除术无学习曲线。在分别进行 23 例和 31 例椎板切除术和 MI-TLIF 时达到熟练程度。（2）手术时间：微创椎间盘切除术无学习曲线。在分别进行 36 例和 31 例椎板切除术和 MI-TLIF 时达到熟练程度。（3）透视时间：无学习曲线。（4）辐射剂量：在分别进行 42 例和 33 例微创椎间盘切除术和椎板切除术时达到熟练程度。MI-TLIF 无学习曲线。（5）手术并发症：无法评估微创椎间盘切除术和 MI-TLIF。在进行 29 例椎板切除术时达到熟练程度。（6）重复旋转：无法评估微创椎间盘切除术和椎板切除术。对于 MI-TLIF，时间顺序与重复旋转无关。（7）定位错误：无。
皮肤锚定 ION 不会导致任何错误的手术水平。其他参数的学习曲线因手术类型而异，但在大多数结果中，在 25-35 例时达到熟练程度。
3 级。
