经皮固定术中导航辅助微创脊柱手术的时间需求、辐射暴露与结局：学习曲线的影响。
Time-demand, Radiation Exposure and Outcomes of Minimally Invasive Spine Surgery With the Use of Skin-Anchored Intraoperative Navigation: The Effect of the Learning Curve.
机构信息
Hospital for Special Surgery.
Weill Cornell Medical College, New York, NY.
出版信息
Clin Spine Surg. 2022 Feb 1;35(1):E111-E120. doi: 10.1097/BSD.0000000000001167.
STUDY DESIGN
Retrospective review.
OBJECTIVE
The aim was to evaluate the learning curve of skin-anchored intraoperative navigation (ION) for minimally invasive lumbar surgery.
SUMMARY OF BACKGROUND DATA
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.
METHODS
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.
RESULTS
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.
CONCLUSIONS
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 OF EVIDENCE
Level III.
研究设计
回顾性研究。
目的
评估皮肤锚定术中导航（ION）在微创腰椎手术中的学习曲线。
背景资料总结
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。
方法
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。
结果
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。
结论
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。
证据水平
3 级。
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