Baumann Anthony N, Callaghan Megan E, Walley Kempland C, Anastasio Albert T, Muralidharan Aditya, Talaski Grayson, Rocos Brett
College of Medicine, Northeast Ohio Medical University, Rootstown, OH.
College of Medicine, Case Western Reserve University, Cleveland, OH.
Spine (Phila Pa 1976). 2024 Apr 1;49(7):470-477. doi: 10.1097/BRS.0000000000004859. Epub 2023 Oct 31.
A systematic review and meta-analysis.
The objective of this study is to examine the impact of the learning curve for endoscopic cervical foraminotomy for clinical outcomes and patient safety.
Endoscopic cervical foraminotomy is a minimally invasive surgical technique emerging in the literature for surgical management of cervical radiculopathy without the use of open incision. The adoption of endoscopic cervical foraminotomy may be hindered by the learning curve, although no review and meta-analysis exists to date on the topic.
A systematic review and meta-analysis was performed using PubMed, CINAHL, and MEDLINE from database inception until July 11, 2023. Inclusion criteria were articles that examined endoscopic cervical foraminotomy, reported outcomes, and/or complications for endoscopic cervical spine surgery relevant to the learning curve and had full-text. A random effects meta-analysis was performed for outcomes and complications.
A total of three articles (n=203 patients) were included from 792 articles initially retrieved. The learning curves from four surgeons were examined with a FWM 21 procedures until the competency phase. There was no significant difference in the postoperative hospitalization length ( P =0.669), postoperative recovery room time ( P =0.415), intraoperative blood loss ( P =0.064), and total complication rates (10.9% vs . 1.2%, P =0.139) between endoscopic cervical foraminotomy procedures performed in the learning phase as compared with the competency phase of the learning curve. There was a significant decrease in operative time from the learning phase to the competency phase ( P =0.005).
Competency was achieved on the learning curve for endoscopic cervical foraminotomy after about 21 procedures. There is no significant difference in postoperative hospitalization time, postoperative recovery room time, intraoperative blood loss, and complication rates between the learning phase and the competency phase of the learning curve for endoscopic cervical foraminotomy, noting the relatively small sample size of this study that may underpower this finding.
系统评价与荟萃分析。
本研究的目的是探讨颈椎内镜下椎间孔切开术学习曲线对临床疗效和患者安全性的影响。
颈椎内镜下椎间孔切开术是文献中出现的一种微创手术技术，用于在不进行开放切口的情况下手术治疗神经根型颈椎病。尽管目前尚无关于该主题的综述和荟萃分析，但学习曲线可能会阻碍颈椎内镜下椎间孔切开术的应用。
使用PubMed、CINAHL和MEDLINE进行系统评价与荟萃分析，检索时间从数据库建立至2023年7月11日。纳入标准为研究颈椎内镜下椎间孔切开术、报告与学习曲线相关的颈椎内镜手术结局和/或并发症且有全文的文章。对结局和并发症进行随机效应荟萃分析。
从最初检索的792篇文章中，共纳入3篇文章（n = 203例患者）。对4位外科医生的学习曲线进行了研究，直至熟练阶段共进行了21例手术。与学习曲线的熟练阶段相比，学习阶段进行的颈椎内镜下椎间孔切开术在术后住院时间（P = 0.669）、术后恢复室时间（P = 0.415）、术中失血量（P = 0.064）和总并发症发生率（10.9%对1.2%，P = 0.139）方面无显著差异。从学习阶段到熟练阶段，手术时间显著缩短（P = 0.005）。
在进行约21例手术后，颈椎内镜下椎间孔切开术的学习曲线达到熟练阶段。颈椎内镜下椎间孔切开术学习曲线的学习阶段和熟练阶段在术后住院时间、术后恢复室时间、术中失血量和并发症发生率方面无显著差异，但需注意本研究样本量相对较小，可能使这一发现的效能不足。
