1 / 26

Analysis of Learning Curve for Minimally Invasive Transforaminal Lumbar Interbody Fusion

Analysis of Learning Curve for Minimally Invasive Transforaminal Lumbar Interbody Fusion. Byung-Joon Shin, Jae Chul Lee , Hae-Dong Chang, Su-Jin Yun, Yon-Il Kim. Spine Center Department of Orthopaedic Surgery Soonchunhyang University Hospital Seoul, Korea. Introduction.

lorie
Download Presentation

Analysis of Learning Curve for Minimally Invasive Transforaminal Lumbar Interbody Fusion

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Analysis of Learning Curve for Minimally Invasive Transforaminal Lumbar Interbody Fusion Byung-Joon Shin, Jae Chul Lee, Hae-Dong Chang, Su-Jin Yun, Yon-Il Kim Spine Center Department of Orthopaedic Surgery Soonchunhyang University Hospital Seoul, Korea

  2. Introduction • Minimally Invasive TLIF • Advantages • Decreased soft tissue injury • Unilateral exposure & lessmuscle dissection • Preservation of contralateral structure • Decreased operative bleeding • Disadvantages • Technically demanding • Increased operative time Steep learning curve Peng et al., Spine, 2009; Scheufler et al., Neurosurg, 2007; Schizas, Int Orthop, 2008

  3. Introduction • ‘New’ vs. ‘Gold standard’ procedure • False negative result • Too early assessment • Indifferent result • Positive result When? New Old (Gold standard) Learning curve for MIS TLIF? Ramsay CR et al: Statistical assessment of the learning curves of health technologies. Health Technol Assess 5:1–79, 2001

  4. Materials • Prospective analysis of • The first 41 cases of MIS TLIF procedure • Degenerative lumbar disease treated by • Decompression thru tubular retractor • Obliquely inserted a PEEK cage • Percutaneous pedicle screw fixation and fusion • F/U > minimum 1yr

  5. Materials • Patients characteristics • Average age: 57 yrs (36-76) • Average F/U: 21 m • Etiology • Spinal stenosis: 24 cases • Spondylolisthsis: 12 cases • HIVD: 3 cases • IDD: 1 case • Seg. Instability: 1 case

  6. Materials • Procedure (41 patients) • No. of operated levels • 1 level TLIF: 31 cases • 1 level TLIF + 1 level decomp: 8 cases • 2 level TLIF: 2 cases • Laminectomy • Unilateral: 37 cases • Bilateral: 4 cases • Contralateral decompression • 16 cases

  7. Methods • Assessing parameters of learning curve • Length of operative time • Amount of bleeding • Intraoperative bleeding • H-vac drain • Total perioperative bleeding • Starting day of ambulation • Transfusion incidence • Occurrence of complications • Clinical outcome • Oswestry disability index • Visual analogue scale • Low back pain • Radiating pain to legs Learning curve

  8. Statistical analysis • Regression analysis for learning curve • Bivariate analysis • Case # vs. parameters (operative time, bleeding) • Logarithmic curve-fit • Former 20 vs. Latter 21 cases • Student T-test • Operative time, Blood loss, Start of ambulation • Chi-square test • Transfusion need, Occurrence of complications • SPSS (ver.13.0) • p<0.05

  9. Results • Operative time (F/U > 1yr; n=41) Min * p=0.000 Case #

  10. Results • Operative time (Whole series; 72 cases) Min Asymptote Case #

  11. Results • Operative time * * p=0.000

  12. Results • Operative time * * 198 185 * P < 0.05 § P > 0.05 §

  13. Results Amount of Bleeding • Intraoperative Bleeding ml * p=0.005 Case #

  14. Results Amount of Bleeding • Postoperative H-vac Drain ml § p=0.547 Case #

  15. Results Amount of Bleeding • Perioperative Blood Loss (Intraop + Drain) ml * p=0.004 Case #

  16. Results * • Amount of Bleeding p=0.000 * § p=0.190 * §

  17. Results • Start of ambulation PO Day X 1 X 2 X 13 X 17 X 6 X 2 * p=0.000 Case# 1-20 Case# 21-41

  18. Results • Transfusion incidence * p=0.009

  19. Results • Occurrence of Complications Yes • Case # • #10: Deep infection • #24: Bone graft frag. extrusion from the cage • #25: Screw malposition • #41: Minimal dural tear No

  20. Results • Oswestry Disability Index

  21. Results • VAS for Low Back Pain

  22. Results • VAS for Radiating Pain to Legs

  23. Results • Case #1-20 versus Case #21-41 * * * * P<0.05

  24. Summary and Conclusions • Learning curve for minimally invasive TLIF was steep, but acceptable. Asymptote of the curve was approximately 35-40 cases. • Operative time was significantly decreased with a surgeon’s experience.

  25. Summary and Conclusions • Amount of bleeding and needs for transfusion also significantly decreased with a learning curve. • Minimally invasive TLIF can be an effective method treating degenerative lumbar diseases, provided appropriate training is obtained.

  26. Thank you very much.

More Related