Learning curve of full endoscopic technique for the surgical treatment of lumbar disc herniation / 中华骨科杂志

ABSTRACT

ObjectiveTo evaluate the learning curve of utilizing the full endoscopic technique for the surgical treatment of lumbar disc herniation.MethodsFrom August 2008 to February 2009,30 patients with lumbar disc herniation underwent lumbar discectomy by the full endoscopic-only approach were retrospectively analyzed.The patients were divided into three groups of 10 sequential cases each.Group of early time consisted of the first 10 cases,Group of medium term the subsequent 10 cases,and Group of later time the last 10 cases.The clinical evaluation data included operative time,length of hospital stay,leg and back pain visual analogue scale (VAS),and complications.ResultsAll patients were observed prospectively for (1.61±0.22) years.There was no measurable intraoperative bleeding,no postoperative infections and symptomatic recurrences in the three groups.Compared to group of early time,the operative time in group of medium term was significantly decreased(P＜0.05).The patients in group of later time had much less operative time than that in group medium term(P＜0.05).There was no significant difference with length of hospital stay between the three groups (P＞0.05).The improvement of leg and back VAS in each group was similar:there was a significant improvement 3 months post-operation compared with pre-operation (P ＜0.05),but no statistical difference between 3 months post-operation and final foliow-up(P＞0.05).The complication rate was 12.5％ for group of early time,10％ for group of medium term,and 0 for group of later time.There were two cases conversed to an open procedure for group of early time compared with 0 cases in both other groups.ConclusionExcellent clinical and minimally invasive outcomes can be obtained in the surgical treatment of lumbar disc herniation via the interlaminar approach assisted by full endoscopic technique.However,attention must be paid to the steep learning curve with use of this complex technique.Obtaining microsurgical experience and suitable patient selection can help shorten the learning curve and decrease the complications.