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2014년 10월 14일 화요일

합병증은 최소침습 척추수술의 초기 학습곡선과 연관성이 있다 Complications associated with the initial learning curve of minimally invasive spine surgery: a systematic review

Brief review

최소침습적인 척추수술의 Learning curve(학습곡선)을 주요 항목으로 하여 체계적 문헌고찰을 시행한 연구 입니다.
Pubmed에서 검색된 논문을 정해진 프로토콜대로 리뷰하여 최종적으로 15개의 논문이 선택되었습니다.
각 연구별로 complication, procedure time, fusion rate, estimated blood loss, level of evidence, sample size, intervention, study design등을 조사하여 정리하였습니다.
decompressive procedure에서는 durotomy, 그리고 fusion에서는 implant malposition,neural injury, and nonunion가 가장 흔한 합병증이라는 결과가 나왔습니다.
또 수술 후의 전체적인 합병증 발병률은 11%입니다.
아래 링크 따라가시면 전문 보실 수 있습니다^^


*Title: Complications associated with the initial learning curve of minimally invasive spine surgery: a systematic review
합병증은 최소침습 척추수술의 초기 학습곡선과 연관성이 있다: 체계적 문헌고찰

*Authors: Sclafani JA, Kim CW



BACKGROUND
-There is an inherently difficult learning curve associated with minimally invasive surgical (MIS) approaches to spinal decompression and fusion.
-The association between complication rate and the learning curve remains unclear.


QUESTIONS/PURPOSES
-Evaluated the learning curves of MIS procedures for the spine
-Defined as the change in frequency of complications and length of surgical time as case number increased, for five types of MIS for the spine.


METHODS
Searching protocol: PubMed database
-terms: "minimally invasive spine surgery AND complications AND learning curve”

Clinical outcome and learning curve metrics were categorized for analysis by surgical procedure (MIS lumbar decompression procedures, MIS transforaminal lumbar interbody fusion, percutaneous pedicle screw insertion, laparoscopic anterior lumbar interbody fusion, and MIS cervical procedures).

Procedure time and complication rate: the most consistent parameters to evaluate the learning curve

total 15 original studies are remained.

 

RESULTS
-The most common learning curve complication for decompressive procedures was durotomy.
-For fusion procedures, the most common complications were implant malposition, neural injury, and nonunion.
-The overall postoperative complication rate was 11% (109 of 966 cases).
-The learning curve was overcome for operative time and complications as a function of case numbers in 20 to 30 consecutive cases for most techniques discussed within this review.


CONCLUSIONS
-The quantitative assessment of the procedural learning curve for MIS techniques for the spine remains challenging because the MIS techniques have different learning curves and because they have not been assessed in a consistent manner across studies.

-Complication rates may be underestimated by the studies we identified because surgeons tend to select patients carefully during the early learning curve period.


-The field of MIS would benefit from a standardization of study design and collected parameters in future learning curve investigations.