Google+ Friends!

2014년 10월 14일 화요일

집도의의 최소침습 척추수술의 술기수준에 따른 PELD의 학습곡선 Learning curve for percutaneous endoscopic lumbar discectomy depending on the surgeon's training level of minimally invasive spine surgery

Brief review


*Title: Learning curve for percutaneous endoscopic lumbar discectomy depending on the surgeon's training level of minimally invasive spine surgery
집도의의 최소침습 척추수술의 술기수준에 따른 PELD의 학습곡선

*Authors: Wang H, Huang B, Li C, Zhang Z, Wang J, Zheng W, Zhou Y
*Bibliography: Clin Neurol Neurosurg. 2013 Oct;115(10):1987-91.


PURPOSE
To evaluate the differences of learning curve for PELD depending on the surgeon' s training level of minimally invasive spine surgery.


METHODS
Reviewed the medical records: 120 patients with sciatica and L4-5 disk herniation who underwent PELD

Divide the group as surgeons’s training level
-Group A: surgeon with little professional training of PELD
-Group B: surgeon with 2 years of demonstration teaching of PELD

Patients can be divided into 3 stages: 1–20(earlier stage) / 21–40(middle stage) /41–60(latest stage)


RESULTS
Age, Sex, symptom duration, herniated disc location, rates of smokers/ patients with accompanying disease/ history of injury: No statistically significant differences




















Op time: Significant differences (p=0.000)
-significant differences were observed between the 1-20 patients group and 41-60 patients group in Group B (p=0.041), but there were no significant differences among the 1-20 patients group, 21-40 patients group and 41-60 patients group in Group A


Hospital stay: Significant differences (p=0.026)
-Significant differences in the 1-20 patients group between Group A and Group B (p=0.011)










Reoperation rate: Significant differences (p=0.050)
-Significant difference was observed between the 1-20 patients group and 41-60 patients group in Group A (p=0.028) but there were no significant differences among the 1-20 patients group, 21-40 patients group and 41-60 patients group in Group B.












Clinical outcomes: Significant differences between pre/post VAS back, leg, JOA score. 
-Higher improvement in the VAS leg score was observed in Group B than Group A (p=0.031).

















CONCLUSIONS
-The surgeons' training level of minimally invasive spine surgery was an important factor for the success of PELD

-Especially the demonstration teaching of PELD for the new minimally invasive spine surgeons.